4. Physical and human resources
n 2014, there were 527 hospitals in Romania, over two thirds of which were public. While the number of public hospitals has fallen in recent years, the number of private hospitals has seen the opposite trend. The former was mainly due to the closure of 67 poorly performing public hospitals in 2011, while the latter was largely driven by the change of payment for day surgery and day care cases in 2014. There is no officially available information regarding the condition of public hospital buildings; however, since the majority were built in the 1970s and 1980s, and have not been well maintained, it is likely that their technical condition is rather poor. Hospitals are evenly distributed across the national territory, but accessibility is limited in certain geographical areas, such as the Danube Delta and remote mountain regions, and in rural areas. The 2014–2020 Health Strategy envisages a restructuring of the regional hospital network with the goals of reducing the number of hospital facilities and providing integrated services in order to improve coordination of treatment.
The total number of hospital beds per 1000 population decreased from 7.9 in 1990 to 6.3 in 2013 (lower than the EU average of 11.7). This is in line with the government’s efforts to reduce the number of hospital beds and strengthen the role of primary care, which was recently (in 2014) reinforced by the decision to subject the reimbursement of hospital services to limits on the total number of beds in the country. The reduction in the number of beds can mainly be attributed to the decrease in numbers of acute beds; the number of psychiatric beds per 1000 population fell less than the number of acute beds, while the number of beds in nursing and elderly homes increased. The average length of hospital stay in all hospitals decreased from 11.4 days in 1990 to 6.3 days in 2013 (similar to the EU average of 6.3 days), and the bed occupancy rate increased from 68% in 1990 to 84% in 2005, decreasing to 73% in 2013 (slightly below the EU average of 77%).
Family physicians and ambulatory care specialists pioneered the use of information and communication technology (ICT) in the health sector when electronic reporting requirements were introduced in 1999. Hospitals started to use electronic reporting with the introduction of the DRG system in 2006. More recently, in 2012, electronic prescribing was introduced for all reimbursed pharmaceuticals and is currently used across the country. Since May 2015, the National Health Insurance Card has been in use, which contains patient identification data (and may contain medical data, at the patient’s request). An Electronic Health Record for patient data is currently being implemented.
Despite increasing trends, in 2013 the numbers of physicians and nurses per 100 000 people were relatively low in Romania: 248 doctors per 100 000 compared to 347 in the EU, and 581 nurses per 100 000 compared to 850 in the EU. In 2013, 23.5% of physicians specialized in family medicine, which is lower than in 2010 (29%) and at odds with efforts to strengthen the role of primary care.
The relatively low number of physicians and nurses has mainly been caused by high rates of external migration over the past decade, exacerbated by Romania’s EU accession and the economic crisis. The most common reasons for leaving the country are: lower salaries compared to non-health professions; low social status; lack of performance recognition; limited career development opportunities; and wide discrepancies between the levels of required competences and working conditions that do not enable the skills acquired to be applied in practice (for example, lack of equipment and supplies). Some measures that have been implemented in the past five years to halt the exodus of health workers (such as slight increases of wages for young doctors) have failed to make a difference. One of the negative effects of this trend is a shortage of some medical specialties and skills at the hospital level, especially in deprived regions.
4.1 Physical resources
4.1.1 Capital stock and investments
Current capital stock
In 2014, there were 527 hospitals in Romania. Of these, 366 were public hospitals (69% of the total) and 161 were private (31%) (see section 5.4 for information on the classification of public hospitals). While the number of public hospitals decreased by 15% between 2008 and 2014, the number of private hospitals increased by over four times. Overall, the total number of hospitals increased by 15% between 2008 and 2014 (National Institute of Statistics, 2015a).
The decline in the number of public hospitals was driven, mainly, by the closure, in 2011, of 67 public hospitals due to their not fulfilling certain criteria (see Table6.1) (Official Gazette, 2011). Local authorities as owners of these hospitals were recommended to transform the buildings into health care centres or nursing homes. However, since most of the buildings were in a very poor state, such transformations were deemed to be economically unviable. Following public and political pressure, many of the closed hospitals were reopened as hospitals or other health care facilities, e.g. LTC facilities, in the following years.
