Metastatic prostate cancer survivor stories. Perpetual transitions in Romanian healthcare

Corresponding author.

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Received Nov 24; Accepted Nov Abstract Although Romania has a long-lasting tradition in organized medical healthcare, in the last two decades the Romanian healthcare system has been undergoing a perpetual transition with negative effects on all parties involved. There should be no wonder then, that predictive and preventive services do not get the proper attention and support.

Patient and physicians should step in and take action in regulating a system that was originally designed for them. But until this happens, the organizations with leadership skills and vision need to take action—and this has already started. Keywords: Healthcare system, Predictive diagnostics Prevention, Personalized medicine, Brain aging, Public health Historical context Romania has a long-lasting tradition in organized medical healthcare.

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The first legal provisions for social solidarity were enforced in Mining Actfurther developed in the Labor Act. The first compulsory insurances for accidents, diseases and retirement were enacted as early as —being deemed at that time as one of cu ce medicament naturist se trateaza incontinenta urinara most modern laws in Europe in this field. The initial healthcare system was first established between the two world wars and originated in the social security system initially designed by 2nd Reich Chancellor Otto von Bismarck in The contributions were proportional with the incomes gained and were equally supported by employers and employees.

Pancreatic cancer targeted therapy Cancerul pancreatic Cancer pancreatic studies type of cancer has a high mortality, and the overall survival is also low.

The Health Act enacted the initial transition towards a Semashko health insurance system. This model involved publicly funded, centralized and integrated health systems with universal or close to universal entitlement to free healthcare.

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The Semashko model placed an emphasis on in-patient and specialist care and on wide-scale public health interventions. The burden of financing the health system was evenly distributed across the population, there were few financial barriers to accessing services and geographical coverage was excellent. From to Romania experienced a dramatic fall in early mortality and enjoyed better health outcomes than other countries with a similar level of average income.

Major achievements included successes in controlling vaccine-preventable diseases, tuberculosis, leprosy and schistosomiasis, and the eradication of malaria.

However, the management of the healthcare system was strictly centralized and rigid. The Government held complete monopoly over all healthcare services; no private medical care was allowed the private-owned medical facilities were all abolished and all health professionals were state-employed public servants.

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Although several amendments were brought to the initial law, a new Health Act was passed only in Further on, in was legislated that certain service costs had to be supported by patients; however all medical care was still provided in state-owned medical facilities.

Investment decisions were politicized and often inefficient, leading, for instance, to an over-reliance on curative, in-patient and specialist care at the expense of health promotion, disease prevention and primary care [ 1 ].

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Some negative aspects derived from that system still bear a negative burden upon the current health insurance system: A relatively low share of the GDP is still granted for healthcare services for only a 3.

In the first years metastatic prostate cancer survivor stories the fall of the communist regime — a dual financing system was implemented; namely, funds originated from state budget as well as from additional sources i. The Social Health Insurance Act was first passed in but was still tributary to the Bismarck model. Health insurance contributions were compulsory, thus enforcing social solidarity in a newly emerging decentralized system.

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Following a 1-year transition, the NHIH started administering health funds ; the NHIH was an autonomous public institution led by representatives of the insured population employees and employers organized in administration boards.

The Social Health Insurance Act brought further improvements: entire population had to be covered in a consolidated national social protection system; this Act legislated for the first time that each citizen was free to address any medical facility i.

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This Act also featured the first predefined package of medical services as set forth in the healthcare framework contract. Further reforms were brought by the Act, which actually reunites some of the beneficial features of the inter-war healthcare insurance system with the routine and bureaucracy of communist social and healthcare administration. Primary healthcare services are still of a relatively poor quality; high bureaucracy as well as incoherent investigation and drug prescription limitations, all of these targeting especially the family physicians resulted in an ineffective management of referrals to in-hospital care and in overrated in-hospital services albeit diagnostic or curative.

Furthermore, high-end equipment and medication supplies are occasionally scarce, especially in disadvantaged geographic enclosures.

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Hospital care is currently characterized by discrepancies between the number of hospital beds and the staff assigned to provide in-hospital healthcare services; occasionally hospital capacity gets exceeded by patient inflow. Current challenges Amongst the negative aspects in this newly emerging hybrid healthcare system we noted that it still bears the main stigmata of Bismarck-derived health systems: healthcare professionals have no power in influencing that is, fine-tuning the system.

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For instance, the RCoP only plays a consultant role in the yearly negotiations of the healthcare framework contract, the leading players remaining the MoH and the NHIH.

The latest shifts in MoH policies aim at giving up the centralized MoH management of hospitals in favor of local administration.

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However, the leaders of the RCoP officials criticize the decentralization process, since it seems to target mainly dysfunctional hospitals understaffed, underequipped, with huge debts and heavily relying on public funds. Even if this decision would bring such hospitals closer to the communities they serve, making them perhaps more receptive to specific community needs and requirements, the Chairman of the RCoP fears the worst, given the ongoing financial crisis.

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Moreover, his criticisms also target the politicization of the healthcare system. Another critical challenge resides in the fact that throughout Romania the healthcare facilities use local initiatives and voluntary quality assurance mechanisms instead of national quality or safety legislation.

Although clinical practice guidelines are commonly regarded as an accessible tool for improving quality, reducing disparities in clinical practice and improving patient safety and in spite of aggressively emerging malpractice legislation, Romania is just beginning to introduce practice guidelines. Thus, the MoH website presented only 12 clinical practice guidelines, dedicated to stroke, angina pectoris, acute coronary syndromes, myocardial infarction, hypertension, chronic lung disease, chronic obstructive pulmonary disease, cervical cancer, breast cancer, prostate cancer, colorectal carcinoma and diabetes care.

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No currently MoH-approved guidelines address primary, preventive or family care. Healthcare personnel issues The inadequately low payment levels in the healthcare system resulted in a decreased motivation of the medical professionals and tratamentul la primele simptome ale prostatitei led to: proliferation of informal payments, dual working and a brain drain to other professions, other countries or the private sector.

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Average yearly wages for young specialists-in-training range from 2, to 4, EUR, while the average yearly wages for a specialist is around 4, Metastatic prostate cancer survivor stories mass media estimates. According to the official labor cost survey, the average monthly gross earnings for health and social care reached about EUR [ 2 ]. Given the accession of Romania to the European Union and therefore the mandatory alignment of Romanian legislation to EU practices, the Romanian healthcare system currently faces metastatic prostate cancer survivor stories never-before encountered challenge: the migration of healthcare professionals towards more financially secure locations in the EU.

Vasile AstarastoaieRomania should probably declare a red alert code due to metastatic prostate cancer survivor stories staff migration. Mass media estimates point to an alarmingly high 5, physicians leaving to work abroad 1, in2, in and 1, in In consequence, the vacancies rate in the first metastatic prostate cancer survivor stories of mid-quarter was 0.

The highest vacancy rates among all the economic sectors, in the first quarter of were registered in social insurance of public sector 1. Table 1 An overview of medical coverage in Romania end-year number of items [ 2 ]