The rates reimbursed by the National Health Insurance House (CNAS) do not cover the actual costs of hospital services in either the public or private sector, according to a study conducted by researchers and experts from the Bucharest Academy of Economic Studies (ASE).

'In Romania, public and private providers jointly contribute to ensuring patient access to medical services. However, the mechanisms through which they are funded differ, creating inequities among providers and affecting the conditions for performance-based competition,' states one of the conclusions of the second edition of the study 'Transparency of Funds in the Romanian Medical System,' which analyzes in detail how healthcare system resources are collected and spent.

The study shows that, for many public hospitals, over 50% of the revenue received from the National Health Insurance House (CNAS) consists of salary-related allocations—granted through a mechanism distinct from payment for medical services and independent of the volume of services provided. This mechanism creates an 'inequity among providers,' as private hospitals do not benefit from it, while public hospitals end up receiving significantly higher total funding for the same medical services.

According to the cited source, in 2025, transfers from the Unified National Social Health Insurance Fund (FNUASS) intended to cover salary-related costs in public hospitals reached approximately 16.9 billion lei, exceeding by two billion lei the 14.87 billion lei reimbursed for medical services in public hospitals.

The study also shows that the value of these transfers increases independently of the volume of services provided and is not linked to performance or medical activity.

At the same time, the study data highlight the private sector's contribution to care capacity, noting that in 2025, private hospitals handled 2.31 million day-hospitalization cases—nearly 40% of the national total.

'The public and private sectors are complementary; we need both to perform well. However, performance is driven by fair competition, which requires a uniform set of rules. Providers should compete based on quality, efficiency, and their ability to meet patient needs, rather than on access to different funding mechanisms. While studies, debates, and roundtables are valuable, they must be followed by action. We are growing old at the negotiating table, waiting for measures that ensure stability and predictability. And just when we reach a conclusion, all too often we have to start over because the government changes,' noted Cristian Hotoboc, President of PALMED, at the study's launch event.

According to the document, the fundamental issue lies in the way medical service funding is structured. The study shows that the rates currently reimbursed by the CNAS for hospital services are insufficient to cover the actual costs of care in both the public and private sectors. The difference is that, for public hospitals, the shortfall is offset by wage-related adjustments and other supplementary funding sources, whereas private providers do not benefit from the same mechanisms.

The study also indicates that inadequate tariff rates and the absence of additional financing mechanisms in the private sector explain, at least in part, the need for patients to make out-of-pocket payments to cover the difference between the amount reimbursed by the CNAS and the cost of the medical service.

Against this backdrop, the study's authors also propose a solution: recalculating the reimbursed rates for hospital services to reflect the actual cost of the service—including the wage component—while simultaneously phasing out the separate mechanism for wage-related adjustments. The report suggests a transition period of 3 to 4 years.

PALMED advocates for the principle of transparent funding based on the actual cost of medical services and applied according to uniform rules for all providers under contract with the CNAS. This approach is also supported by the study's findings, which identify provider neutrality as a fundamental principle of a health insurance system: the same payment for the same service, regardless of the provider's legal status.

'We call for funding to reflect the actual cost of medical services and to adhere to the same principles, regardless of the provider. The public and private sectors must compete on the basis of quality, efficiency, and outcomes. The winner of such competition must be the patient,' concludes Cristian Hotoboc in a statement sent to AGERPRES.

Last but not least, the study also indicates that data on expenditure trends between 2023 and 2025 must be viewed in relation to the services provided and the outcomes achieved for patients. A comprehensive analysis of system performance must track not only how much each provider spends, but also the results generated by these resources.

'Waiting times, geographic access, cost relative to case complexity, quality of care, clinical outcomes, and patient experience should become indicators by which provider contributions are evaluated in a comparable and transparent manner. Real progress in healthcare is measured by better access, quality care, and patient outcomes. These must become central criteria for evaluating provider performance and the way healthcare system resources are utilized,' PALMED representatives state in the press release. AGERPRES (RO - writing by: Mariana Nica;EN - writing by: Catalin Cristian Trandafir)

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