Strategia Națională de Sănătate 2023-2030

Objectives

Romania’s National Health Strategy 2023–2030 aims to build a citizen-centred, resilient, sustainable and equitable health system that increases healthy life expectancy and quality of life, reduces avoidable mortality and disability, and enables informed public participation in health decisions. It is structured around public health; appropriate, high-quality health services and safe, innovative, accessible medical technologies; and an intelligent, sustainable and predictable health system.[1][2][3]

• Strengthen public health capacity, surveillance, preparedness and rapid coordinated response to health risks, while addressing social determinants of health and inequalities through intersectoral action and local partnerships.[4][5][6]
• Improve health promotion and prevention across the life course, including health education, healthier behaviours, vaccination, screening, early diagnosis and integrated interventions for communicable and non-communicable diseases.[7][8][9]
• Reduce the burden of non-communicable diseases, which account for more than 75% of annual deaths in Romania, and reduce inequalities between population groups.[7]
• Control communicable diseases by improving vaccination, prevention and reporting of healthcare-associated infections and antimicrobial resistance, and prevention, diagnosis, treatment and monitoring for tuberculosis, viral hepatitis, HIV/AIDS and other sexually transmitted infections.[9][10]
• Ensure equitable and timely access to safe, high-quality and cost-effective services, medicines, medical devices and other health technologies, particularly for vulnerable and disadvantaged groups.[11][12][13]
• Shift care towards integrated community, primary-care and outpatient services, while rationalising hospital care and expanding rehabilitation, palliative, post-acute, home-based and long-term care.[12][14][15]
• Strengthen the health workforce through long-term planning, improved territorial distribution, retention, professional development, flexible management and better workforce information.[16][17]
• Improve governance, transparency, accountability and evidence-informed prioritisation, supported by interoperable digital systems, disease and population registries, clinical management tools, quality assessment and health technology assessment.[18][19][20][21]
• Develop research, innovation and infrastructure that support healthy ageing, precision and personalised care, digital health, disease prevention, service quality and patient safety.[22][23][24]
• Ensure sustainable and financially resilient health financing, including predictable multiannual revenues, efficient allocation, strategic contracting, payment mechanisms based on real costs and financial protection for vulnerable people.[25][26]

Implementation

Delivery is intended through general and specific objectives, programmes and an integral action plan, combining national policy leadership with regional, county and local planning, integrated service networks, institutional development, digitalisation and performance monitoring.[3]The Ministry of Health is envisaged as a proactive interministerial coordinator, working with public health institutions, health insurers, local authorities, providers, professional bodies, researchers, civil society and citizens.[5][6][27]

• Assess public-health and service-delivery capacity, identify population needs and use national, regional and local health-service plans and regional masterplans to guide investment, territorial organisation and service restructuring.[5][28]
• Organise integrated local primary-care teams coordinated by family doctors, linked with community services, outpatient diagnostics, hospital care, rehabilitation and social support, and supported by interoperable digital tools and remote services.[29][30]
• Develop territorial networks and patient pathways for priority conditions, including acute coronary syndromes, stroke, polytrauma and other problems associated with avoidable disability and mortality.[31][32][28]
• Expand integrated medico-social and community services through local authorities, with central financial, logistical and informational support, especially for disadvantaged populations, older people, children and people with disabilities.[33][13]
• Establish and strengthen institutions and operational capacity, including the National Agency for Health Infrastructure Development, regional planning structures, a National e-Health Agency and improved capacity within the Ministry of Health, National Health Insurance House, National Institute of Public Health and public health directorates.[1][27][21][34]
• Modernise health information management by integrating systems operated by the Ministry of Health, National Health Insurance House, other authorities and providers; expand electronic appointments, referrals and health records; develop registries; and enable data-driven policy, research, quality improvement and expenditure efficiency.[19][20][21]
• Apply clinical guidelines, pathways, provider comparison, monitoring, audit and feedback to improve quality, safety, coordination and patient outcomes.[14][31]
• Professionalise national health programmes, use objective intervention-prioritisation and health technology assessment, and evaluate technologies before and after implementation to support cost-effective reimbursement decisions.[35][26]
• Mobilise financing from health-insurance contributions, state-budget subsidies, public budgets, European Union funds, non-repayable external financing, local budgets, International Bank for Reconstruction and Development loans, private insurance and public-private partnerships.[25][26][24][34]
• Monitor progress through targets including a 50% increase in the public-health workforce, partnerships between public health directorates and one fifth of local public authorities, vaccination coverage above 90%, reductions in avoidable mortality, expanded preventive coverage, integrated community teams and specified infrastructure delivery by 2030.[5][8][10][33][34]

Monitoring & Evaluation

The strategy establishes a broad monitoring and accountability agenda centred on surveillance, integrated health information, service-quality assessment, performance measurement and evaluation of the National Health Strategy, regional plans and national programmes. It also identifies substantial existing weaknesses in data quality, interoperability, monitoring capacity and evidence use.[4][27][19][28]

