Hospital bed reform: CNAS proposes 20% cuts and a redistribution in line with reality

Reducing the number of continuous hospitalization beds in Romania is becoming a "necessary and inevitable" measure, according to the president of the National Health Insurance House (CNAS), Horaţiu-Remus Moldovan. He claims that the current system has artificially encouraged the maintenance of unused capacities, with direct effects on the financing and efficiency of the healthcare system. The statements come in the context of a government decision initiated by the Ministry of Health, which provides for a reduction of approximately 20% of hospital beds in the next three years.The head of CNAS states that the discussion is no longer about the opportunity of the reduction, but about how it will be implemented: "There are hospitals that can and even want to reduce hundreds of beds." According to him, quoted in a press release from the institution, the current system has created the wrong incentives: the number of beds influences the contractual financing ceiling, even if many units fail to fully use the funds.

• Major imbalances: excess staff vs. deficit in critical wards

The current model has generated structural dysfunctions: oversized staff in wards with low activity; resource deficit in areas with high demand; inefficient use of public funds; discrepancies between declared capacity and actual activity. To correct these problems, CNAS has requested county hospitals and public health directorates to carry out detailed analyses for each hospital.

• Objective indicators for "resetting" the system

The evaluation is based on criteria considered essential: bed occupancy; average length of hospitalization; number of discharged cases; complexity index (case-mix); capacity utilization rate; admissions/beds ratio;

personnel distribution; efficiency of fund use. According to CNAS, the beds targeted for reduction are those "constantly unoccupied", which distorts both the image and the financing of the system.

• Major deficit in palliative care

In parallel with the reduction of unused beds, CNAS signals a critical deficit in the field of palliative care: approximately 3,000 beds missing nationwide;

patients forced to stay at home without adequate medical support. The institution encourages hospitals to propose the expansion of this type of service when contracting.

The reduction of beds is part of a broader package of reforms announced by CNAS: reclassification of hospitals; inclusion of salary costs in the settled tariffs; recalculation of the weighted tariff per case; adjustment of values for discharged cases; adaptation of hospital structures to the real needs of the population.

The plan to reduce beds marks a paradigm shift in the healthcare system: from financing based on declared capacity to one focused on activity and performance. Authorities say the goal is not to close hospitals, but to eliminate inefficiencies and redirect resources to critical areas. The success of the reform will depend, however, on how the analysis from the ground is translated into concrete decisions, in a system known for its resistance to change.