The largest increase in the number of private hospitals occurred from 2013 to 2014, following a change in the payment method for day surgery and day care cases in 2014 (see sections 3.7.1 and 5.4.1). The majority of new private hospitals are day care facilities that perform simple procedures. The number of private hospitals that report cases in the RO-DRG database rose from 73 in 2013 to 197 in 2014; out of these, 107 (54%) reported day cases only. The total number of hospitals reporting in the national DRG system in 2014 was 594 (197 private and 397 public). The difference between the total number of hospitals reported above and the number of hospitals reporting in the national DRG system is due to the fact that some health care facilities with beds (for example, among the health centres; see section 5.4) are not registered as hospitals but are paid like hospitals.
There is no officially available information regarding the condition of public hospital buildings. However, since the majority of public hospitals (over 90%) were built in the 1970s and 1980s (Ministry of Health, 2014) and have not been well maintained due to the scarcity of public resources, their technical condition is likely to be poor. Public hospitals are evenly distributed across the national territory, but are less easily accessible in certain geographical areas, such as the Danube Delta and remote mountain regions (see for example Ciutan & Chiriac, 2009). Almost 90% of public hospitals are located in urban areas and because transport costs can be high, accessibility in rural areas is further compromised (see section 5.1). Private hospitals are also mainly located in larger cities, in particular in the more affluent regions.
The 2014–2020 Health Strategy envisages a restructuring of the regional hospital network, which would include designation of strategic hospitals, investment in their infrastructure (this was also included in the Budgetary Strategy for 2014–2016; see section 2.8.1), and the building of seven new regional hospitals. It further envisages the transformation of local hospitals in small and medium-sized urban areas into units providing ambulatory care, day care or care for chronic patients. This would include reducing the number of hospital facilities (entire hospitals or departments within hospitals) and integrating selected facilities into new or refurbished regional hospitals, allowing for the closure of beds, streamlining of services and improvements in the coordination of treatment of complex cases requiring an integrated approach (Ministry of Health, 2014).
Investment funding into specialized care facilities is mainly covered from the budget of the Ministry of Health and the budgets of local authorities, whereas investment at the primary care level into primary care practices has to be covered by the owners of those practices. Transfers are made according to a pre-approved yearly capital investment plan, which is developed by the Ministry of Health in accordance with the strategic investment plans and with the technically documented proposals made by the health facilities. For example, in line with the infrastructure development objective of the Health Sector Strategy for 2011–2013, in 2012 the Ministry of Health spent 361.9 million lei (€81 million) on the refurbishment of eight hospital buildings, plus 152 capital repair works and one feasibility study for the building of a regional hospital. In 2013 it spent 92.5 million lei (€21 million) on the refurbishment of nine hospital buildings and 47 capital repair works (Ministry of Health, 2013).
The second largest source of capital investment funding is from the World Bank and EU structural funds. For example, the Romania Health Sector Reform Project, conducted between 2005 and 2013 with funding from the World Bank, supported the development of feasibility studies, technical analyses and architectural designs for the refurbishment of 20 hospital maternity units, as well as the renovation of emergency departments in 17 hospitals (World Bank, 2014).
Other sources of investment funding include the NHIH and public–private partnerships (P–PPs), but these play a small role. Until 2014, it was not possible to use funding received for the reimbursement of service delivery through the NHIH for capital investment purposes but the legislation around this was amended in 2014 (see section 2.8.6). However, given the low levels of public funding, not many hospitals have been able to fund capital investments from this source.
