Life expectancy in Romania is among the lowest in Europe, and the Covid-19 pandemic reversed some of the gains made since 2000. The pandemic has highlighted the importance of strengthening primary care, preventive services and public health, in a health system currently heavily reliant on inpatient care.
Health workforce shortages and high out-of-pocket spending are key barriers to access. The Covid-19 pandemic stimulated the creation of several electronic information systems to manage overstretched health resources better, and these may offer avenues to future health system strengthening.
Romania’s health status
Life expectancy in Romania increased by more than four years between 2000 and 2019, but declined temporarily by 1.4 years in 2020 due to the impact of Covid-19. There is a marked gender gap, with women living almost eight years longer than men. Cardiovascular diseases are the leading causes of mortality while lung cancer is the most frequent cause of cancer death.
Risky health behaviours contribute to nearly half of all deaths. Romanians report higher alcohol consumption and unhealthier diets than the EU averages, but adult obesity is the lowest in the EU. Smoking in adults is now marginally lower than the EU average. These risk factors are more prevalent among men than women. Overweight, obesity and smoking rates among adolescents are high, and have been growing steadily over the past two decades.
Romania’s health system
Health spending in Romania increased in the last decade but remains the second lowest in the EU as a whole – both as a share of GDP and per capita. About 44% of health spending was allocated to inpatient care in 2019, which is the highest proportion among EU countries. Although the public share of health spending is high and in line with the EU average, out-of-pocket payments are above the EU average and are dominated by outpatient pharmaceutical costs.
The preventable mortality rate is the third highest in the EU and can be attributed mainly to cardiovascular disease, lung cancer and alcohol-related deaths. Mortality from treatable causes is more than double the average for the EU and includes deaths from prostate and breast cancers that are amenable to treatment.
Although self-reported unmet needs for medical examinations had declined by more than half between 2011 and 2019, a high rate of forgone care was recorded in the first year of the Covid-19 pandemic. Teleconsultations were not used as widely as in other EU countries.
Before the pandemic, Romania invested significantly in the health sector, albeit from a low base, but Covid-19 put great pressure on the system. Planning and communication for the Covid-19 vaccination campaign began early, but the rollout was delayed due to supply shortfalls. Vaccination coverage is low, largely due to vaccine hesitancy.
OECD/European Observatory on Health Systems and Policies (2021), Romania: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.