Republic of Moldova

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Eastern Europe and Central Asia

7.7%CHE/GDP

29.4%OOP/CHE

14.6%GGHE-D/GGE

14BGDP (USD)

2.6MPopulation

14.2%Catastrophic Health Spending

The Republic of Moldova (Moldova) is an upper middle-income country in southeastern Europe near the Black Sea, bordering Romania and Ukraine. It is part of the Commonwealth of Independent States (CIS) and gained independence from the Soviet Union in 1991. Moldova’s share of GDP for health declined from 10.13% in 2010 to 7% in 2020, which is equal to the CIS average (6.73%).^[1] Current health expenditure (CHE) per person has also been at CIS average, reaching Int$ 877 in 2020.^[1]

The country’s Ministry of Health (MOH) is responsible for health policy and regulating the health sector. MOH agencies include the National Agency for Public Health, which manages public health services; the Agency for Medicines and Medical Devices regulates the pharmaceutical industry; and the Centre for Centralized Public Procurement in Health procures medical and protective equipment for public providers. Local public authorities are responsible for the development and maintenance of health facilities and infrastructure, which they also own, but they do not finance health services.^[2]

The Moldovan health system is centralized and has a single purchaser of publicly financed health services. A publicly financed mandatory health insurance system has been in place since 2004 with a defined benefits package managed by the National Health Insurance Company (CNAM), the single purchasing agency.^[2] CNAM pools and manages health insurance revenues, including mandatory health insurance contributions set as payroll tax and transfers from the state budget for the nonworking population.^[2]
In 2020 government contributions covered 11 categories of noneconomically active people registered as residents. In 2021 the share of the population covered by CNAM was 87.7%. CNAM contracts with both public and private providers.

Addressing the challenges

The benefit package is relatively broad for insured people, but out-of-pocket (OOP) payments accounted for 36% of CHE in 2019 and 31% in 2020.^[1], ^[2] Although Moldova’s OOP payments were lower than the CIS average rate of 50% (2020), they were double the European Union (EU) average rate of 14.39% among 27 EU countries in 2020 [1]. Relatively low public spending on health as a share of GDP and per person, and high OOP payments led to unmet needs and households becoming impoverished.^[2] Efforts were undertaken to address informal payments, but issues with access to care and financial hardship still remain.^[2]

Primary care has been strengthened through health financing reforms that have encouraged gatekeeping for specialist services while covering the cost of primary care office visits for people who are uninsured.^[2]
Hospital sector reforms to improve the efficiency and quality of services have also been implemented in the past. While in 2021 CNAM spent 54.1% of its funds on hospital care and 25.2% on primary care, the share of primary care in the CNAM budget has been increasing over time.^[2]

References

[1] Global Health Expenditure Database. Accessed 4 Oct. 2023.

[2] Health Systems in Action: Republic of Moldova | European Observatory on Health Systems and Polices. Accessed 4 Oct. 2023.