Patients’ Right to Medical Services

A look at Romania's healthcare system and its problems.

România Internațional, 06.05.2015, 12:52

Life expectancy in Romania is lower than in other countries in Europe; a Romanian lives on average 7 years less than a German, 8 years less than a Spaniard or a Frenchman and 9 years less than a Swiss. According to a report of the European Commission and of the Organisation for Economic Cooperation and Development, Romania fares better in terms of diabetes and cancer rates, but has a big child mortality rate.

In the rural regions, where 46% of Romania’s population lives, and 50% of its children, child mortality in 2013 stood at 10.4 per thousand as compared to cities, where it was 6.8 per thousand. The main cause is premature birth, which occurs in 10% of the cases. The factors causing this phenomenon include the life style, the lack of information and lack of attention paid to prevention, and last but not least, Romania’s under-funded healthcare system. Many infant mortality cases could be prevented in rural regions by developing mother & child assistance programmes, and by fitting maternity hospitals and wards with high-tech equipment.

These are the conclusions of a series of debates organised by World Vision Romania jointly with specialised committees in the Romanian Senate, under the title, ‘Patient Rights: between Theory and Practice’. On this occasion participants urged all decision-makers to improve the access to high-quality healthcare services, particularly for the vulnerable families in the rural regions. The organisers set out to reveal the gap between theory and practice when it comes to the patients’ right to high-quality medical services. The World Vision Foundation is mainly operating in rural areas, where children have low access to basic services, including medical ones, as World Vision executive director Daniela Buzducea said:

Daniela Buzducea: “In a survey that we published last year and which was called ‘Child Well Being in Rural Romania’, we show what we have found out, namely that one out of five children up to five years old has never seen a doctor; and we know that toddlers always need to be seen by doctors to get their vaccines in time, to be monitored. Unless we identify in time the problems that might appear in children at an early age, not only are future interventions more expensive, but they can also impede a child’s development and potential to make a contribution, in social and economic terms… No serious investment has been made in parent training, so as to help them know how to properly bring up their children. There are many parents who still don’t know that whether they have a health insurance or not, under the Romanian legislation, their children have a right to healthcare services and treatment. Pregnant women also have a right to medical treatment, whether they have insurance or not. Sadly we have lately witnessed an anti-vaccination trend and I believe that authorities should think about how to inform people better on the importance of vaccination. There is no survey to justify the parents’ lack of interest or unwillingness to have their children vaccinated.”

The debates have also been attended by doctor Vasile Ciurchea, president of the National Health Insurance Agency, who among other things referred to the health insurance cards, which have become compulsory as of May 1st. He also discussed the expenses for patients’ treatment abroad, which stand at 70 million euros per year. Vasile Ciurchea admitted there are many towns and villages in Romania without family physicians; in the Danube Delta, for instance, there are only three doctors:

Vasile Ciurchea: “At national level, 300 towns and villages have no family physicians. There are such places in Moldavia, the Apuseni Mountains, and in some other remote, isolated regions… And in order to motivate healthcare personnel to remain in these rural regions we have introduced significant bonuses and incentives. Those doctors who choose to go to the Danube Delta, a region with special conditions, can get a bonus of up to 200%, because they must deal with a large number of patients; one doctor has about 45 hundred patients there, and we are trying to convince the local authorities to contribute money to motivate physicians to go there.”

Tuberculosis is a curable disease, if detected at an early stage. Unfortunately, Romania registers the largest number of cases, as one in five Europeans diagnosed with tuberculosis is from Romania. Three people die of tuberculosis in Romania every day. Untreated cases are a threat to those around, as only one individual infected with TB can infect up to 15 people around. The need to get local authorities involved in containing and eradicating tuberculosis by financing free psychological and social support services for patients was the main topic of discussion at a roundtable that has been recently organised by the Romanian Angel Appeal Foundation.

TB patients already benefit from free of charge psychological and social counselling services in four specialised hospitals across Romania (Bucharest, Bisericani, Baia Mare and Leordeni) as well as from financial support to undergo treatment. This is due to a programme started last year by Romanian Angel Appeal Foundation, under which 1,000 TB patients get help to cope with the disease. Here is what physician Cristina Popa, a doctor at the “Marius Nasta” Pneumophthysiology Institute in Bucharest, one of the four hospitals which provide such services, has to say:

Cristina Popa: “More than 200 patients have been enlisted in the project and 163 social surveys have been made. Also, 172 people received financial support of 100 lei each, which means that every month they took the proper medication correctly, and 26 patients have attended professional training courses. Most of the 218 patients are men. My personal observations with respect to this programme are related to the fact that when there is teamwork or a collective approach, patients get accurate information from several sources, there are more standpoints and consequently the quality of the medical service is better. Furthermore, there is a direct and open communication between the team members and the patient. We believe that a very important role was played by the nurses in the treatment rooms, who monitored the patients. This boosted people’s confidence in medical services. I dare say the programme has produced good results, even though two of the 218 TB patients have abandoned the treatment. This accounts for 1% of the total number of patients, in the context in which The National Programme for TB Control tolerates a maximum dropout rate of 10%”.

A huge step forward that Romania has taken in the fight against tuberculosis is a National Strategy for TB Control adopted by the government for 2015-2020. The budget allotted to this strategy is around 1.5 billion lei.