The medical system in 2026, the thin line between reform and improvisation. “Every time we put out the fire”

After a year that put the Romanian medical system under continuous pressure – insufficient budgets, administrative dysfunctions and crises of confidence generated by medical tragedies -, 2026 is expected to be the moment when the announced reforms must be seen concretely. Not in strategic documents and public statements, but in the day-to-day operation of hospitals, offices and national programs.

Expectations for healthcare reform are high PHOTO: Pexels/Thirdman

The first big stake remains financing. After the major pressures on the CNAS budget in 2025 and the accumulation of arrears, the announced intention to rethink payment mechanisms and reduce the imbalances between actual costs and settled rates becomes a necessity, not an option. With a financing level of around 6% of GDP in 2025, Romania remains below the European Union average, estimated at 8-9%. For 2026, the advanced target exceeds 6.5% of GDP, which would mean a budget of approximately 80-85 billion lei, a significant part of which should cover accumulated arrears.

For patients, however, the numbers become relevant only when shortages disappear from hospitals. Radu Gănescu, the president of the Coalition of Organizations of Patients with Chronic Diseases in Romania (COPAC), speaks bluntly about this reality: “I would certainly like to see a fair funding of the health system and that we no longer sit every year – either at the end of the year or at the beginning of the year – to hear that hospitals have run out of money for drug programs, that they have run out of money for saline or that they are unable to purchase syringes. I hope that I will no longer hear and see patients who end up in the hospital and, unfortunately, end up in the hospital for nothing, that they cannot be provided with medical services for various reasons, whether there are doctors, either there is no equipment, or someone is sleeping in the guard, or the ambulance did not arrive in time, things that should not happen again”.

Digital infrastructure and grass roots

A second major test of 2026 is digitization. After the poor functioning of the Health Insurance Information Platform in 2025, the Ministry of Health and CNAS announced the acceleration of the implementation of the patient's electronic file, the interoperability of the systems and the expansion of online appointments. The stake is no longer the launch of platforms, but their actual operation, without blockages that directly affect patients and medical staff. This chapter also includes telemedicine, which should become a developed segment in 2026, the objective being that especially the rural population that currently has little access to medical services can benefit from remote consultations. Family medicine should be better supported, including by providing incentives to cover areas with deficits.

In parallel, infrastructure investments remain under the public eye. The regional hospitals in Iași, Cluj and Craiova, which accumulate more than 2,000 beds, should enter a visible phase of execution in 2026, after repeated delays. Together with the projects financed through the PNRR, they represent a test of the administrative capacity of the state, but also a real risk of losing European funds, if the deadlines are not respected.

Also, the screening programs launched or expanded in 2025 would also be strengthened in 2026, with better funding and greater involvement of family doctors. However, the success of these programs will depend on the ability to ensure continuity and real access, not just the legislative framework. The average patient will look at the system evaluating whether it offers them more safety, faster access to services and a consistency of the above. Prevention is also a burning issue, constantly mentioned in 2025, which has clear targets, being millions of people to be investigated in cancer screening programs (cervical cancer, breast cancer, colorectal cancer), but also screening for cardiovascular diseases and diabetes. We should also see progress in the field of vaccination, with substantial increases in vaccination rates for the main vaccines in the national programs being pursued.

The state-private duet

Amid the medical tragedies of 2025, the relationship between the public and private systems becomes another central topic. The discussion moves from competition to regulation, uniform safety standards and accountability. Radu Gănescu pleads for complementarity, not for an artificial break between the two systems: “I think there should be complementary services. There will always be a need for the private system for various reasons. A private system, first of all, if it offers better conditions, can invest in equipment, can train staff, can offer quality services. We have examples of a private system that has been operating in Romania for years: the dialysis program. 90% of patients are treated in the private system. It is a national program, the National Health Center pays for that service. Most of the centers are private and have managed to keep this system functioning because they had the opportunity to invest. The state would never have been able to invest enough to cover the needs of all patients”.

At the same time, there are services that remain, structurally, the responsibility of the state. “They are services that only the public can provide. Why? Because they are very costly. Many times they are patients who do not have insurance, they are in a car accident, or they are simply complicated things, and it is clear that only the public system can solve such things”points out Gănescu for “Weekend Adevărul”.

However, the gray area appears in everyday practices, especially regarding the migration of doctors between public and private: “There are doctors who transfer the patient from public to private and I don't know if it's a good thing. There are doctors who, for example, no longer want to work in the public hospital, they only work in private because they have different conditions, probably better pay, and there are doctors who, unfortunately – and here is a big problem – at 8.00, 9.00, 10.00 they leave the public hospital, go to the private hospital and have the same schedule as in the hospital public, i.e. instead of being where he is employed, unfortunately you can't find him”. Thus, the staffing crisis remains a structural vulnerability, and the effectiveness of the announced measures will be judged in 2026 not by strategies, but by the real capacity of hospitals to function without chronic overload.

Action in a crisis situation

Another key chapter for predictability is the decades-delayed implementation of patient registries:
“When you have registers, you will have the data in real time: the number of patients, the costs you have in the health system on various national programs and you will be able to monitor much better. Eventually, you will be able to monitor also the fact that a certain patient who has been diagnosed and is under treatment and always comes to the hospital. Why does he always come to the hospital, what is happening? He is not treated well, he has relapses, why does he have relapses?”. Without these tools, the system continues to react to crises, not prevent them. “Every time we put out the fire”summarizes Gănescu.

Finally, the stake of 2026 is also the regaining of patients' trust, seriously affected in 2025. Here, communication appears as the weakest link: “Actually, I think this is the biggest problem in the health system: problematic communication. And when I mean communication, I mean at all levels, but especially at the doctor-patient level. Many times it's problematic that the patient doesn't understand what the doctor says or the doctor doesn't have time to talk to him, doesn't explain all the risks, all the facets of the problem”.

For the average patient, the expectations from 2026 are clear: more safety, faster access and continuity. If not, it will be another year of the system running on failure. Beyond the percentages and promises, it will be seen there whether the reforms really produced effects.