4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
MEASURES INTRODUCED IN 2020
Health services and pharmaceuticals provided for the treatment of COVID-19 cases are covered by the national health insurance budget in Romania during the declared state of emergency. To that end, regulations regarding DRG coding have been modified, allowing hospitals to report and to be paid for both testing and treatment of COVID-19 cases. In addition, online/telephone consultations provided by family physicians and specialist physicians are covered during the pandemic.
The Ministry of Health pays for any costs not covered by the national health insurance fund: drugs, devices, equipment, reagents, tests, consumables. A Ministry of Health Order sets out how to manage financing for priority actions in the areas of monitoring, treatment, and care of critical patients with emergent and re-emergent infections, along with identifying the institutions involved and reporting tasks and responsibilities of all stakeholders. The Ministry of Health also covers the cost of isolating COVID-19 patients in specially designated facilities.
The government has introduced a legislative budget adjustment in order to assure funds needed to pay for COVID-19 services, including a bonus of approximately 500 euros for health workforce dealing with these cases. It is estimated that 14,355 health workers received this bonus in April, and 13,969 in May. Other health workers received a bonus of 30% of the base salary - 29,719 workers in April, and 32,596 in May (see Section 2.2). Besides reallocations from the national budget, additional funds will come from the European Commission, consisting of unspent pre-financing for the European Structural and Investment Funds from 2019 (around 483 million euros) and the 2020 pre-financing (around 637 million euros). These funds will be used for the procurement of PPE, tests and medical equipment, home medical and social services for elderly, hygiene products for vulnerable groups and the 500 euros bonuses paid to health workforce dealing with COVID-19 cases, but also for sustaining small- and medium-sized enterprises.
Since the end of October 2020, the family physicians are paid 105 RON (approx. 21 Euros) for every COVID-19 patient monitored online at home.
Some additional funds or in-kind contributions come from donations and charity.
At the end of July, the Parliament has adopted the Law no. 152/2020 on the organization and financing of health promotion and disease prevention services, thus creating the legal framework for payments of preventive actions in addition to health care services paid for through the social health insurance system. This law states that the funds allocated for health promotion and disease prevention will be no less than 3% of total health expenditure, and both financing and activities will be intersectoral.
The Emergency Ordinance no. 50/2020 on state budget rectification from 17 April increased public health budget by 3,796.4 million RON (approx. 808 million Euros) out of which 2,791.4 million RON (594 million Euros) was added to the social health insurance fund for healthcare services, and 1,005 million RON (214 million Euros) was allocated to pay for equipment, health workforce bonuses and preventive measures. Another 570,000 thousand RON (114,000 thousand Euros) was redirected in October from the National Reserve Fund to the Ministry of Health to cover testing, treatment and control of SARS-CoV-2 outbreak, but also to cover immunization against flu, HIV/AIDS treatment, blood collection and transplants.
Donations (including in-kind contributions such as PPE, disinfectants, tests, etc.) to 66 public institutions verified by the Romanian Court of Accounts for spending during COVID-19 pandemic amounted to 55,179 thousand RON (11,740 thousand Euros), out of which 28,414 thousand RON (6,045 thousand Euros) was directed to the health sector (hospitals, ambulance services, district public health authorities, the General Inspectorate for Emergency Situations).
MEASURES INTRODUCED IN 2021
HOW WILL HEALTH BUDGETS CHANGE IN 2021?
At the time of writing (early March) final reports on total health spending in 2020 are not yet publicly available. The total health expenditure in 2019 was 50,660.0 million RON, representing 4.8% of GDP. Out of this, 41,801.3 million RON represented the expenditures from health insurance fund. According to partial reports of the Ministry of Finance, spending from health insurance fund increased to 45,219 million RON in 2020. Representatives of the Budget Commission of the Deputy Chamber have declared that the health budget in 2021 is 750 million RON higher than in 2020 and 2.2 billion RON higher than in 2019. Budget for PHC increased by 6%, by 25% for ambulatory secondary care, by 8% for laboratory and other medical investigation and by 1% for hospitals.
The 2021 health budget includes an allocation of 2,180 million RON for vaccine procurement and financing the functioning of vaccination centres. In addition, the government has the power to use the budgetary Reserve Fund to finance measures related to control and prevention of SARS-CoV-2 infection that are not covered by the current health budget.
No new information has yet been made available about the reimbursed benefits. The main legislation that governs the provision of health services under the national health insurance system (the Framework Contract) and the implementation of the National Health Programmes in the years 2018-2019, has been successively extended until March 2021 and will likely be further extended until the 1st of July.