Abstract
The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.
Highlights
The Social Health Insurance (SHI) scheme was introduced in Romania in 1999 and represents the health care system’s main source of funding and is managed by the National Health Insurance House
The SHI expenditure is spliced yearly in the Romanian Parliament through the vote for the State Budget Law; we consider that this budget allocation represents the main influencer of the activities of each provider of health care services
All categories of expenditure had increased about 5–15 times, except for Dentistry and Multifunctional medical centers which had only increased about 1–2 times
Summary
The Social Health Insurance (SHI) scheme was introduced in Romania in 1999 and represents the health care system’s main source of funding and is managed by the National Health Insurance House We believe that our study makes a significant contribution to the literature with the longitudinal approach of the trends of SHI expenditures per type of health care services. This brings another perspective of the health reforms from a financier lens, applying the axiom that services follow the money in Romania
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