Access to medical services – how much in fact, how much on paper? What the elderly say. CJAS director: “He prefers to work privately”
The package of medical services provided to those insured in the public system looks good on paper, starting with the family doctor and ending with home care. In fact, waiting lists, insufficient budget or lack of interested doctors speak for themselves.
The elderly exposed their problems regarding access to medical services PHOTO: A. Mitran
Every patient in Romania has the opportunity to register with a family doctor and benefit from at least a minimum package of services – if they are uninsured, or an extended package – if they contribute or have contributed until retirement to the health insurance budget. The insured (and even the uninsured, in the case of many services) benefit from medical services in hospitals, dental services, laboratory analyses, imaging services (x-rays, ultrasounds, CT, MRI, etc.), medical devices, home care, recovery services and medical transportation. There are services that the insured know about, others that they have no idea about. There are services to which they have easy access and others for which they either wait on longer or shorter waiting lists, or take money out of their pockets and are treated in the private environment.
“The legislator came and gave the right to be able to carry out activity until the age of 70”
The representatives of several associations of pensioners in Olt county were invited, on Friday, April 24, 2026, at the meeting of the Advisory Committee for Civic Dialogue for the Problems of Elderly Persons, to discuss access to medical health services offered in the public system, their questions answered by the director of the Olt County Health Insurance House, Sorina Oancea.
The list of medical services financed by CJAS is long, perhaps much longer than many of the patients insured in the public system know. It's just that for almost every landmark in this vast list there are also mentions of the “if…” type.
“The medical record starts from the family doctor”, explained dir. Sorina Oancea, presenting the situation of the offices in Olt county.
The county is beginning, like almost all counties in the country, to have problems related to the provision of these services. There are 212 family doctors under contract with CJAS, at this time only two localities – Gura Padinii and Ștefan cel Mare – are not covered. The problem, instead, is related to the age of family doctors, with approximately 70% approaching or exceeding the legal retirement age, which calls into question the continuity of providing these services in the years to come.
“We have special appreciation and respect for family doctors who continue their work beyond retirement age. The legislator came and gave the right to be able to carry out activity until the age of 70, precisely because at the level of the country, not of Olt, there is a deficit in family medicine. But when we talk about family medicine, we have to talk about Residency. (…) We are satisfied and happy if we see that a young family doctor – we actually had one last year and we still have one now – addresses us”, stated Oancea.
The facilities offered to these young doctors who agree to go to localities without a family doctor are important. The budget for the office is approximately 40,000 lei/month, money received from the state, with a percentage increase of 100%, without the doctor being conditioned by the existence of a list of patients, stated the director of CJAS Olt.
“I'm still doing the post-mortem MRI”
From the family doctor, based on the referral ticket, the patient is referred to other specialists. This is where the problems come in.
The representative of an association of MApN pensioners indicated that patients are denied the right to a second referral/month to the same specialty if they have already benefited from such a service. In addition, even elderly patients are put in a position to wait their turn on a long waiting list for an MRI or CT investigation.
The elderly exposed their problems regarding access to medical services PHOTO: A. Mitran
“When they retire, most of them are sick, they need MRIs, CTs. I find only counter-cost. I think that after 3, 4, 6, 8 months they will do a post-mortem”, signaled the representative of the pensioners. Pensioners from the military system (insured at Casa OPSNAJ) also face another problem: limited access to compensated medicines.
“On the 1st, let someone come to the pharmacies, to see that there are enormous queues. I come from 9.00 in the evening, from 12.00 at night. Those who come at 10.00 in the morning do not get time. There are some who take anticoagulants and if they don't take them for a day or two, they're gone. Referral, if they refer you to a specialist in a month and let's say you are not satisfied, you want to consult another specialist, do not refer to the same specialty again”the pensioner also pointed out.
At least the last of the situations should not exist, explained the head of CJAS Olt, family doctors having the possibility to issue a second referral ticket based on the “per capita” service.
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“What kind of drugs are we compensating for?”
The representatives of the elderly were also dissatisfied with the list of compensated medicines. The degree of compensation is important, but it is even more important that new drugs, considered by patients to be more effective, appear on this list. The representative of another association exposed the situation of patients being treated for prostate adenoma, and on the list of compensated drugs is, the patient believes, a drug “disaster in terms of side effects”, although the treatment schemes also include newer, more expensive, but more effective treatments with fewer side effects.
“What kind of medicines do we reimburse? (…) The cheapest drug for the prostate, the effect – it's a disaster in terms of side effects. I went to the doctor, at a private clinic in Craiova, he recommended another medicine, one pill a day, 130-150 lei per month, compared to the other one, which is about 30 lei. (…) Do we want to put health first in this country? The central authorities prove to us that it is not. It proves to us that health is an expense, not an investment. We have to make it an investment. We compensate with 30%, with 90%, a medicine that anyone can afford”signaled the pensioners' representative.
35 dentists under contract with CJAS, in a county with 112 localities
A segment of services settled through CAS still less represented is that of dental services. In the county of Olt there are only 35 offices (with 50 doctors) under contract with CJAS and of these only 15 offices are in rural areas, given that the county has 112 localities (104 of them being rural localities).
“They are dentists, for example, in Slatina, but they prefer to work privately and not in the health insurance system. Fortunately, we currently have 10 requests, so we could increase, five of them are also in the countryside. It is an area where doctors need support from the community in which they work, because an office requires equipment, which is expensive”, stated Sorina Oancea, director of CJAS Olt.
The small number of doctors who offer free services cannot even come close to meeting the demand. The low interest on the part of dentists, on the other hand, is understandable, the amount that CJAS gives monthly to the practice is 6,000 lei/doctor/month. The cost of dental services is very high, a fact known to everyone, so doctors are put in the delicate position of choosing whom to provide free services and who not.
“It's not a big ceiling, it's not a big allocated amount, but taking into account that a few years ago it was a thousand or so lei, we say it's good”added Oancea.
Home care, without ceiling for oncology patients
Another category of very poorly funded services for years in a row is that of home care. It is also the reason why, at least in Olt county, the interest of suppliers has been reduced. Today there are four providers under contract with CJAS, the waiting lists are no longer as long as they used to be, and one aspect that has helped to improve the situation is that these providers are no longer subject to a ceiling for oncology patients, being able to provide services depending on the human and logistical resources available to the provider. For the other categories of patients who need care at home, the conditioning remained linked to the allocated ceiling.
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Things aren't even as good for unassisted medical transportation, a service that most insured patients don't know they can get. In Olt there is only one supplier under contract with CJAS, two others showing interest in entering into a relationship with CJAS as well. If a patient needs this service (the patient's condition does not require the presence of medical personnel), call 112, and the County Ambulance Service, which receives the request, can direct it to the contracted service for unassisted medical transport.
Many patients do not know the list of medical services they can benefit from if they are insured in the public system, which is why the number of notifications to CJAS, when their rights to these services are violated, is still low, Oancea said.
Pensioners' representatives wanted to know if CJAS could control how service providers set rates (for services provided outside of the contract with CJAS) because they noticed large differences for the same type of service between different providers, and the answer was no. What patients need to know instead is that the price cannot be different from one provider to another for similar services offered under the CJAS contract.
Also useful information is that bedridden patients who need devices such as disposable diapers can get them, if they are insured, based on the recommendation of their family doctor. This is possible even in the situation where the patient is being cared for in a center (it was the situation presented by one participant), in this case the family doctor making a home visit (in this case the care center) after which he can make the recommendation.
