The reduction in the number of funded beds in public hospitals has begun, with the first figures being sent to health units. Romania should have, from 2028, 14,000 fewer beds than at present. “Numbers don’t always express reality.”
From lengthy and costly hospitalizations, the health system should begin to deliver faster medical services, provided as often as possible in the outpatient or day hospital system. Romania has too many continuous hospitalization beds, i.e. 724 beds per 100,000 inhabitants, compared to the European average of 511, and hence high maintenance costs in conditions where not all these beds are used. By 2028, the number of beds in public hospitals should decrease by more than 14,000, with the first tranche of reductions being operated right now, when almost 4,700 beds disappear nationally.
“Optimization” is done by public health directorates (DSP) and health insurance companies, and the criterion used is performance, demonstrated with indicators. Concretely, beds in wards where occupancy is low are disappearing, or should disappear, with the exception of beds for palliative care (terminally ill patients) and intensive care wards.
The intention, although well-argued when the indicators are invoked, cannot be applied only with an eye on the numbers, says the manager of a hospital in a small town, but which serves a relatively large area.
Out of three Neonatology beds, only one will remain
The Corabia City Hospital is one of the health facilities where patients can receive medical services mostly during normal working hours and less on call. It has a number of 129 beds, 123 for continuous hospitalization and 6 for day hospitalization.
It has an Internal Diseases section, a Pediatrics section, a Surgery section, an Obstetrics-Gynecology section, a Psychiatry section, but also an outpatient clinic with 12 offices, a medical analysis laboratory, a radiology laboratory and a TB dispensary.
After the “optimization” it will have five beds less. In Neonatology, out of three beds, only one will remain, two will disappear from Internal Medicine, one more will be cut from Pediatrics.
“Some measures were taken where there was no degree of occupancy. The discussion has been opened. They result from the data. What could I say in Neonatology, when I had five births all year?!”says manager Marian-Petre Ilin, after the meeting at CJAS.
And other hospitals in Olt county, Ilin also specified, also lost obstetrics-gynecology beds, also due to the reduction in the number of births.
The need to optimize expenses is no longer in doubt. Efforts have been made and are being made, but things must be seen as a whole, says the manager of the Corabia hospital. The weaker indicators of the Internal department (hence the proposal to reduce by two beds) last year have a simple explanation: two female doctors were on maternity leave, they returned to work at the beginning of the year, when the indicators began to improve.
“I showed them that in 2025 it is a completely different percentage, but the statistics are taken from 2025 and a few months from here. Next year there will be discussion again”says the manager.
The Department of Internal Medicine, on the other hand, must become one of the strengths of the hospital, because pathology also requires it. “Given that out of the Internal Medicine beds, I have done three for Diabetes, three for Pneumology (I have a pulmonologist), three for Neurology, six for Cardiology (but my doctor has only been coming since September, because he is on maternity leave), it can be a strong point. Internal Medicine and Pediatrics should become our strong points”says the manager.
The data in question, to which all the institutions involved in the optimization have access, may not be the final ones, but the heads of the hospitals fear. A further reduction, on the other hand, is also coming next year, most likely earlier than this year, before contracting with CJAS, and hospitals with very weak indicators could be reorganized.
“And we will adapt. From the beds at the Internal Medicine, I will take five more beds to make a few recovery beds, for baleno-physio-therapy, because I have BFT only in the ambulatory and I have appointments in four months, it is 100% occupied”, also indicates to the manager how he could increase the degree of occupancy which is currently at Internal to approximately 50-60%.
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The second shift in the outpatient clinic, difficult to organize due to the lack of staff
The manager says that he thought of multiple options to improve the quality of the services offered. For all of them, however, it is necessary before investments.
“I could equip the lab. At the laboratory, I have devices that are even older than 15 years, not 5, as the conditions are. And with a laboratory equipped and with everything I need staff there, so we can do work. Do you want cases to stop being sent to Slatina? Let’s all, including the DSP, including the CJAS, let’s say – let’s supplement the personnel list and see what equipment we need so that the Corabia also has medical investigations. But the ship is not the problem, I can transfer a stroke to a guard. If there is something serious on Cardio, I send directly to Craiova. We send very little,” draws the manager’s attention.
The focus on a single hospital in a county has led to the situation in which that hospital, as is the case of the county hospital in Olt, will be assaulted by cases, the manager also indicates.
The development of outpatient services, a very good thing in theory, also involves additional staff, says Ilin. “The whole government has said that you are not allowed to hire anymore. I have only one doctor in the Laboratory. I have two doctor positions in the Laboratory and I have only one doctor now. The doctor has a schedule from 8.00 to 14.00. To extend the schedule obviously I need a second doctor. I will be tied hand and foot again regarding the afternoon shift. Someone comes to see him and the man says he feels sick. Indeed, he needs an analysis, he needs something else: we have the offices and each office has a nurse, at the moment I am discovered with the doctor (n. red – for the afternoon shift), I have to take a nurse. It is not that simple. the manager also drew attention. When the shortage of average medical staff is hospital-wide, it becomes almost impossible to organize the extension of the schedule, because the second outpatient shift actually means a longer schedule and additional human resources.
“They have 500 or so beds in some context”
The reform that only takes into account the number of beds per hundred thousand inhabitants has no way of producing the expected results, the manager also believes.
“Do we have their infrastructure? I will make even fewer beds, but do you have their infrastructure? That they have 500 or so beds in a certain context. How can I get one from Ștefan cel Mare, which is 35 km to Corabia and 45 km to Caracal, if you abolish the beds from Corabia?”, asks Marian-Petre Ilin.
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The situation of hospitals should be judged in context, Ilin believes. The Corabia City Hospital serves the entire south of Olt county. There is no continuous guard on the surgical branches and the Internal Affairs neither at the hospital in Dăbuleni (Dolj) nor at the one in Turnu Măgurele (Teleorman), says Ilin, and this makes the hospital in Olt serve both areas. Day admissions and outpatient services are suitable for certain cases, but if the patient needs to return for treatment and he lives a long distance away, access to that service is already affected.
On the other hand, the hospital in the city on the banks of the Danube is a grade IV hospital, therefore it has limited capacities, hence the transfer of certain cases to higher grade hospitals. Imaging investigations, for example, can only be done in the day program, not possible on call.
The manager also says that he studied for a while the possibility of also developing a segment of palliative care, precisely because it is a field discovered in the public system, and the demand is very high. It’s just that investments are needed for that as well, and what the local Council, under which the hospital is under, can afford in addition, is very little. And this very little means, for example, paying for the transport of the doctors who come to Corabia to be on call, given that there are hospitals in the country that pay extra for the on-call service.
