PALMED demands withdrawal of CNAS draft, warning that new rules may delay patient treatments

The Patronage of Private Medical Service Providers (PALMED) demands the immediate withdrawal of the draft order published by the National Health Insurance House regarding the modification of the norms for the implementation of national curative health programs, claiming that it may delay patients' access to treatment and reduce their chances of survival. The organization believes that the draft does not represent a real reform of the healthcare system, but an administrative measure that limits patients' access to an important part of the existing medical infrastructure in Romania.

• Criticisms regarding the method of assessing access to treatment

PALMED representatives claim that the new methodology proposed by CNAS does not take into account essential indicators for assessing patients' real access to medical services, such as: waiting time for treatment; waiting lists; continuity of treatment; effectively available capacity of medical units; the number of patients who cannot be taken on; the impact of treatment delays on the evolution of the disease.

Instead, the project would use statistical formulas that compare the estimated need for patients with the declared capacities of public health service providers. According to the employers, such an approach ignores the concrete consequences for patients, especially for oncology patients, for whom delaying the start of treatment can decisively influence the prognosis.

• Private sector, ignored in the evaluation

PALMED states that the project treats the medical system as if the private infrastructure did not exist, although it provides a significant part of medical services in Romania. According to the data presented by the organization, private providers represent: approximately 78.5% of the providers of specialized clinical services; approximately 82.89% of the providers of paraclinical and imaging services; approximately 89% of dialysis services;

88% of the activity of the National Oncology Program for drug treatment;

82% of the National Oncology Program's activity for radiotherapy; approximately 43% of the medical staff in Romania. The organization emphasizes that the private sector has made investments of hundreds of millions of euros in hospitals, laboratories, oncology centers and modern medical equipment in recent years.

• Invoking OECD standards

PALMED draws attention to the fact that Romania is in the final stage of the accession process to the Organization for Economic Cooperation and Development and that health policies should be oriented towards results and patient experience. In the organization's opinion, the CNAS project does not contain indicators that measure the real patient experience or mechanisms for assessing the impact on access to treatment.

The employers' association demands: the withdrawal of the draft order from the decision-making transparency procedure;

the establishment of a working group with the participation of all relevant actors in the healthcare system; the performance of an independent impact analysis; the development of a methodology that reflects the real access of patients to medical services; full use of existing capacities of the health system, regardless of whether they belong to the public or private sector.

• CNAS position

On May 30, the National Health Insurance House announced the publication in decisional transparency of the draft order, claiming that it introduces an "objective and transparent” formula for assessing situations in which the capacity of public providers is exceeded within the framework of national health programs. The debate occurs in a sensitive context for the Romanian health system, in which the authorities are trying to optimize the use of public funds, and private providers are calling for a more efficient integration of existing capacities to reduce waiting times and increase patients' access to treatment.