The Romanian Health System: A Perspective Based on Essential Health Indicators

BackgroundThe catastrophe caused by the Coronavirus disease has affected all services worldwide. A range of policies were introduced to slow the virus spread, which in turn, affected the accessibility and quality of healthcare services. This was a problematic and concerning for patients with chronic diseases, such as patients with diabetes mellitus (DM) and chronic respiratory diseases (CRD), due to their sustained need for ongoing health care. The aims of the study were: 1) assessing the level of both accessibility and quality of healthcare services during the Covid-19 pandemic from the DM and CRD patients’ perspectives, 2) assessing the association between the patients’ socio-demographics and their perspectives on health services accessibility and quality, and 3) exploring the perspectives of DM and CRD patients on barriers and facilitators of health services accessibility and quality during the era of COVID -19.MethodDesign. A sequential explanatory mixed-method was used in this study. In the quantitative part, a self -administered questionnaire was used to collect data from 300 patients with DM and/or CRD. In the qualitative part, focus group approach was used to collect data from 25 patients.Setting. Public, private and teaching hospitals were involved.Analysis. SPSS Version 25 was used to analyze the quantitative data. Thematic analysis was used to analyze the qualitative data.ResultsThe quantitative findings indicated that almost 99% of the participating patients perceived barriers, ranging from low to high, to accessing health services during COVID-19. Additionally, more than half of the sample perceived low to moderate level of quality of health services. Four themes and nine subthemes related to barriers and facilitators were identified in the qualitative part of the study.ConclusionThe study revealed that both quality and accessibility of healthcare services for DM and CRD patients were impacted during the era of COVID -19. The findings lay the ground for developing future health programs and establishing or revising policies with the goal of improving healthcare services quality and accessibility for the target population.

Provision of high quality healthcare services is a priority issue for European citizens. eHealth has enabled a tremendous development of healthcare systems of EU Member States over the last few years. It has already brought many opportunities to raise the quality and accessibility of healthcare services. It facilitates provision of more efficient services which has become one of the most important goals of health care. Lithuania as a Member State has developed a national e-Health strategy for the period of 2007-2015 tailored to respond to its own specific needs. It was approved by an order No. V-811 of the Minister of Health (9th October, 2007). The paper analyses the good practice of the Center outpatient clinic in Vilnius. This Center was the first of health care institutions in Lithuania to introduce information communication technologies for administration of their services. In total, 372 patients and 122 medical employees participated in a virtual survey and 150 patients and 77 employees in a written survey. Majority of respondents positively evaluate the IT solutions implemented at the Centre outpatient clinic. The positive results are particularly prevalent among younger respondents who work as officers and who are presumably computer literate. The survey proved that established and implemented IT system improved accessibility of services, the quality of their provision and the management efficiency at the public Centre outpatient clinic. The main conclusions were: the Centre outpatient clinic will further develop an IT system, will implement new information solutions that will permit an effective activity of the institution as well as simplify and improve accessibility and quality of health care services; an implemented IT system and its accessibility possibilities as well as interoperability in public institution Centre outpatient clinic complies with national e-health strategy. The Centre outpatient clinic will petition the Ministry of Health, asking to reverse the orders of the Minister of Health, regulating the filing of medical paper forms and accelerate IT development both in Centre outpatient clinic and in other medical institutions.

The COVID-19 pandemic has caused a public health crisis which affected all the fields including economic, social, humanitarian, and human rights fields. According to International human rights law and Sustainable Development Goals (SDGs), the right to healthcare stands as a fundamental aspect of ensuring the right to life due to its inherent connection to human well-being. To measure the state of health care in a country, we should assess four criteria which are availability, accessibility, acceptability, and quality of healthcare services. Using doctrinal research and legal analysis, this paper aims to evaluate the status of the right to healthcare in Southeast Asia during the COVID-19. It is concluded that most Southeast countries effectively managed to control the spread of COVID-19. However, they grappled with challenges related to the availability, accessibility, quality, and acceptability of healthcare services. Therefore, this paper recommends that Southeast countries work to provide health care for all. As well as to take steps to achieve systemic reforms to improve the availability, accessibility, acceptability, and quality of healthcare services. These improvements include Investment in healthcare infrastructure, equitable resource allocation, community engagement and health education, training and support for healthcare workers, and international collaboration among Southeast countries through (ASEAN) and collaboration with other countries and organizations. All these improvements are essential not only for future pandemic preparedness but also for ensuring the fundamental right to health care for all as stated by International human rights law and Sustainable Development Goals (SDG).

