ROMANIA: Austerity Deals Mortal Blow to Health System

• by Claudia Ciobanu (bucharest)
• Thursday, August 26, 2010
• Inter Press Service

'I'm surprised such tragedies don't happen more often, given the conditions we work in,' said resident doctor Raluca Grumazescu from the Brasov Children's Hospital.

The sole nurse attending the newborns at the Giulesti maternity in Bucharest had stepped out of the ward when the fire broke out. Three babies in incubators died instantly and two others did not survive severe burns.

'In Romanian hospitals, it is common that only one doctor and one nurse supervise up to 100 patients during nightshifts, and they have to deal with emergencies on top of that,' Grumazescu says. 'The night duty can come in the middle of a 36-hour shift during which, if the hospital takes emergencies, there is no time to rest.

'We would need double the number of staff we have now,' Grumazescu told IPS. 'At the moment, nurses also do the job of orderlies, carrying patients and even cleaning the floors.'

Reports of understaffed emergency rooms or expensive machines unused because the specialists left their jobs abound in Romanian media. Hospital managers complain about lack of auxiliary personnel, such as bodyguards or technicians to do maintenance work.

Insufficient staffing is one of the chronic problems of the Romanian health system. New hiring has been blocked for years to save money. Austerity measures following a deal with the International Monetary Fund last year mean 70,000 state jobs are being cut in 2010, including in health.

The austerity plan introduced by the Romanian government this spring was centered around 25 percent cuts in salaries of all state employees, the most severe income reduction in Europe.

For many medics, losing a quarter of their pay was the last drop. According to the National College of Doctors, 2,500 doctors and nurses have left the country this year. The country has lost 10 percent of its medics in the past three years.

Thirty-year old Grumazeanu, in her fifth year of residency, made little over 300 euros monthly before the 25 percent. She says she could make at least 3,000 euros abroad. The block to new hiring also means there will be no job openings at the end of her residency, forcing the young doctor to consider leaving the country.

Commenting on the mass exodus of medics on national television this month, President Traian Basescu said, 'Let us not make a drama out of the fact that Romanians are leaving. The best thing we achieved (since 1989) has been the liberalisation of the labour market. The Romanian state cannot pay its medics and teachers as they deserve, this is the reality.'

The health budget in this country of 22 million has stayed below 4 percent of the GDP (estimated around 120 billion euros for 2010) over the past years -- well below average EU spending. In the 2009 Euro Health Consumer Index, Romania's health system ranked worst in the EU.

Hospitals are regularly in debt. In mid-2010, the 435 Romanian hospitals owed 300 million euros for pharmaceuticals and utilities. Hospitalised patients often have to bring in their own basic drugs. This year, funds for materials such as syringes and bandages were exhausted in July in most hospitals.

National funds for medication finish in the first half of the year, causing conflict between pharmacies and the state, and halting sales to chronic patients. This year, the half billion euros awarded from the budget for compensated medication covered only last year's debts to pharmaceutical companies.

Romania has a tradition of universal state-sponsored care dating back to the socialist period. Private clinics opened since 1989 are yielding increasing returns but the number of those who can afford going private is low. Less than 400,000 Romanians had private health insurance last year.

The centre-right government claims it will halt 'irresponsible' spending in health. Legislation is ready for introducing a system of 'co-payments' by patients for drugs and medical services. From 2011, patients will pay set amounts for each visit to the family doctor, ambulance call or hospital entry.

Additionally, only the prices of the cheapest generic drugs for chronic patients will be compensated from September.

According to the Coalition of Organisations of Chronic Patients in Romania (COPAC), patients wanting to continue their current treatments will pay on average 125 percent more and additional monthly expenses could reach hundreds of euros (four million pensioners in the country have income below 300 euros monthly).

According to COPAC director Cezar Irimia, if the planned measures apply, patients with cancer, mental illnesses, Parkinson's, heart conditions and even children suffering from AIDS will not have proper treatment.

'The authorities are not listening to us, so we will be forced to sue the state for breach of the right to life,' Irimia says.

The Ministry of Health refuses to comment on the new price of medication, arguing the responsibility falls with the National Health Insurance House (CNAS). In its turn, CNAS accuses COPAC -- which represents 2.5 million patients -- of being 'sold out to pharmaceutical companies.'

According to the government, the greatest hope for the collapsing health system comes from decentralisation. This year, almost all hospitals have passed from central to local management in the hope municipalities will be more efficient managers and fundraisers. Minister of Health Cseke Attila claims decentralisation will be a 'positive shock' to the system.

However, Mihai Albu, the medic in charge of decentralisation in Bucharest, has estimated that up to half of the country's hospitals -- often in rural areas -- could close down in the process.

Other gloomy consequences of the reform are anticipated. 'A cancer patient might be forced to buy his drugs from a hospital 80-90 kilometres away; in some cases, this patient cannot even afford to pay for the trip, not to mention the drugs,' Irimia told IPS. 'Many will be forced to give up their lives.'

© Inter Press Service (2010) — All Rights ReservedOriginal source: Inter Press Service

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