Only 1 Romanian out of 3 pays health insurance and this indigorates us. When we take a category category, we might change our opinion

The health system has 17 million insured and only a little over 6.6 million contributors, which makes it have a “sustainability problem”, according to the study “The transparency of money from the Romanian medical system”, Made by the Academy of Economic Studies (ASE), with the support of the Regina Maria health network.

The over 10 million unpaid insured represent the social categories exempt from the payment of the contribution.

The money from the contribution to the health insurance “covers 40% of the total health expenses in Romania and about 60% of the public health expenses”, says, in a dialogue with Hotnews, Radu Comșa, consultant in health policies and one of the authors of the study “Transparency of money from the Romanian medical system”. But, he adds, “do not expect, in any health system, for the income from contributions to cover the total expenses.”

About the exempted categories, Radu Comșa states that the majority “are not relevant (for a possible taxation – n.red.), Because they make no income”.

But, with the exception of Bulgaria and Hungary, “everyone around us taxes pensioners,” he adds.

Social categories exempt from paying the contribution to health insurance:

• Children, children in placement, students, students (
• Co-insurance (husband, wife, parents without income in the maintenance of an insured person)-654,244 persons.
• Politically, deported, veterans, revolutionaries – 149,221 people.
• Persons with disabilities – 171,460 people.
• Persons included in curative national programs, without income – 60,682 people.
• Pregnant women and non -revenue praises – 24,623 people.
• Persons on leave for the child's growth – 133,362.
• Unemployed beneficiaries of allowance – 38,612 persons.
• Persons with a deprivation of liberty – 19,567.
• Persons beneficiaries of social assistance – minimum guaranteed income – 239,309.
• Monahal staff – 2,515.
• Pensioners (including 430,786 invalidity pensions and 15,161 institutionalized persons) – 4,287.274.
• Foreign citizens and other categories of insured persons Except for CASS payment – 25,739.

Rafila: “We cannot start to pay students”

Present at the launch of the study “The transparency of the money from the Romanian medical system”, the Minister of Health, Alexandru Rafila, said, about the categories exempt from the payment of the contribution, that “we cannot start to pay”.

The Minister of Health also put the exemption from the payment of the Romanian pensioners on account of the small pensions.

Rafila believes that the solution to be able to allocate more money to the health system would be “to improve the performance of collecting funds to the state budget.” Otherwise, according to the Minister of Health, the increase of the health budget “will continue to be slow or not”.

Two solutions

In order to increase the amounts from the contribution, there are two solutions, says the health policies Radu Comșa, in the dialogue with Hotnews: to work at the tax base – who pays and how much he pays.

“At the tax base now, the only solution for a major beneficial change is to tax pensions or the amount of pensions exceeding 2,000 – 3,000 lei – as is the ceiling for income tax,” says Radu Comșa.

“Other significant categories you can bring in the tax base you do not have, because they do not make income,” adds the expert. “You do not start perceiving contribution from people who do not make income. I do not think the other categories are relevant.”

In addition, the problem “is also raised” if at the moment we still have a substantial gray economy in which people do not pay health insurance contributions. As such a policy will produce results, taxpayers will also appear to the health insurance fund. “

“A continuous cloth”

Of the surrounding countries, only Bulgaria and Hungary are exceptioning the pensioners from the payment of the health contribution, says Comșa. “On the other hand, what were the Bulgarians and the Hungarians doing? They gave subsidies to the background that were quantified according to the number of pensioners and the average or minimal pension.”

“We do not do this. IV, so the increased subsidies are allocated in order to cover the fourth quarter.

Basically, in Romania, the Health Insurance House “works ad-hoc. You have no way to have a health insurance system that delivers quality under these conditions. It is a continuous cloth”, stresses Radu Comșa.

Increasing the contribution, slightly probable

A second solution would be to increase the contribution rate to health insurance. But it is a slightly probable variant at this time, says Radu Comșa: “At the moment, I do not think it is recommended. It would only increase the costs of companies and discourage or to cook even more economic growth. To increase taxes in a period of economic uncertainty would not be very good.”