The COVID-19 pandemic has caused a public health crisis which affected all the fields including economic, social, humanitarian, and human rights fields. According to International human rights law and Sustainable Development Goals (SDGs), the right to healthcare stands as a fundamental aspect of ensuring the right to life due to its inherent connection to human well-being. To measure the state of health care in a country, we should assess four criteria which are availability, accessibility, acceptability, and quality of healthcare services. Using doctrinal research and legal analysis, this paper aims to evaluate the status of the right to healthcare in Southeast Asia during the COVID-19. It is concluded that most Southeast countries effectively managed to control the spread of COVID-19. However, they grappled with challenges related to the availability, accessibility, quality, and acceptability of healthcare services. Therefore, this paper recommends that Southeast countries work to provide health care for all. As well as to take steps to achieve systemic reforms to improve the availability, accessibility, acceptability, and quality of healthcare services. These improvements include Investment in healthcare infrastructure, equitable resource allocation, community engagement and health education, training and support for healthcare workers, and international collaboration among Southeast countries through (ASEAN) and collaboration with other countries and organizations. All these improvements are essential not only for future pandemic preparedness but also for ensuring the fundamental right to health care for all as stated by International human rights law and Sustainable Development Goals (SDG).

Aim:To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians’ perceptions towards the quality of the services provided to the general population.Methods:A cross-sectional study was conducted in January-March 2013 including a representative sample of 132 physicians (59 men aged 41.3±6.9 years and 73 women aged 43.7±4.8 years; overall response rate: 132/150=88%) providing primary health care services in several polyclinics (health centers) of Tirana, the Albanian capital city. A structured self-administered and anonymous questionnaire was applied including physicians’ perceptions regarding different dimensions of the quality of primary health care. Binary logistic regression was used to assess the association of self-perceived quality of health care services with baseline characteristics of physicians.Results:Self-perceived adequate quality of health care services was positively related to the age of physicians, their working experience, female gender, a lower population served, and specialization in family medicine.Conclusion:Our findings provide useful evidence on the self-perceived quality of health services from primary health care physicians’ perspective in transitional Albania. Health authorities in Albania should implement suitable instruments to measure the quality of health care services at all levels.

تعد الرعاية الصحية الوقائية مطلبًا أساسيًا لدى جميع المواطنين الكبار والأطفال وخصوصَا لدى الأطفال لأنهم أكثر الفئات العمرية تعرضًا للأمراض, وأقل مقاومة للأمراض المعدية والمستوطنة, ومن هنا بدأ الاهتمام بنوعية جودة خدمات الرعاية الصحية وتطويرها لتحقيق رضي المستفيدين الذي يعتبر بدوره هدفًا اساسيًا تسعي المنظمات الصحية إلي بلوغه فهو انعكاس لمستوي هذه الخدمات ويولد ولاء لها, كما أن التوجه العالمي الحديث يعطي اهتماما متزايد بالخدمات الصحية ورعاية المريض, وأصبح إدراك مفهوم رضى المستفيدين عن جودة الخدمات الصحية الوقائية المقدمة في المنظمات الصحية مطلبًا أساسيًا لتحقيق النجاح في سياستيها الهادفة إلي تحقيق تطور مستمر من خلال زيادة القدرة التنافسية بينها, وقد دأبت المنظمات الصحية علي وضع ورسم الخطط والسياسات لمعالجة المعوقات التي تواجه عملها.فتسعى هذه الدراسة إلى رصد واقع التخطيط الاستراتيجي بوحدات الرعاية الصحية الوقائية, وكذلك تحديد مستوي جودة خدمات الرعاية الصحية الوقائية, تحديد العلاقة بين استخدام التخطيط الاستراتيجي وتحسين جودة خدمات الرعاية الصحية الوقائية, تحديد المعوقات التي تواجه استخدام التخطيط الاستراتيجي في تحسين جودة خدمات الرعاية الصحية الوقائية , وكذلك تحديد مقترحات تفعيل استخدام التخطيط الاستراتيجي في تحسين جودة خدمات الرعاية الصحية الوقائية, التوصل إلى صياغة استراتيجية مقترحة لحسين جودة خدمات الرعاية الصحية الوقائية. وتوصلت الدراسة إلى أنه توجد علاقة طردية إحصائيًا عند مستوى معنوية (0.01) بين استجابات الأمهات والمسئولين بالنسبة لتحديدهم لمستوى المعوقات التي تواجه استخدام التخطيط الاستراتيجي في تحسين جودة خدمات الرعاية الصحية الوقائية لصالح استجابات الأمهات , توجد أيضًا فروق جوهرية دالة إحصائياً عند مستوى معنوية (0.05) بين استجابات الأمهات والمسئولين بالنسبة لتحديدهم لمستوى مقترحات تفعيل استخدام التخطيط الاستراتيجي في تحسين جودة خدمات الرعاية الصحية الوقائية لصالح استجابات الأمهات, ود يرجع ذلك إلى وجود ارتباط طردي بين هذه الأبعاد وأنها جاءت معبرة عما تهدف الدراسة إلى تحقيقه.

