CNAS: Real reform does not mean "breaking the monopoly”, but autonomy and spending money correctly

The President of the National Health Insurance House, Horaţiu-Remus Moldovan, states that the true reform of the healthcare system does not consist in abolishing the current model, but in granting real autonomy to the institution and in the efficient use of funds for patients. The statements come in the context of debates regarding the modification of the way the social health fund is administered and the introduction of private insurance houses. The head of CNAS emphasizes that the current system has a major advantage: it ensures a relatively uniform package of services for all citizens, regardless of income or health status.

According to him: the current model is a solidarity one, in which the contributions of the healthy support the sick; transferring the fund to private administration would send a dangerous signal regarding the role of the state; Romania is not in a situation of institutional collapse that would justify such a change. He warns that the introduction of multiple insurance companies, including private ones, can lead, if there are no strict regulations, to: patient selection (favoring the young and healthy); increased administrative costs; the emergence of a "two-speed healthcare”.

• The real problem: the lack of autonomy of the CNAS

Moldovan claims that the institution's autonomy is, in practice, limited. Although the CNAS is theoretically autonomous, in reality: it cannot independently establish its contracting policy; it is sometimes forced to finance inefficient hospital structures;

it cannot quickly redirect funds to modern services or prevention.

"It does not always matter what patients want, but what the Ministry of Health wants”, he says.

• What a real reform would mean

The president of the CNAS proposes a series of concrete directions: real autonomy of the institution; free contracting of services according to patients' needs; complete digitalization of the medical system; performance-based financing; transparency in hospital purchases; development of voluntary complementary insurance. He also draws attention to the fact that a significant part of the problems do not relate to the insurance model, but to the management of hospitals, especially in the area of inefficient and non-transparent procurement.