The Law on Public–Private Partnerships was issued in Romania in 2010 but P–PP initiatives have been obstructed by numerous limitations of this Law (Government of Romania, 2015) and technical problems with its implementation. For example, although the legislation provided that the selection and awarding of P–PP notices were to be published exclusively through a dedicated section of the electronic public procurement system, P–PP contracts were only included in this system in 2013. The central government and local authorities have expressed interest in using P–PPs for the building or refurbishment of hospitals and other health facilities but there are no public data on the number of partnerships that have been set up. A new draft law on P–PP was proposed in 2014 and is still under debate at the time of writing (December 2015) (for more detail, see DPIIS, 2015).
The total number of hospital beds per 1000 population decreased from 7.9 in 1990 to 6.3 in 2013 (Fig4.1). This is lower than the number of beds recorded in the majority of comparator countries, except for Bulgaria (also 6.3 in 2013), which range from 7.4 in Poland to 13.3 in Hungary, or the EU, at 11.7 (WHO Regional Office for Europe, 2016). This decreasing trend is in line with the government’s efforts to decrease the number of hospital beds and strengthen the role of primary care (see sections 5.3 and 5.4). Important reductions took place in 1992 (from 7.9 to 6.8), when excess beds were cut in departments with low occupancy rates (mainly maternity wards, following the decrease in the birth rate after the abolition of the abortion ban; see section 1.4), and in 2003 and 2010 as a means to enhance efficiency (19 912 or 12% of beds were closed in 2003 and 8266 or 6% in 2010). Additional reductions occurred in 2011 in the context of the aforementioned closure of 67 hospitals (a reduction of 3%). Policies to reduce the number of hospital beds were further enforced by Decision no. 449 of 2014 on the approval of the National Plan for Hospital Beds for 2014–2016, which made the reimbursement of hospital services by the NHIH subject to limits on the total number of beds in Romania (everything above the total number will not be paid for from the health insurance funds). These limits are: 121 579 hospital beds in 2014 (there were 125 798 beds in 2013), 120 579 in 2015 and 119 579 in 2016 (Official Gazette, 2014b).
Much of the observed decline in hospital beds was in the acute care sector, with beds falling by almost 60% between 1990 and 2013, from 7 to 4.2 per 1000 population. The 2013 figure was the same as in Slovakia and Poland (4.2 and 4.3, respectively), but higher than Hungary (4) and the EU average (3.6) and lower than the Czech Republic (4.4) and Bulgaria (5.2) (Fig4.3). The number of psychiatric beds per 1000 population fell by almost 20%, to 0.8 in 2013, which was the same as in Slovakia but higher than in Poland (0.6), Bulgaria (0.7) and the EU average (0.7) and lower than in Hungary (0.9) and the Czech Republic (1). The number of beds in nursing and elderly residential care facilities increased from 0.96 per 1000 population in 1999 to 1.3 in 2013. Comparisons with other countries are difficult due to differences in the definitions of nursing and elderly home beds (WHO Regional Office for Europe, 2016).
The ALOS in acute care hospitals was 6.3 days in 2013 (down from 6.6 days in 2009) (Fig4.2, a). This is similar to Slovakia (6.2) and the EU average (6.3) and higher than Hungary (5.2 in 2012), the Czech Republic (6.6) and Poland (6.7) (WHO Regional Office for Europe, 2016).
The bed occupancy rate increased from 68% in 1990 to 84% in 2005, but then fell to 70% in 2014 (Fig4.2, b). Some of the factors that are likely to have contributed to this decline were the introduction, in 2010, of ceilings in the Framework Contract on the number of ambulatory care consultations, which are often followed by a referral to a hospital at the request of patients, and the decrease in the number of doctors (see section 4.2). The bed occupancy rate in Romania in 2013 was higher than in Slovakia (67%) and Hungary (69% in 2012), but lower than the Czech Republic (74%) and the EU average of 77% in 2012 (WHO Regional Office for Europe, 2016).
4.1.3 Medical equipment
Medical equipment is usually funded by the Ministry of Health. It can also be financed by local authorities, from donations and from externally funded projects. Since 2014, hospitals have also been allowed to purchase medical equipment from the income they receive under health service contracts with the NHIH (see also sections 2.8.6 and 4.1.1).
