The county health centers intensified controls to verify the authenticity of medical leaves granted by doctors, and on this occasion hundreds of fines were issued. Doctors and patient representatives complain about the lack of regulation and say they are caught in the middle.
Doctors are often forced to refuse to grant leave. PHOTO: Unsplash
The county health centers carried out thousands of checks, and in 2023 alone, fines totaling 530,000 lei were issued.
Only last year, following the analysis of the control actions carried out at the CNAS level and the county health insurance companies, 2,264 control actions were carried out, informs TVR Info. As part of these actions, a total of 78,333 medical leave certificates were verified.
In addition to fines of over half a million lei, 85 contractual sanctions were imposed on medical service providers for non-compliance with contractual obligations.
Doctors and patients, caught in the middle
Doctors and patient representatives say they are caught in the middle and accuse the Ministry of Health representatives of being inflexible and never taking their suggestions into account, and debates are completely lacking.
“Adevărul” discussed this topic with doctor Gino Dumitra and Vasile Barbu, president of the National Association for Patient Protection.
Gino Dumitra says that he does not dispute the checks, but claims that there is a problem with the methodology of applying the fines. He too complains about the lack of clearer regulations and the lack of digitization in the system. Many times, family doctors are penalized for errors that are not theirs.
“In a way, the controls are as normal as possible. Now, indeed, there is a problem with the methodology of applying the fines that we are talking about, because for aspects of form, for example that the certificate is not in accordance with the employer or other aspects like that, the one who collects the fine is the family doctor”he says.
Lack of regulation breeds monsters
Gino Dumitra also gave some examples for the case where doctors risk fines due to ambiguous regulations.
“Of course, when you are in front of a patient who has sciatica or a condition that does not allow him to move, and the employer issues a certificate that is sometimes non-compliant, the family doctor is put in a position to refuse. In fact, that tells me to make sure, to deny the issuance of leave in this situation until such time as a compliant certificate is received. Well, here is a very delicate situation. Because the patient who is immobilized or may be in an area where he cannot carry out his activity in the usual way, because that is why he is on leave, and putting him on the road is, how can I tell you, enough out of order. That’s why, in one way or another, we being practically a lightning rod – the doctors, of some administrative aspects, of some administrative inconsistencies, it’s not okay to pay fines for this”adds Dumitra.
Although the representatives of the family doctors tried to make themselves heard and submitted several proposals, the Ministry of Health and the health insurance companies did not even give an answer. “We have not had discussions on this topic up to this point, in the sense that several addresses have been made by the National Society, but also by other associations of the family environment, especially employers, but we still do not have an answer. OUG 158 is still there”, explained the doctor.
Doctors and patients did not find discussion partners
He also talked about a possible solution in this regard.
“It seems to me that we are in an area of computerization and these forms seem inappropriate for the current period. We need to find another solution than walking the man around to receive a paper, bring it, confirm that it is good, return it that it is not good, and so on”added Gino Dumitra.
For his part, Vasile Barbu, the president of the National Association for Patient Protection, says that the basic problem is the lack of clear regulations and that the representatives of the Ministry of Health have so far not shown much interest in sitting down at the same table to find solutions.
“We noticed, and not just now, since 2010-2011, that, at the present time, the criteria for granting medical leave are not very clear. And they are not clear even for some of the doctors who are in good faith and want to help the patient, but within the limits of the law, they are also not clear for the health insurance company, which has to manage the funds very well, and the way they are granted these medical leaves. In addition to that, there is no relationship and debate, and together with the employers who have to bear the first three days of sick leave, from their own fund, I mean the payment of the allowance. It’s a big problem here”Barbu confirms.
He also spoke about the fact that Prime Minister Marcel Ciolacu tried to solve certain problems by himself, although he has no expertise in the field. And those who should sit down at the table to clarify things and find the right solutions do not.
Doctors are made to make arbitrary decisions
“The taxation of vacations has also been discussed. Please, the prime minister did not understand them very well, because, please, we are to blame, I do not play politics, but I criticize him for the way he comments on problems in the health system where it is totally broken. And he tries to bury the answers to the problems given by both doctors and patients on his own. A part of things also belongs to the prime minister, also belongs to the minister of health, also belongs to the Health Insurance House, also belongs to the professional societies, which, they must make certain guidelines, protocols related to how medical leaves are granted on various types of pathologies. Basic pathology plus, say, associated pathologies. So here is the big problem“, he adds.
Another major problem is the lack of regulations. Many times, says Barbu, doctors are the ones who have to make certain decisions, in the absence of clearer criteria. Or, often everything turns against them.
“If we have some eligibility criteria for people with disabilities, for people with temporary disability, we don’t have them for medical leaves. Here it is left to the doctor’s discretion. A doctor who often prefers not to give the right medical leave to the patient and not risk paying damages to the house or fines. So here is a problem. And we will have to rethink this system so that, depending on the status of the patient and depending on a series of conditions“, he says.
Another case is when employers refuse sick leave, and the patient has to go to work even if he presents an epidemiological risk or simply cannot work due to poor health. And sometimes catastrophic situations are reached.
“There are complex situations, starting from epidemiological measures related to the risk of disease transmission, communicable diseases, to, here, the incapacity of a person working in an environment and that person ends up representing a danger to himself or others. That is, due to a patient condition, an illness, either mental or simply due to stress, the person’s work capacity decreases. And if he works, let’s say, as a driver, truck or bus driver or on other machines, in his work, he can cause damage to himself, but also to other people and even end up representing a danger. So, certain criteria must be made. For example, on one pathology, now more recently, another pathology appeared, sleep apnea, but for which no medical leave is given. And there are other conditions“, adds Vasile Barbu.
If doctors face stiff fines, patients in some cases risk having their sick leave canceled and paying it all out of pocket. And not only that. “There is the risk that doctors will indeed pay fines even though they are not at fault, there is the risk that sick leaves will be canceled for patients and they will be charged if it is deemed to be their fault, but it also happens that the employer not to consider a medical leave, and the patient to have to go through the courts”says Vasile Barbu.
“Sickness tax”, the scandal extinguished by the proximity of the elections
The scandal of the fines given by the county insurance companies is not the only one in the medical system. At the start of the year, the “sickness tax” scandal, a 10% tax to be applied from 1 January 2014 to all patients taking sick leave, heated spirits both among politicians and among patients who – they woke up with reduced income.
It all started after Prime Minister Marcel Ciolacu complained that Romanians were requesting medical leave “because we sneezed and had a cold”. He argued that the abuse of unjustified sick leave must be discouraged and spoke of the need for legislative clarification.
“From what I remember, there were 274,000 leaves given because our backs hurt. There were 187,000 medical leaves given in Romania because we sneezed and had a cold. If we want to encourage… so a clear distinction must be made between those who are in need, are in need, who have a serious illness, between pregnant women, leave, you know very well that the biggest expenses are when the child is very young“, said Ciolacu then.
In the face of so many reproaches, the Minister of Health, Alexandru Rafila, announced that he is eliminating overtaxation, but only for cancer patients. The statement added more fuel to the fire.
In the end, under the pressure of patient associations and some doctors, but also in the perspective of a year with several rows of algae, the ruling coalition gave up the “sickness tax” law.
