Over the past two decades, Romania’s health system has made notable progress, reflected in increased life expectancy and significant reductions in infant and maternal mortality. Despite this progress, performance remains low relative to OECD countries in several areas, including health risk factors, access to healthcare, quality of services, healthcare capacity and financing. In response, Romania has implemented reforms to strengthen system efficiency and resilience, from enhancing health budgeting, to increasing remuneration for healthcare professionals, and the introduction of performance-based payment models. Persistent challenges remain to be addressed, notably in addressing wasteful health spending, workforce shortages, corruption, inefficiencies in primary and community healthcare, inadequate access to services, and fragmented health data systems. This review highlights Romania’s ongoing efforts to improve sustainability, efficiency, quality, access, and resilience, providing policymakers and stakeholders with evidence-based insights to guide future reforms.
OECD Reviews of Health Systems: Romania 2025
Abstract
Executive summary
Over the past two decades, life expectancy in Romania has increased by more than 5 years, reaching 76.4 years in 2023, while infant and maternal mortality have decreased. Despite this progress, health outcomes and performance remain relatively low compared to OECD countries, as reflected in OECD indicators on health status, risk factors for health, access, quality of care, and healthcare capacity and resources. Avoidable mortality in Romania is one of the highest compared to OECD countries, signalling persistent challenges in public health policies and in the healthcare system.
Conscious of these challenges, Romania has recently adopted a strategic vision for a more efficient and resilient health system, particularly with the National Health Strategy 2023-2030. The country has led key reforms aiming to address issues of fiscal sustainability, shortages in health professionals, and deficiencies in quality and safety. First, to streamline public spending on healthcare, Romania performed a health spending review in 2023 that served to draft the 2024 budget proposal. To enhance financial sustainability, Romania is phasing out contribution exemptions for certain workers, and it is expected to expand the National Health Insurance Fund’s contributor base. Second, to address the significant health workforce emigration, Romania has substantially increased the salaries of health professionals working in the public hospital sector. Third, Romania is fostering patient-centred care and safely through the National Authority for Quality Management in Healthcare and greater patient engagement, but further steps are needed to ensure continuous quality improvement and extend focus beyond hospitals.
Despite these recent policy developments, Romania faces important challenges that need to be addressed. This review identifies three main broad areas for improvement.
First, Romania should step up efforts to improve health system efficiency, including cutting wasteful spending and addressing corruption and bribery. Indicators point to inefficiencies in Romania’s health system: avoidable hospital admissions are above the OECD average (569 vs. 473 per 100 000 population), antibiotic prescriptions are among the highest (26 defined daily doses per 1 000 inhabitants vs. 16 in the OECD average), and informal payments to doctors are estimated to be three times the EU average (9% vs. 3%). Romania needs to intensify efforts to reduce wasteful spending and improve efficiency, by limiting unnecessary hospital use, improving care quality and continuity, promoting value‑based prescribing, and developing health technology assessments to update the public benefits package. To address corruption and bribery, Romania has taken recent measures, including raising doctors’ salaries, improving awareness among medical staff and patients, implementing a patient feedback system in public hospitals, and providing integrity-related training. Yet, better co‑ordination, strengthened institutional capacity and sustained political high-level commitment are needed to ensure the full adoption of the National Anti-Corruption Strategy measures in the health sector.
Second, Romania should further strengthen primary care and prevention and leverage health data use, to achieve its objective for a more efficient, people‑centred and resilient health system. The healthcare system remains hospital-centred, with hospital bed rate above the OECD average (7.3 versus 4.2 hospital beds per 1 000 inhabitants), and hospital services accounting for 44% of health spending (vs. 39% in the OECD average), while primary care accounts for just 9% (vs. 14%) in 2023. A shift toward primary and community-based care is needed, including transferring hospital beds to day care and long-term care in regions identified in the Regional Health Services Masterplans, strengthening gatekeeping, and collaborating with health professionals and patients to ensure appropriate service use. Primary and secondary prevention must be strengthened. Preventable mortality and behavioural risk factors – tobacco, alcohol, overweight and obesity – exceed OECD averages. While screening and preventive activities are incentivised (e.g. the “riskogramme”), broader strategies addressing the social determinants of health through education, regulation and fiscal measures, are needed. Secondary prevention, such as cancer screening, is limited by the lack of nationwide population-based programmes. Romania is working on pilot population-based screenings, developing a national cancer registry, and using mobile caravans and health mediators to reach underserved populations. But additional funding is necessary to procure more diagnostic and treatment equipment and to train specialised staff for diagnosis. To strengthen crisis preparedness and response, which was highly challenged during the COVID‑19 pandemic, Romania is improving emergency co‑ordination, upgrading laboratory infrastructure, and implementing a National Strategy for Disaster Risk Reduction 2023-2035 to improve resilience to health and natural shocks.
Mental health disorders, the second leading cause of years lived with disability in Romania, remain underdiagnosed due to stigma and limited access. The mental health system relies heavily on institutional care and pharmacotherapy, while unmet needs for mental healthcare are comparatively high. While a 2024-2029 action plan aims to improve psychiatric hospital conditions and ensure dignity in care, a broader national mental health strategy, supported by adequate resources and political commitment, is needed to address mental health through a whole‑of-society approach.
Health data remain fragmented and underused for research and public interest purposes. Electronic health records exist but their usage is limited to administrative and accounting purposes. Romania is currently working on a National Digital Health Strategy to improve the potential for health data use. The strategy will aim to improve data integration, governance, and interoperability, establish a National Agency for Digital Health for data management, and expand telemedicine.
Third, Romania should improve access to healthcare. Unmet needs for healthcare in Romania are high compared to European countries, mainly due to low population coverage and high cost-sharing for certain services. Workforce shortages and uneven regional distribution further restrict access. While recent salary increases curbed doctor migration to some extent, further efforts are needed to improve working conditions. Expanding community nursing and adopting task-sharing models could help relieve pressure particularly in rural areas, especially if paired with local government support for housing and education incentives. Telemedicine, introduced during the pandemic, has the potential to widen access, but the absence of a secure national platform limits its reach. Greater digitalisation could also help attract physicians to underserved regions. As a significant step forward in the development of a strategic vision for workforce planning and retention, the government launched the Multi-Annual Health Workforce Development Strategy 2022-2030.
