Cardiology Practice in Romania

Romania has a population of 21.7 million inhabitants and a gross domestic product (GDP) of 186.9 billion dollars. Health care spending in Romania reached 10.1 billion USD dollars in 2013. This is translated into 5% of the gross domestic product and approximately 504 USD dollars per capita. The public healthcare expenditure accounted for 80% of the total healthcare expenses. Out-of-pocket expenditure accounted for 97% of private health expenditure, whereas private insurance reached 1% of the private health expenditure, almost insignificant.

Between 2000 and 2012, the life expectancy in Romania increased for both males and females by 3 years. The average WHO European region life expectancy increased 4 years during the same  interval. Healthy life expectancy in Romania in 2012 was 9 years, lower than the overall life expectancy at birth. Therefore this represents 9 years of full health that are lost through years lived with morbidity and disability. Ischemic heart disease was the leading cause of mortality, followed by stroke and hypertension.

Regarding the population risk factors, the prevalence of hypertension in population aged 25 and higher reached 32.9% for females and 39% for males, both relatively higher compared to the WHO European region average of 33.1% and 25.6% accordingly. Obesity rates in 2008 were significantly low, 16.3% for males and 19% for females, compared to the WHO European region average which accounted for 20.4% and 23.1% respectively.

The healthcare system in Romania is highly centralised.The government is the highest authority and performs its tasks through the Ministry of Health. The National Health Insurance Fund (NHIF) is the main structure in charge for financing the healthcare services; it also  receives the funds collected by the Ministry of Finance agencies . The Ministry of Health is responsible for defining the general objectives and fundamental principles of the government health policy.The healthcare services are established at a regional level according to local needs and funding. In accordance with the Yearly Framework Contract, the NHIF agrees with the College of Physicians (CoPh) the health care services to be contracted by the District Health Insurance Funds (DHIFs) from both public and private  health  care  providers. At  the  state  level,  there  is  a  cross-sectoral collaboration between the Ministry of Health, the Ministry of Labour, Social Solidarity and Family, the  Ministry  of  Interior  and  Administrative  Reform,  the  Ministry  of  Education  and  Research, Ministry of Finance, the CoPh, the College of Pharmacists and the NHIF. At the regional level, there is a cross-sectoral   collaboration   between   the   District   Public   Health   Authorities (DPHAs), the DHIFs, district   councils,   district   public   finance   departments   and   district departments   of   the   Ministry   of   Labour,   Social   Solidarity   and   Family,   district   school inspectorates, and district local governments.

At the local level, the DPHAs are responsible for the organisation and supervision of the preventive activities. In 2006, there were four main national programmes; a) the Community Public Health Programme, b) the National Programme on Prevention and Control of Non-Communicable Diseases, c) Maternal and Child Health and d) the National Programme on Management and Health Policies.

Primary care is mostly provided by GPs or family doctors and is the first-line of the healthcare system. GPs act as gatekeepers of the healthcare system as all insured citizens should first consult their GP for any health problem or complaint. Depending on the health problem, the GP decides if a referral to a specialist is needed or not.

In-patient healthcare is provided by hospitals which are categorised according to the geographic position to: a) regional hospitals, which treat more severe cases that cannot be treated at local or district level, b) district hospitals, which offer almost all medical and surgical specialties including  an emergency care unit and c) local hospitals,  which  are  general hospitals. Secondary care is delivered also through: a) long-term care hospitals, specialising in chronic diseases, b) medico-social care units, which operate under local authorities, c) sanatoriums and
d) health centers which provide care in at least two specialties.

The general and the cardiac related infrastructure of Romania consists of 473 hospitals, 6 of which have cardiac facilities. There are 20 centres capable of undertaking PCIs, 24 units implant cardiac rhythm devices, and 3 which undertake percutaneous interventional valve replacement techniques.  There are also 13 cardiac surgery units.

The private hospitals are present in Bucharest, Timisoara, Brasov and Sibiu with clinical cardiology departments and interventional procedure facilities.

There were 1 270 registered cardiologists in Romania in 2011. According to the same statistics there were 59 cardiologists per million people, 458 cardiologists in training, 15 electrophysiologists, 87 interventional cardiologists and 65 cardiac surgeons.

The data concerning the provided cardiac services in Romania in 2014 were: 15 000 PCIs, 4 258 pacemaker implantations, 332 ICD implantations, 5 TVRIs. The vast majority of the procedures were done in public hospitals. There is no official number of procedures done  in the private hospitals.

The data presented in this paper were taken from the report of Romanian Society of Cardiology prepared for the ESC Atlas of Cardiology, Country Profile Romania, RSC Survey, Survey on Romanian Society of Cardiology, April 2015.