There are no publicly accessible national data on the types and amount of medical equipment available in health care facilities and anecdotal evidence suggests there are large variations in the distribution of medical equipment across hospitals and geographical regions, and that the availability does not reflect the level of need.
Data that are available provide insights into aggregate numbers of medical equipment only. According to Eurostat data (Table4.1), between 2007 and 2013, the number of magnetic resonance imaging (MRI) units in Romania increased from 24 to 87 and the number of computed tomography (CT) scanners from 72 to 194. In 2013, there were 43.5 MRI units per 1000 population, which was higher than in Hungary, at 30.3, but lower than in Poland (64.4), Slovakia (66.5) and the Czech Republic (74.2). Similarly, the number of CT scanners was, at 97.1, higher than in Hungary (78.8) and lower than in the Czech Republic (150.3), Slovakia (153.3) and Poland (171.7) (Eurostat, 2016). In terms of utilization, in 2012, there were 1.7 MRI scans per 1000 population, compared to an EU average of 46.5 (the average excludes Italy and Sweden) and 13 CT scans per 1000 population compared to 98 in the EU on average (the average excludes Estonia, Italy and Sweden) (OECD, 2014a). There are no data on the number of positron emission tomography (PET) scanners in Romania.
4.1.4 Information technology
Data from the National Institute of Statistics show that, in 2014, some 54.4% of households in Romania had Internet access. Access rates are higher in urban areas (70.9%) and vary across geographic areas, from 46.1% in the south of Romania to 76.7% in Bucharest (National Institute of Statistics, 2014a). Also in 2014, 61% of Romanians reported having ever used the Internet, a figure that is low compared to the average among EU countries, at 82% (Eurostat, 2016). The share of Internet users is lower when only daily users are considered, at 32% in Romania compared to 65% in the EU (2014 data; Eurostat, 2016). Furthermore, 27% of Romanians aged between 16 and 74 used the Internet for seeking health-related information (injury, disease, nutrition, improving health, etc.) compared to an average of 44% among EU countries.
Electronic reporting requirements were first introduced in the ambulatory care sector; since 1999, family medicine physicians and ambulatory care specialists have to report to the NHIH on the services provided to their patients in order to get reimbursed. Hospitals started to use electronic reporting with the introduction of the DRG system in 2006 (see section 3.7.1). In 2008, the NHIH implemented the SIUI (see section 2.7.1), which harmonized existing electronic reporting systems. SIUI is used by all providers for the reporting of services performed under the contract with the DHIHs. It also collects data on the insured population. In 2012, electronic prescribing was introduced for all reimbursed pharmaceuticals and is currently used across the country, and on 1 May 2015 the National Health Insurance Card was established as a tool for validating service provision. The Card contains patient identification data and may contain medical data upon a patient’s request. Patients’ health records are currently kept in paper form but an electronic health record is currently being implemented within SIUI. Electronic appointment booking systems are rarely used, typically in some private ambulatory care facilities.
4.2 Human resources
4.2.1 Health workforce trends
Romania has relatively low numbers of physicians and nurses, at 248 physicians and 581 nurses per 100 000 population in 2013, compared to most comparator countries and the EU average (Fig4.4 and Fig4.5), and compared to other countries in central and south-eastern Europe (Fig4.6). This was despite a steady increase since 2000, of about 20% among physicians and just under 10% among nurses (Table4.2). The number of pharmacists and dentists almost doubled during the same period (Table4.2) and, in 2013, the number of dentists per 100 000 population was, at 67, almost the same as in the EU (67.3) (Fig4.7). The number of pharmacists remained lower, at 76.3 per 100 000 population in 2013, compared to an EU average of 82.8, although similar to Hungary (76.1) (Fig4.8). There is no information on the number of managerial staff working in the health care system.
