Romania: health system review

This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union (EU). Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action

Refugee and migrant health in Bosnia and Herzegovina: the role of WHO in complex political environments

Nowadays, refugees and migrants are the focus of intense political debate worldwide. From the public health perspective, population movement, including forced migration, is a complex phenomenon and is a high priority on the political and policy agenda of most WHO Member States. Health diplomacy and the health of refugees and migrants are intrinsically linked. Human mobility is relevant to all countries and creates important challenges in terms of both sustainable development and human rights, to ensure equality and achieve results through the Sustainable Development Goals. This book is part of the WHO Regional Office for Europe’s commitment to work for the health of refugees and migrants. It showcases good practices by which governments, non-state actors and international and nongovernmental organizations attempt to address the complexity of migration, by strengthening health system responsiveness to refugee and migrant health matters, and by coordinating and developing foreign policy solutions to improve health at the global, regional, country and local levels

Cutaneous leukocytoclastic vasculitis after second dose of mRNA COVID-19 vaccine

Numerous cutaneous reactions following COVID-19 vaccination have already been described. Vasculitis, however, is a rare adverse event, occurring mainly after the first COVID-19 vaccination. Herein, we report a patient with IgA-positive cutaneous leukocytoclastic vasculitis, unresponsive to a moderate dose of systemic corticosteroid that erupted after the second dose of the Pfizer/BioNTech vaccine. Since booster vaccinations are being administered, we intend to raise awareness among clinicians and to highlight this potential reaction and its therapeutic approach

Time Series Analysis and Forecasting with Automated Machine Learning on a National ICD-10 Database

The application of machine learning (ML) for use in generating insights and making predictions on new records continues to expand within the medical community. Despite this progress to date, the application of time series analysis has remained underexplored due to complexity of the underlying techniques. In this study, we have deployed a novel ML, called automated time series (AutoTS) machine learning, to automate data processing and the application of a multitude of models to assess which best forecasts future values. This rapid experimentation allows for and enables the selection of the most accurate model in order to perform time series predictions. By using the nation-wide ICD-10 (International Classification of Diseases, Tenth Revision) dataset of hospitalized patients of Romania, we have generated time series datasets over the period of 2008–2018 and performed highly accurate AutoTS predictions for the ten deadliest diseases. Forecast results for the years 2019 and 2020 were generated on a NUTS 2 (Nomenclature of Territorial Units for Statistics) regional level. This is the first study to our knowledge to perform time series forecasting of multiple diseases at a regional level using automated time series machine learning on a national ICD-10 dataset. The deployment of AutoTS technology can help decision makers in implementing targeted national health policies more efficiently

SUNT MEDICII DE FAMILIE PREGĂTIȚI PENTRU SĂNĂTATEA 2020?

CONTEXT: Primary care has the potential to effectively address the most pressing challenges to the Romanian health system. A series of international health systems surveys have recently been conducted to evaluate primary care in the country. We present selected findings from a recent European Commission-funded study: Quality and Costs of Primary Care in Europe (QUALICOPC).METHOD: We have selected findings from this study which we believe are key in addressing Romania’s health system challenges. To do this, we used the priority area recommendations from the World Health Organization European Region’s Health 2020 strategic policy framework as a guide. RESULTS: Study results are presented for primary care provision to the elderly, harmful alcohol use, mental health, service integration and professional relations in primary care.CONCLUSIONS: Using Health 2020 to explore survey results was helpful in framing the QUALICOPC results. Our analysis shows that family doctors in Romania have improved their performance and are better positioned towards strengthening primary health care. Keywords: Health 2020, family doctors, primary health care, management, health policies, health care study, health systemsCONTEXT: Asistenţa medicală primară are potenţialul de a rezolva cele mai presante provocări cu care se confruntă sistemul sanitar românesc. Recent, au avut loc câteva studii internaţionale cu privire la sistemele sanitare, în vederea evaluării asistenţei primare la nivel naţional. Prezentăm o serie de rezultate selectate dintr-un studiu recent finanţat de Comisia Europeană: Calitatea şi costurile serviciilor de asistenţă primară în Europa (QUALICOPC).METODĂ: Am selectat rezultate din acest studiu despre care credem că sunt elemente-cheie în rezolvarea problemelor sistemului sanitar românesc. Pentru aceasta, am utilizat ca ghid  recomandările prioritare în domeniu din cadrul de politici Sănătatea 2020 al Organizaţiei Mondială a Sănătăţii – Regiunea Europeană.REZULTATE: Rezultatele studiului sunt prezentate sub forma asistenţei medicale primare pentru vârstnici, consumul nociv de alcool, sănătate mintală, integrarea serviciilor şi relaţiile profesionale în asistenţa primară.CONCLUZII: Utilizarea strategiei Sănătatea 2020 pentru a explora rezultatele studiului a fost utilă în privinţa încadrării rezultatelor QUALICOPC. Analiza noastră arată că medicii de familie din România şi-au îmbunătăţit performanţa şi sunt mai bine orientaţi în privinţa consolidării asistenţei medicale primare. Cuvine-cheie: Sănătatea 2020, medici de familie, asistenţă medical primară, management, politici sanitare, studio asistenţă medicală, sisteme de sănătat

Romania: health system review

The Health system profiles (HiTs) are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems. They also describe the institutional framework, process, content, and implementation of health and health care policies, highlighting challenges and areas that require more in-depth analysis. Sections include: Geography and sociodemography; Political and economic context; Health status; Organizational structure; Decentralization and centralization; Patient empowerment; Health care financing; Health expenditure; Population coverage; Pooling; Purchasing; Payment mechanisms; Regulation and planning; Physical and human resources; Provision of services; Public health; Primary care; Hospital care; Emergency care; Social care; Palliative care; Mental health care; Dental care; Pharmaceuticals; Health care reforms; Assessment of the health system