The president of the National Health Insurance House (CNAS), Horaţiu Moldovan, claims that the reform of the health system is a real necessity for Romania, but the real reform does not mean “breaking the CNAS monopoly”, but the real autonomy of health insurance and the correct spending of money for patients.
Horațiu Moldovan, the president of CNAS, reacted following the statements of the Minister of Health, Alexandru Rogobete, who said on Saturday that he intends to break the monopoly of the National Health Insurance House.
“The real health reform is not the “breaking of the CNAS monopoly”, but the real autonomy of health insurance and the correct spending of money for patients. I have never liked to publicly contradict my colleagues, let alone those with whom we have common goals and achievements. But I cannot let dangerous ideas for the patient roll in the public space. The reform of the health system is a real necessity for Romania. No one disputes the fact that patients face bureaucracy, long waiting times and services sometimes below European standards. But the essential question is not whether we need to reform the system, but how to do it, without jeopardizing equal access to medical services.”the President of CNAS, Horaţiu Moldovan, transmitted on Sunday evening.
According to him, the current system, based on the National Health Insurance House, has a great advantage: it offers a relatively uniform basic package for all patients, regardless of income, age or health status.
“It is a solidary system, in which the healthy contribute for the sick, and those with higher incomes support the access of the vulnerable. This is a fundamental principle of any modern public health system”, explained Moldovan.
He claims that the transfer of the social health insurance fund to private administration “would send a dangerous signal, that the state is no longer capable of managing social problems”.
“However, this is not true in Romania today. The Romanian state pays pensions, manages the public pension system and provides, from a social perspective, basic medical services for the population. We are not in a situation of institutional collapse that would justify the abandonment of public administration of the social health fund”. the CNAS president also wrote.
According to him, neither “breaking the CNAS monopoly”, as the breaking of the monopoly of the National Public Pension House does not represent, in any form, “pretexts or premises for replacing the role of the Romanian state in the management of the social protection system in Romania”.
“It is true that it is difficult for any state to rely exclusively on a minimum social fund to cover all the medical needs of the population. But this is precisely where the real competition is: in the area of complementary health insurance, not in the area of the basic social fund. The social fund must remain solidary and universal, and competition can occur above this level, through complementary, voluntary policies, additional services and extended packages”Horatiu Moldovan also transmitted.
According to him, the proposal to introduce more health insurance companies, including private ones, seems attractive at first glance.
“They talk about competition, efficiency and the patient’s freedom to choose. But the experience of other countries shows that, without extremely strict regulation, such systems can lead to the selection of patients, to the increase of administrative costs and to the emergence of a two-speed healthcare: one for those with money and one for the rest of the population. In a competitive system, insurance companies will have an economic interest. It is natural. But economic interest also means the temptation to attract patients young and healthy and to avoid the chronically ill or expensive cases. If there are no well-designed compensation mechanisms, we risk that the most vulnerable patients will be pushed into an underfunded public system”claims the president of CNAS:
He adds that, moreover, a system with several insurance companies does not automatically mean better services. It also means higher administrative costs, marketing, parallel structures, separate IT systems. All this money does not go to the patient, but to the bureaucracy of the system.
“On the other hand, we have to be honest: the current system is not perfect. We have excessive bureaucracy; resistance to change; insufficient control of waste and fraud; an outdated IT system. But these problems are not caused by the fact that there is only one insurance company. They are caused by many years of management without objectives correlated with policyholders’ expectations, poor digitization and control disproportionate to the real needs on the ground. And these problems can be solved without dismantling the whole system”the CNAS president also declared:
He also complains about the lack of real autonomy of the CNAS: “In theory, the National House is an autonomous institution. In practice, it cannot make its own policy of contracting medical services according to the real needs of patients, but according to the decisions and priorities of the Ministry of Health”.
“Many times, CNAS is obliged to pay for the artificial maintenance of hospital structures that are not needed or requested by patients, instead of being able to direct the funds to modern medical services, correct payment in specialized outpatient clinics, prevention or to high-performing hospitals. In other words, in the current system it does not always matter what the patients want, but what the Ministry of Health wants. The autonomy of CNAS is, for the most part, only on paper”. added Horatiu Moldovan.
He believes that a real reform would mean:
– that the CNAS can freely contract medical services, depending on the needs of the patients;
– to be able to redirect the funds to the most requested and efficient services;
– to be removed from the direct coordination of the Ministry of Health and to become a truly autonomous institution.
In addition, concrete reforms can be made within the current health system:
– complete digitization of the health system; not only that of CNAS, but the digital integration of all medical service providers in Romania, public and private alike;
– transparent purchases of sanitary equipment and materials;
– funding based on performance, not just on the number of patients;
– real control of frauds and stopping waste;
– the development of voluntary complementary insurances, which would relieve patients of significant expenses.
“Reform is necessary, but it must be a responsible one. We must not radically change a solidary system just because it works imperfectly. We must repair it, modernize it and make it more efficient. Because, in health, we are not only talking about economic efficiency. We are talking about people’s lives. And a good system is not only one that produces profit, but one that provides fair and safe access to treatment for all patients“, adds the CNAS president.
He claims that we do not need to fragment solidarity, but to make it more effective.
“The real reform is not to replace CNAS, but to make it truly autonomous, efficient and patient-oriented, and to encourage competition where it does not jeopardize universal access to medical services”, Moldovan also transmitted.
He also warns that an important part of the CNAS money ends up in hospitals, and there, often, there are purchases of equipment and sanitary materials at overvalued or ill-justified prices.
“This is not a problem of the insurance model, but a problem of management and control in the hospital system. A real reform would mean that the Ministry of Health stops this scourge of inefficient and non-transparent procurements. A real reform would be for the ministry to focus on what is really related to its duties: the training and training of medical personnel, the proper management of human resources in health, starting from the work schedule of doctors to the flexibility human resources in health, the correct organization of guards and their payment in a fair way”Moldovan also transmitted.
He concludes that if these problems of management, control and organization are solved, “we will take a much bigger step towards a functional health system than by changing the architecture of the social health insurance fund”.
Rogobete wants to break the CNAS monopoly
The Minister of Health, Alexandru Rogobete, reaffirmed on Saturday that he intends to break the monopoly of the National Health Insurance House and introduce a competitive system, in which several insurance houses, both public and private, will operate. The measure is considered essential in the framework of the reform of the way of financing the health system in Romania.
“The fact that there is a monopoly through CNAS means that we cannot talk about a competition”said Alexandru Rogobete.