Since 1997, all doctors have been required to undertake specialist training (see section 4.2.3) and, in 2013, 23.5% of physicians working in the Romanian health system were family medicine physicians (Table4.2). This is somewhat lower than in 2010, when family medicine physicians accounted for 29% of all practising physicians. It is difficult to be certain about how many doctors work in the ambulatory care sector compared to the hospital sector, or work in the public sector compared to the private sector. This is because doctors working in hospitals can also practise in ambulatory care settings and those working in the public sector may practise in the private sector after hours. In 2013, 49.8% of practising doctors were hospital based (WHO Regional Office for Europe, 2016).
4.2.2 Professional mobility of health workers
Over the last decade, Romania has seen a comparatively high number of the health workforce migrating abroad, although there is a lack of precise data on the number and type of health workers moving abroad. According to official statistics from receiving countries, the number of Romanian medical doctors in pre-2004 EU Member States increased from 977 in 2003 to 2433 in 2007 (the year of Romania’s EU accession) (Buchan et al., 2014). Unfortunately, there are no accurate statistics. The majority of Romanian doctors who have migrated work in Germany, Italy and the United Kingdom, and countries such as France and Belgium report Romanians to be the most numerous group among health professionals from the Member States that have joined the EU since 2004 (Buchan et al., 2014). The number of Romanian nurses in pre-2004 EU countries rose from 811 in 2003 to 8481 in 2007, with the majority located in Italy (7670 nurses) (Buchan et al., 2014). Romania’s EU accession in 2007 amplified and accelerated the trend of outward migration of doctors and nurses.
The most common reasons for leaving the country include low salaries compared to non-health professions in Romania, low levels of satisfaction with social status and lack of recognition, limited career development opportunities, and discrepancies between the level of competences required and the working conditions (equipment, access to consumables, drugs and modern diagnostic tests) (Wismar et al., 2011). As a consequence of this emigration of health care workers, there is a shortage of some medical specialties and skills at the hospital level in Romania, especially in deprived regions. Even large hospitals experience difficulties in filling vacant positions and these often remain unfilled due to their low attractiveness compared to similar jobs abroad as well as the lack of effective retention policies. Some measures that have been implemented since 2010 to halt the exodus of health workers, such an increase in wages for young doctors, have not been effective. The problem of filling vacant posts was further exacerbated by the government-imposed freeze on all new public sector recruitment introduced in 2010 in the wake of the economic crisis.
4.2.3 Training of health workers
Medical education in Romania takes six years (five years for dentists). The yearly number of medical school graduates in Romania has been stable since 2010, at around 3700 (Olsavszky et al., 2010). After graduation, physicians have to pass an exam in order to enter specialty training. The duration of specialty training is five years for most specialties but may be longer (e.g. six years for neurosurgery), while specialty training in family medicine takes three years, and public health and health management four years. From 2009, undergraduates pursuing a specialist qualification in oral and maxillofacial surgery have to obtain two licences to practise, one in medicine and one in dentistry. The length of the specialization for dentistry is five years. Historically, it was not mandatory for medical graduates who wished to practise as family medicine physicians to undertake further specialist training. However, with the introduction of family medicine as a specialty in 1997, all new graduates who wish to practise family medicine have to undertake specialist training. In 2010, there were 52 medical recognized specialties in Romania (two for dentists) (Olsavszky et al., 2010).
Nursing training takes three years in nursing schools (vocational schools) after completion of high school or four years in university colleges. Nurses can specialize in several disciplines: laboratory, public health and hygiene, balneo-physiotherapy, radiology and nutrition. Specialization takes one year.
Continuing professional development is required for both medical doctors (including dentists) and nurses. The professional associations set the educational standards and the criteria for periodical accreditation of their respective professions. Continuing professional development is validated every five years through the accumulation of a sufficient number of continuous education points. If the minimum number of points has not been achieved, the doctor or nurse must pass revalidation exams.