• Strengthen surveillance, monitoring and coordinated rapid response to public-health threats, alongside assessment of public-health-system response capacity and performance-improvement planning.[5][6]
• Develop an integrated health information system that produces valid, useful and regular reports for policy-making, while improving data collection, validation, reporting, interoperability and the use of programme results.[4][5][8]
• Monitor community health status and inequalities in access to services, including through local public-health capacity and partnerships with local authorities.[5][6]
• Track health-education coverage, screening uptake, vaccination coverage, healthcare-associated infection reporting and avoidable incidence and mortality for priority communicable diseases. Targets include health education for 75% of eligible children and adolescents, 50% of eligible adults, early detection or screening for 50% of eligible populations, vaccination coverage above 90%, and at least a 5% reduction or maintenance of incidence with reduced avoidable mortality for major public-health problems against 2022 values.[8][10]
• Measure access times, guideline and protocol compliance, patient-reported outcomes, avoidable hospitalisation, early rehabilitation, laboratory quality and health technology assessment. Selected 2030 targets include 75% provider compliance with relevant standards, a 30% reduction in avoidable hospitalisation, a 20% reduction in total hospital episodes, and assessment of at least 50% of non-medicinal health technologies.[14][33][13]
• Establish national primary-care performance assessment, digital reporting of quality and performance incentives, hospital-infrastructure planning and monitoring, population and disease registries, and a framework for monitoring, evaluating, auditing and advising service providers.[30][36][37][20][21]
• Evaluate national health programmes transparently for their effects on population health, avoidable mortality and disability; monitor, measure and communicate health-system performance; and provide institutional partners and the public with information on reforms, progress, obstacles and solutions.[27][35]
• Monitor and evaluate the National Health Strategy, regional health-service plans and regional masterplans, using needs assessments and applied research to inform continuous policy improvement.[28][23]

Previous evaluation found moderate overall implementation of the 2014-2020 strategy, with comparatively stronger public-health performance, moderate health-service performance and low transversal-measure performance; infrastructure and e-health were among the weakest areas.[38]Emergency digital applications can generate operational and statistical reports, but delayed registers, electronic records and referral systems limited assessment of e-health progress, while telemedicine could not be evaluated because data were unavailable.[39]Although the strategy specifies numerous targets and mechanisms, the supplied material does not consistently define indicator methodologies, reporting cycles, named monitoring leads, independent evaluation processes or formal accountability procedures.[4][18][31]

Costing & Financing

The strategy seeks a sustainable, resilient and predictable financing system that aligns multiannual revenues, budget allocations, contracting, tariffs and payment mechanisms with health needs, regional plans and national objectives. It identifies underfunding, fragmented financing, weak resource allocation and insufficient emphasis on quality and outcomes as major constraints.[35][25][26]

• Increase predictable multiannual revenues for the National Health Insurance Fund and the Ministry of Health, reduce contribution exemptions while protecting low-income groups, and establish transparent state-budget subsidies for the National Health Insurance Fund.[25][26]
• Expand private health insurance and proportionate personal contributions, while extending publicly funded services available to uninsured people and maintaining financial protection for vulnerable groups.[25][26]
• Align multiannual public budgets, strategic contracting, payment mechanisms and service tariffs with national health objectives, regional plans, real provider costs and quality incentives.[25][26]
• Improve purchasing efficiency through centralised procurement, objective ex-ante and ex-post assessment of medical technologies, revised medicine and device contracting, and performance-based financial rewards.[35][26]
• Mobilise infrastructure finance from the state budget, local budgets, non-repayable external funds, the National Recovery and Resilience Plan, the Health Programme, International Bank for Reconstruction and Development loans, private capital and public-private partnerships.[40][38][24][34]

Health-service expenditure reached 6% of gross domestic product in 2020, of which approximately 80% came from public sources; Romania nevertheless spent less on health than most European Union Member States.[41]More than half of National Health Insurance Fund resources were allocated to hospital care, with less than half remaining for primary care, outpatient care, medicines, other services and technologies.[41]Fourteen per cent of the resident population was uninsured and could access only the minimum package.[41]

Financing pressures include a deficit in the social health-insurance fund, a negative contributor-to-beneficiary ratio, contribution exemptions or unpaid contributions for some groups, chronic underfunding of prevention, and historical underfunding of primary and specialist outpatient care.[41][7][35][42]The strategy also highlights uncoordinated investment sources, the absence of a fully integrated multiannual investment plan, limited administrative capacity and an incomplete assessment of total public-health infrastructure investment needs.[40][11]

Research financing is comparatively limited: Romania allocates 0.5% of gross domestic product to research, against a European Union Member State average of 2.3%, and access to European Union health research and innovation funding is described as deficient.[28][22]The supplied material does not provide a total strategy budget, programme-level allocations, costed implementation plans, quantified funding gaps, unit costs, financing shares or macroeconomic assumptions.[11][25][34]