Romania

Both the Ministry of Health and the NHIH have local level representation through district public health authorities (DPHAs) and district health insurance houses (DHIHs). Health care services are delivered in 41 districts (judet) and Bucharest in line with centrally determined rules. DHIHs buy services from health care providers (GPs, specialist practices, laboratories, hospitals, home care providers, etc.) at local level; moreover, health care providers might be paid by the Ministry of Health under national Health Programmes.  

The Romanian health system is financed from four main sources: national health insurance funds, the state budget, local budgets, and out-of-pocket (OOP) payments. The contribution of VHI is marginal. OOP payments consist mainly of direct payments for services offered by private providers and co-payments for medicines and other services. Informal payments are not visible in the statistics, but their share may be considerable. 

Primary care is provided by family medicine physicians, mainly in solo practices, under contracts with the DHIHs. Family medicine physicians have a gatekeeping role, although direct access to a specialist is possible for specific conditions. Specialized ambulatory care is provided through a network of hospital outpatient departments and polyclinics, specialized medical centres, centres for diagnosis and treatment, and individual specialist physician offices under contract with the DHIHs. Inpatient care is provided by a large hospital network, with hospitals varying in terms of size, competencies, and catchment areas. Similar to primary care, the accessibility of ambulatory specialized care and inpatient care is poorer in rural areas compared to urban areas.