The Ministry of Health in Romania has extended the specialization options for nurses through Order no. 942/2017. New disciplines include: pediatrics, palliative care, psychiatry, dentistry, community care, neonatology, intensive care, pulmonology, clinical pathology, operating room, geriatrics, diabetes, oncology, nephrology, cardiology, gastroenterology, pharmacy.
Until now, nurses in Romania could specialize in fewer disciplines (laboratory, public health and hygiene, balneo-physiotherapy, radiology and nutrition) during an academic year, after the completion of high school or four years in university colleges.
The extension of the specialization programme has the purpose of increasing quality of care and facilitating the relocation of jobs, in case of need.
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4.2.4 Doctors’ career paths
The criteria for employment and professional promotion in terms of obtaining a higher professional title (e.g. senior doctor) for physicians working in the public sector are set at the national level by the Ministry of Health, which also organizes exams for the professional promotion of medical doctors. For each specialty, there are several areas in which a physician can obtain a competence (called Atestat), which relate to medical or nonmedical skills in a particular area (e.g. palliative care or management), the use of particular technologies (e.g. bronchial endoscopy) or the ability to perform particular interventions (e.g. gynaecological laparoscopic surgery). To obtain a competence, the physician must undergo training and pass an exam. To become the head of department or a ward, a physician must obtain the competence in health care services management and pass a selection process. In order to become a hospital manager, a doctor or other professional (e.g. a person with nonmedical education) must complete a course in health care management. There is little movement of doctors across public hospitals as hospitals have little influence on the establishment of new departments or changing the number of physicians, which both require approval by the Ministry of Health.
Health professionals working in public health administration at central (Ministry of Health, NHIH) or local levels (DPHAs, DHIHs) have the status of civil servants. This means they are not permitted to receive an income from other forms of employment (e.g. from practising medicine), with the exception of teaching and research. Those trained in medicine who have not practised for five years lose recognition of their professional competence by the College of Physicians.
4.2.5 Other health care workers’ career paths
The criteria for employment and the career advance of nurses are also set by the Ministry of Health, which, in collaboration with the Order of Nurses and Midwives, organizes exams for the professional promotion of nurses. For a nurse, the prerequisite for becoming a head of department or of a ward, or the care director of a hospital, is the completion of a course in hospital management.
One of the main problems faced by the Romanian health system is the shortage of human resources. Low salaries for health professionals have been identified as the main cause of this problem, especially in public hospitals. This has accelerated the migration of physicians and nurses to other EU countries, and has determined a reduced level of new entries into the system, as the medical profession is no longer attractive for young people. Due to the limited number of health professionals, some hospitals cannot provide even basic services, which implies a decrease in the level of access to health care for the population. The shortage of human resources has also had a serious impact on the quality of the provision of health services, sometimes causing tragedies (e.g. the fire burst in the intensive care unit of a maternity in Bucharest in 2010, in the absence of the only nurse which was missing from the room, and which claimed the lives of six newborns and injured other five) (Government of Romania, 2017a).
Impetus for the reform
The health professionals, through their trade unions, have put very high pressure on the government to increase incomes in the health sector by organizing protest rallies, strikes and participating in negotiation meetings with government representatives (Dumitrescu, 2017). Health professionals also have gained public support in favour of a change in the existing legislation.
Thus, in December 2017, the government issued an Emergency Ordinance to amend Law 153/2017 on the salary of staff paid from public funds (Government of Romania, 2017b). Law 153/2017 stated a gradually increase in the salary of the staff paid from public funds until 2022. The increase of staff salary in the clinical settings was in line with the Government Programme 2017-2022, where “a motivating salary package for the health professionals in order to stop the physicians’ exodus” was included as part of the government vision (Government of Romania, 2017a).
Content of the reform
The main objective of the new policy that increases health professionals’ incomes is to reduce the shortage of health personnel by decreasing the migration of health workers abroad and even encouraging health workers established out of Romania to return. To achieve the latest, that is to halt external migration and encourage Romanian health workers to return to the country, Law 153 from July 2017 on the salary of staff paid from public funds was modified in December/2017. The original Law stated a gradual increase of salary for all public employees by 2022, but the Law was amended in December 2017, raising the salary of physicians, nurses and other health workers at the level established for 2022, starting 1st of March 2018 (Government of Romania, 2017b).
