Medical Professionals on the Brink of Revolt

The snowball of dissatisfaction has started rolling through Romanian society, becoming larger and harder to stop. Doctors have begun to express their grievances more vocally. The Federative Chamber of Trade Unions of Romanian Doctors (CFSMR) commented on the new fiscal measures taken by the National Health Insurance House (CNAS) by reducing the budget for family medicine practices by 25% for 2024 compared to the previous year. Union representatives believe that the budget reduction for family medicine practices will have negative consequences for the entire healthcare system: "The Federative Chamber of Trade Unions of Romanian Doctors (CFSMR), a national medical union, supports the viewpoints of the College of Physicians of Romania (CMR) and the National Society of Family Medicine (SNMF) regarding the new fiscal measures taken by the National Health Insurance House (CNAS) by reducing the budget for family medicine practices by 25% for 2024 compared to the previous year. This new fiscal measure taken by CNAS will generate a greater influx of patients to the Emergency Units within hospitals where the costs of providing medical care are already known to be higher."

According to CFSMR, this situation is occurring in the context of a major shortage of family doctors, and by adopting the fiscal measures mentioned above, the deficit will increase and worsen: "According to SNMF data, it is revealed that 25% of family doctors are over 65 years old. In the not-too-distant future, a massive wave of retirements of family doctors is expected, which will significantly increase the aforementioned deficit. It should not be forgotten that family medicine has been underfunded for many years. Family medicine, as known, is also preventive medicine. With the situation created by CNAS, through the drastic reduction of financial resources, this important role of family medicine will also decrease. The value of a point for a consultation with a specialist doctor in the outpatient setting for 2023 was 4.5 lei, and for 2024, it will be 3.3 lei." Union representatives argue that a budget cut has also been applied by CNAS for the budget amounts allocated to the offices of specialist doctors in the outpatient setting. Here, too, the incomes of these medical offices will decrease this year, 2024, compared to the previous year, 2023: "Also, we do not agree with the measure taken by the government that, starting from January 1, 2024, Romanian employees will receive lower amounts for periods of sick leave. The Executive has decided to impose a 10% contribution, representing the percentage for the contribution to social health insurance (CASS) on sickness leave allowances. It follows that, starting from January this year, Romanian employees will receive lower amounts for periods when they are on sick leave."

Family doctors in Bucharest and Ilfov have also requested the "immediate" return to the fees for medical services established for the last quarter of 2023 and the conclusion of additional acts for the entire year 2024 at the current point values. The value of the points calculated by CNAS is as follows: for the per capita point - 7.7 lei; for the point for medical service in primary care - 6.2 lei; for the point for medical service in specialty outpatient care - 3.3 lei. The Bucharest Association of Family Doctors stated: "The publication in decision transparency at CNAS of the draft framework contract rules for 2024, proposing much lower values for family medicine and outpatient services, will immediately result in a drastic decrease in the revenues of offices after February 1, 2024. Along with the additional and burdensome fiscal changes expected in 2024, the increase in inflation, and the introduction of new control and sanction mechanisms, these will generate reductions of up to 50% in the values of our offices' invoices, which will bring primary care and specialty outpatient care to the brink of collapse." According to them, as a result of the changes, many offices will close, and the activity of those remaining will be significantly reduced to cope with expenses: "Today we are talking about the decimation of an important medical segment, by reducing the revenues of family medicine offices by half, an unprecedented decision in the history of Romania for a professional category! Recently, the Prime Minister of Romania referred to family doctors as a category lacking seriousness, thereby demonstrating not only a lack of respect for their work but also a profound ignorance of how the health system in Romania operates and the mechanisms of payment in primary healthcare, mechanisms that have been imposed on us since the beginning of the reform without any consultation. He stated that it is fair to pay better those doctors who work seriously! Meaning that services provided should take precedence over payment based on patient lists, meaning for names written on a piece of paper!"

According to the association, the doctor deficit has reached "disastrous levels," given that "over 4,000 colleagues" have left to practice their profession in other European countries: "After being transformed from professionals with liberal professions into providers of medical services, we are now publicly insulted in corpore, robbed of what belongs to us, controlled as if we were criminals, we and our collaborators, alongside whom we have worked for a lifetime, are sentenced to a decrease in revenues because the Romanian Government refuses to respect its commitments! But what is it with us, Mr. Prime Minister? Don't you want primary and outpatient healthcare in Romania anymore? Do you think that medicine is only practiced in private hospitals and clinics, and you can do without everyone else? Do you want sick citizens, actually?". At the same time, AMFB demands the "capital repair" of the unified integrated IT system, which they claim "is offline more than it works" and currently "does not correctly validate" contracted medical services.