The Romanian health care system is managed almost entirely by the State and Ministry of Health, but there are also private practices and private hospitals which work by their own rules and practices. There are different National Programs for different diseases which are coordinated by the Health Insurance Institute. They reimburse different medical procedures and treatments to State hospitals, other public medical facilities and private practices that have a partnership with the Health Insurance Institute. The medical system is dived into state and private, meaning that if you are insured (you are working or you are in the unemployment period which is, by law, maximum 1 year) you can go to a public hospital or a private practice and can receive free treatment and different analysis covered by the Health Insurance Institute.

Normally, each person would need to have some kind of health insurance. Employees, by their working status, they are insured and they have to pay to the Health Insurance institute 5.5 % from their salary. Their employer pays the amount of 5.2 % of the employees’ salary to the same institute. Children (until the age of 18), those who are studying (until the age of 26), those who don’t work but are financed by a working family member, pregnant women and retirees are automatically insured and can benefit of all free medical treatments and procedures. There is also the possibility of a private insurance but this is not something very common in Romania. Those who are not insured, if they need any medical care, will have to pay the entire cost of a consult/treatment, even if they are going to a State Hospital. The list of reimbursed procedures, treatments, analysis and medical care facilities are decided by the Health Insurance Institute.

What happens if you need to see a doctor?
There are different procedures if you want to see a doctor. First of all, each person needs to have a general doctor (a family doctor). Everyone can choose his doctor and stick to him/her. Of course, the general doctor can be changed and your medical file is transferred to another doctor. If you need a general consult, you just go to your doctor and he will evaluate you. If he considers that you need a specialist, than he will write a recommendation letter and send you to a specialist. With the letter from your doctor you can go to any specialist who has a partnership with the Health Insurance Institute and the consult is free. If you don’t have insurance, or you don’t want to go to a public hospital, then you are free to go to any specialist and you will be charged for your consult. If you have a chronic disease, then you don’t need the recommendation of your general doctor to see the specialist who is taking care of you, so you just need to make an appointment, and the consult is free. If you need a prescription, you can have it from any doctor and you can go to any pharmacy. Not all medication is free, not even for chronic diseases. The copayment depends on the medication and it can be from 5% to 100%.

Who decides what a doctor can prescribe?
In Romania, the list of medication is managed by the Health Insurance Institute. Every year, they decide which medication is free and which needs to be paid for and how much it will cost.

Practically, what is it like with type 1 diabetes in Romania?
In Romania we have a National Diabetes Program which has different aspects. For all people with diabetes, regardless their age, the insulin and medication for diabetes are free. Regarding test strips, children (by the age of 18) receive 100 test strips per month. Once you are 18 if you are on insulin treatment, regardless the type of diabetes, you receive 100 test strips every 3 months. If you need more test strips (and normally you do) you have to pay its entire price (approx. 15 Euro/50 strips). Insulin pumps are covered by the program but in order to receive an insulin pump it might take up to one year, and the number of insulin pump users in Romania is very low. Once you have an insulin pump, you receive all materials needed (infusion set, syringes) for free.

In Romania different types of insulin are available, so a doctor will decide which one is more suitable for his patient. There are not any CGMs available in Romania; you can’t even buy a CGM device from anywhere in Romania. You receive insulin pens, needles (but less than you need) for free. Diabetes specialists are available in most every region and if there are not any serious problems, you will have an appointment every 3 months if you are type 1 or type 2 on insulin. In some regions, there are diabetes hospitals and you can be admitted to hospital and have a set of analysis for free and also a consult for diabetes complications for free. Recently, we have the first podiatry clinic which is a private one, but there are a lot of services there which are covered by the Health Insurance Institute.

What about getting admitted to hospital?
If you have an emergency, you are free to go to the nearest hospital where they will help you immediately. In big cities there is an emergency hospital where you go. After they give you the ambulatory treatment you are either hospitalized in their sector or they send you to another hospital, depending on the gravity of your emergency. Rescue cars are available under the number 112. If you have any medical problems but it is not an emergency, you need to receive a recommendation letter from your general doctor for hospitalization and then you need to make an appointment at the hospital. During your stay at the hospital, you can benefit of free services (analysis, investigations and treatment) but sometimes you may need to pay for different medication you need which is not available in the hospital and also for some investigation procedures which are not covered by the Health Insurance Institute. You can be admitted to the same hospital 4 times per year, unless there are any significant problems.

How does diabetes care vary throughout the country?
Unfortunately, diabetes care varies in different country regions. The National Diabetes Program is the same for the entire country but there is a difference in the number of specialists, facilities for people with diabetes, and access to diabetes education. In big cities, regional diabetes programs are more developed and focused on more aspects of diabetes care. In small cities there are only 1 or 2 diabetes specialists and in rural areas, there are not any diabetes specialists so people with diabetes go to the nearest city for a consult. Sometimes they are treated only by their general doctor. The main problem regarding diabetes in rural areas is the lack of education and the lack of of being in touch with a diabetes specialist. This can cause complications for people with diabetes from these areas.

A big thank you to the wonderful Cristina Petrut in Romania for helping provide this information.