Following the amended Law 153/2017, government data shows that the net salary of a young doctor has increased by 162% (from about 344 to 902 euros), and the net salary of a senior physician has increased by 131% (from 913 to 2112 euros) (Government of Romania, 2018).
It is still too early to have any assessment that might bring evidence on the effectiveness of the current policy. In any case, the Minister of Health has made public declarations concerning the interest of more and more Romanian physicians settled abroad to return home. Further, the Minister of Health recognizes that increasing salaries alone is not sufficient to tackle the shortage of health personnel, and hence, measures are currently being implemented, with the financial support from the EU structural funds, to also improve their working conditions (e.g. equipment, access to consumables, drugs and modern diagnostic tests) (Agerpres, 2018).
Agerpres (2018). Salarile mari nu rezolvă exodul medicilor - invitată Sorina Pintea [The high salaries do not solve the physicians exodus] Agerpres. Monitorizare Presa (http://files.agerpres.ro/eview.php?i=2E8E79F2E661E97630823178B700447537109004&c=194, accessed 27 July 2018)
Dumitrescu Paul (2017). Federația Sanitas continuă greva [The Sanitas Federation continues the strike] Cotidianul.ro 18 October 2017 (https://www.cotidianul.ro/federatia-sanitas-continua-protestele/, accessed 27 July 2018)
Government of Romania (2017a). Program de guvernare 2017-2020 aprobat prin Hotărârea nr.53 din 29 iunie 2017 a Parlamentului României pentru acordarea încrederii Guvernului, publicată în Monitorul Oficial al României, Partea I, Nr. 496/29.VI.2017 [Programme for Government 2017-2020 approved by the Parliament Decision no. 53/2017 for granting confidence to the Government, published in the Official Gazette of RomaniaPart I, No. 496/29.VI.2017] (http://mrp.gov.ro/web/programul-de-guvernare-2017-2020/, accessed 26 July 2018)
Government of Romania (2017b). Ordonanță de Urgență Nr. 91/2017 din 6 decembrie 2017 pentru modificarea și completarea Legii-cadru nr. 153/2017 privind salarizarea personalului plătit din fonduri publice [Emergency Ordinance No. 91/2017 from 6 December 2017 for amending and completing the Law-framework No. 153/2017 regarding the salary of staff paid from public funds] Monitorul Oficial NR. 978 din 8 decembrie 2017 [Official Gazette no. 978 from 8 December 2017]
Government of Romania (2018). Government of Romania / News / Prime Minister Viorica Dancila presented the Government's six-month stocktaking report (http://gov.ro/fisiere/stiri_fisiere/Bilant_guvernare__6_luni.pdf, accessed 27 July 2018)
One of the measures in the health policy agenda of the current government to ensure proper human resources for health is the establishment of a National Centre for Human Resources. The main roles of the Centre will be: the assessment of human resources needs, the coordination of training and the guidance in career development.
The legislation describing the organization and functioning and the tasks and responsibilities of the Centre have not been published yet. However, the Minister of Health has made a public announcement regarding the establishment of the Centre within the Ministry of Health and stressed its role in granting assistance to all Romanian doctors abroad who want to return to Romania. According to the Minister’s statement, there are already evidence that Romanian doctors working abroad may wish to return if some terms are changed, including the remuneration level.
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The National Plan for Hospital Beds for 2017–2019 has been approved by the Government Decision 115/2017. The Plan envisages a stable number of hospital beds over the coming three years, setting for each year a maximum limit of 119,579 (the value of 2016).
The expected changes related to the number of beds, in the light of the National Health Strategy 2014–2020, are: a decrease in the number of acute beds and an increase in the number of beds in long-term care, rehabilitation and palliative care, for which there is a large demand uncovered.
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