Romania has a high incidence of catastrophic health spending, with 1 in 8 households exceeding 40% of their capacity to pay for healthcare in 2015, according to a WHO/Europe report. The burden is greatest on low-income households and older people, driven by out-of-pocket costs for medicines, dental care, and outpatient services.
Gaps in Healthcare Coverage
Despite recent reforms expanding benefits under Romania’s National Health Insurance House (NHIH) and increasing public health spending, significant coverage gaps persist:
- 12% of the population remains uninsured, limiting their access to essential health services.
- Health insurance contributions are unaffordable for some low-income individuals.
- Exemptions from co-payments for prescribed medicines do not target low-income groups, and there is no cap on co-payments, increasing out-of-pocket expenses.
- Balance billing and extra billing by healthcare providers create financial uncertainty for patients.
- Limited public funding for dental care leaves many without access to essential treatment.
- Informal payments to healthcare workers and for medicines further strain household budgets.
- Aging infrastructure and staff shortages, particularly in rural areas, hinder healthcare access.
The WHO report outlines key actions to improve financial protection and ensure universal access to healthcare in Romania:
✔ Expand NHIH coverage to ensure all citizens receive the same set of health benefits.
✔ Introduce income-based exemptions and caps on co-payments to protect low-income households.
✔ Limit additional user charges by regulating balance billing and extra billing.
✔ Improve medicine procurement strategies to reduce costs, including for over-the-counter drugs.
✔ Increase funding for dental care to address high levels of unmet needs.
✔ Combat informal payments through stricter monitoring and enforcement.
✔ Boost public investment in healthcare, as Romania’s public health spending remains below the EU average (4.6% of GDP in 2019 vs. 6% in the EU).
WHO/Europe, through its Barcelona Office for Health Systems Financing, actively monitors financial protection in over 40 countries and provides technical assistance to reduce unmet healthcare needs and financial hardship. Financial protection is a core component of universal health coverage and aligns with the Sustainable Development Goals and the European Pillar of Social Rights.
The high rate of catastrophic health spending in Romania underscores urgent structural reforms to improve financial protection and healthcare accessibility. Ensuring universal coverage, controlling out-of-pocket costs, and increasing public investment in health will be critical in securing affordable, high-quality healthcare for all Romanians.