Healthcare systems are integral to the well-being of societies, serving as the backbone for delivering health services and improving public health outcomes. The healthcare system in Romania is a critical component of the country's socio-economic framework, with its performance directly affecting the health and development of the population. While there have been improvements in certain areas, challenges such as underfinancing, human resource issues and inequitable access to care remain. Artificial intelligence (AI) in healthcare represents a significant shift towards more efficient, precise, and personalized medical care. It encompasses a range of applications from diagnostics to treatment recommendations, patient engagement, and administrative tasks, aiming to enhance the quality and accessibility of healthcare services. The purpose of this study is to analyze the healthcare system in Romania using data on healthcare infrastructure (medical units), medical staff, population, hospital beds and investments. Additionally, it aims to organize ideas regarding the use and perspectives for the development of artificial intelligence in the Romanian healthcare system. A spatial distribution of indicators is created, highlighting the most significant areas in the Romanian healthcare system. Healthcare systems are essential for providing healthcare and promoting public health. Effective health systems promote economic growth, ensure equitable access to healthcare, and respond to public health emergencies.

Nurses on Boards: The Time Has Come

The study analyzed how socioeconomic factors are associated with seeking, access, use, and quality of health care services in São Paulo, Brazil. Data were obtained from two household health surveys in São Paulo. We used logistic regression to analyze associations between socioeconomic factors and seeking, access, use, and quality of health care services. Access to health care services was high among those who sought it (94.91% in 2003 and 94.98% in 2008). The proportion of access to and use of health care services did not change significantly from 2003 to 2008. Use of services in the public sector was more frequent in lower socioeconomic groups. There were some socioeconomic differences in seeking health care and resolution of health problems. The study showed almost universal access to health care services, but the results suggest problems in quality of services and differences in quality experienced by lower socioeconomic groups, who mostly use the Brazilian Unified National Health System (SUS).

<h3>Background</h3> Protection of human dignity, especially in case of terminal (incurable) illness, is among the main pre-requisites of a just society. Although everyone agrees that dignity is the core of human rights, there are many (mis-)conceptions of its meaning. It is important that healthcare providers recognize patient's needs that preserve his/her dignity most. The aim of this paper is to compare opinions of Lithuanian citizens and healthcare professionals on what may pose threat to human dignity in case of terminal illness at the end of life. <h3>Methods</h3> In 2021, a national representative survey of citizens (N=1110) and a survey of healthcare professionals who cared for terminally ill patients (snowball sampling; N=166) were organized in Lithuania. <h3>Results</h3> The findings revealed that higher proportions of healthcare professionals believed that 'Dependence on others' help' (78.9% vs 56.3%), 'Physiological problems' (68.7% vs 55.3%), and 'Reduction in or loss of privacy' (62.0% vs 26.1%) are the dominating threats to dignity of terminally ill patients. Meanwhile, more citizens believed that 'Difficulties in management of pain and unpleasant symptoms' (53.4% vs 27.1%), 'Knowledge that the illness is incurable' (43.3% vs 20.5%), 'Low quality of healthcare services' (28.4% vs 17.5%), 'Low accessibility to medicines and medicinal products' (24.4% vs 2.4%), and 'Difficulties in getting social support' (23.7% vs 13.9%) reduce human dignity. <h3>Conclusion</h3> While health professionals saw physiological and autonomy related issues as negatively affecting patients' dignity, the citizens believed that, besides the knowledge that the illness is incurable, accessibility and quality of health and social care services need to be tackled with empathetic commitment and patient-centered approach. Health and social care systems should focus not only on the quality of health and social care services but also care about the mode of delivery of services to terminally ill patients so they felt dignified until the last moments of life.