“Therefore, you extend the basis as social and politically acceptable – and this can be done. You can add taxpayers from bringing the gray economy to the surface. And in the rest, you rely on economic growth to bring you additional income,” is the expert's vision.

Radu Comșa also says that “for now, it is enough for us. If we do these things, I assure you that the health insurance fund will look different in the coming years.”

Complementary insurance?

In recent years, the health authorities in Romania have spoken about the introduction of complementary health insurance, which will include a number of services not covered by CNAS. However, the intention was never taken to the end.

Radu Comșa says that these complementary insurances are still regulated today in the Health Law. “And, indeed, they would target services and products that are not in the basic packages-they have this complementary nature. That package had to be regulated by Government Decision and Na appeared-for about 10 years it is this delay. There was no approach, this mobilization among the health authorities to create this package.”

At the moment “there are consistent services that are excluded from the service package is the basis, which could be included in that package,” says the expert.

In addition, such a discussion could also aim to transfer some services covered at this time in the basic package of CNAS to complementary insurance: “But I would not make a consistent transfer from the basic service to the complementary insurance. I would rather start with a more supple complementary services package, which I can update or develop, as it is as possible. Complementary insurances not to reduce access to important medical services. ”

“In time, this would lead to a deterioration of the health. It would be a useful policy, but which should be done with great care – planned and gradually,” is Radu Comșa's opinion.

National Health Programs open to all patients – insured and uninsured

Radu Comșa's health policy expert recalls, in the discussion with Hotnews, that in Romania there are, in addition to the services in the basic package provided by CNAS and the minimum package (addressed to the non -insurance) and another package of medical services financed by CNAS, from contributions: the national programs of curative health – oncology, oncology, cardiology Hemophilia.

They provide medicines, services – radiotherapy, investigations, especially imaging and genetic profile and medical devices. “Separate from the basic services package,” says Radu Comșa.

Another type of programs, of public health, are managed by the Ministry of Health: the national vaccination, HIV, transplant, screening program, also open to all citizens of the country.

“We have these national health programs available to anyone who has eligible diagnoses for them. They are packages available to the entire population – insured or uninsured. For example, someone who has a cancer diagnosis and enters the program becomes insured throughout the health insurance system – has access to the basic package + the national program,” explains the expert.

“Which of them are so important that they must remain open to all citizens?”

Radu Comșa considers that the health system “would also need a discussion about these national health programs: which of them are so important that they must remain open to all citizens? Which can be integrated into the basic service package and which can give certain services into the complementary insurance package?”

“Their size is somewhere at 15 billion lei. About 20% of the expenses of the health insurance fund are on these programs,” says the expert.

In addition, “not all chronic diseases are the subject of national programs, but only some. And inside them, only some of the therapeutic solutions.

A cancer patient receives from the National Program for Medication oncology, Radiotherapy, PET-CT tests and some genetic tests to see which of the drugs is right. It's okay. But, at the same time, from the basic service package receives continuous hospitalization services, day hospitalization, it has the monitoring of the disease through laboratory and imaging analyzes that are part of the basic package. ”

“It is a fragmentation of these services that do the correlation and pursuit of their impossible results,” says Comșa.

“Why is diabetes in national health programs and are not cardiovascular disease, chronic kidney disease or respiratory diseases? This discussion should have, because we should put little order in the basic package and in national programs, to see who covers and who benefits.

“To create innovative payment mechanisms, outside the basic package, it would be a reason to hold national health programs. To give the non -insurance? Not necessarily,” he says.

“You can expand the minimum package, which is for not enslaved, with the same products and services that are in the national health programs. They make a sense for the medicines that are bought and issued in the public hospitals, because they come over the tariffs on the services. But you have to have a discussion, if you keep these programs separate from the basic package? The comșa.