Background: Quality of health-care services has grown in importance in both developed and developing countries' health-care systems over the years. This study aims to assess patients’ perception of quality of primary health care services in Osun State in order to improve healthcare outcomesMethods: This study employed the descriptive cross-sectional design to assess patients’ perception of quality of primary health care services in Osun State.Results: A greater proportion of respondents were motivated to utilize primary health care facilities as a result of accessibility to services/good attitude of health service providers compared to availability of services, affordability of health care services and quality of services. Sixty-two percent of 13 items measuring perception of quality of care by health care providers had above average response, only 25% of items measuring perception of quality of health care service delivery had above average response and only 16% of items measuring perception of quality of health facility had more than average responses. Physical accessibility, adequacy of cost and respectfulness of health workers were very important predictors of patient satisfaction with care.Conclusions: Overall quality of care is perceived to be of average quality. It is recommended that strategies be put in place to ensure sustenance of service areas with perceived good quality and continuous improvement of service areas with perceived poor quality especially recruitment of more health workers, provision of adequate medical equipment and improvement of payment arrangements at the facility.

Introduction. The purpose of the research was to analyze what role the accessibility and quality of health care plays in the country chosen as a tourist destination. It also examined where tourists get their information about health care in the country they plan to go to and whether they had to use medical services at the place of their stay. Material and methods. An analysis of source materials was performed and a diagnostic survey was conducted. Results. While the quality and availability of health care at the destination is important to some respondents, the main factors related to location, tourist attractiveness (tourist attractions, tourist infrastructure) and price still determine the choice of destination. Only 4% of the respondents identified the availability and quality of healthcare services as key factors in their decision-making process. At the same time, 38.6% of the respondents considered the quality and availability of healthcare services when choosing a tourist destination. For longer trips, the quality and availability of health care at the destination is more important when choosing a destination. Conclusions. Healthcare facilities are part of the associated infrastructure in tourism. This type of infrastructure primarily serves the local population, but also conditions the proper organization and management of tourism at the destination. In addition, in the situation related to the COVID-19 pandemic, the role of health care in tourist destinations has increased. This also requires increased efforts toward ensuring access to medical services as well as information about them in tourist destinations.

Objectives: The outbreak of the COVID-19 pandemic impacted many aspects of life among various professionalgroups. Healthcare workers were the first line of help and the most vulnerable to being infected with the SARS-CoV2 virus. The efforts to counter the impact of the pandemic were not helped by shortages of staff and personal protective equipment, which affected the doctors’ comfort as well as the patients’ access to quality healthcare services. This study investigates the perception of healthcare services during the COVID-19 pandemic from the perspective of medical doctors living in Poznań, Poland. Material and methods: The questionnaire was distributed in paper form among doctors and dentists. Responses were received from 72 respondents, including 63 women and 9 men. The survey was conducted during Poland’s third wave of the COVID-19 pandemic. Results: Statistically significant correlations were found between access and quality of healthcare services; appointment time and online mode of admission; access to PPE and quality of healthcare services; work comfort and access to PPE; and work comfort and quality of healthcare services. Conclusions: The work of doctors and dentists during the COVID-19 pandemic has changed their perceptionsof the accessibility and quality of healthcare services. The opinions of doctors and other healthcare providers, as the professional group closest to the hardships of the pandemic, should be highlighted and widely considered.

Introduction:Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union.Aim:The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health.Results:Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.

OBJECTIVETo assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status.METHODSThis population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses.RESULTSThe lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status.CONCLUSIONSAlthough no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.