This chapter provides an overview of Romania’s health system, examining its performance, recent policy reforms, and opportunities to enhance efficiency, transparency and data-driven policymaking. The first section analyses the health status and healthcare needs of the Romanian population, addressing both physical and mental health conditions. The second section explores the structure and governance of the health system, outlining key challenges and policy efforts aimed at strengthening primary and community healthcare and addressing corruption and bribery in the health sector. The third section examines the health data infrastructure and governance supporting healthcare delivery, highlighting challenges such as data fragmentation, limited interoperability and underuse of health data for research and public interest purposes.
OECD Reviews of Health Systems: Romania 2025
Abstract
2.1.1. Life expectancy in Romania has progressed over the past two decades, but it is still relatively low compared to OECD countries
Over the last two decades, life expectancy in Romania has increased remarkably by 5.4 years from 71.0 in 2003 to 76.4 years in 2023, reaching 80.4 years for women and 72.6 years for men. During the COVID‑19 pandemic, life expectancy fell more than the OECD average (reduction by 2.8 years versus 0.7 years between 2019 and 2021), which partly wiped out the gains in life expectancy from the previous decades. But life expectancy started to bounce back in 2022 and improved further in the following years. Despite the post-pandemic improvement, life expectancy in Romania remains relatively low compared to the OECD average (81.1), but close to the average (79.0) of five European OECD countries with comparable income level in the same region1 (Czechia, Hungary, Poland, the Slovak Republic and Slovenia, “neighbouring EU5” hereafter) (Figure 2.1). The difference was greater than seven years compared to top performing countries, Switzerland and Japan.
Note: Data refer to 2023 or the nearest year available. 1. 2024 data. 2. 2022 data. The top-right graph shows the trend of life expectancy in Romania over time.
Source: OECD Health Statistics 2025.
2.1.2. Romania’s population has declined considerably in the past decades, compounded with the ageing population
Romania’s population has been declining for more than a decade, though recent trends show signs of stabilisation. Since Romania’s accession to the European Union (EU) in 2007, the population decreased by 10%, from 21.1 million to just above 19 million in 2024. However, this decline has slowed since 2022 due to lower emigration, increased immigration following Russia’s war of aggression against Ukraine, and relatively high fertility rates. Romania’s fertility rate, which had declined consistently through the 2000s, rebounded to 1.8 in 2017 and remained stable until 2022, before dropping to 1.5 in 2023 – still the fifth highest in the EU (Eurostat, 2025[1]). Yet even these relatively high fertility rates have been insufficient to offset overall population loss.
The elderly population has been on the rise, with the share of people aged 65 and over increasing from 16.3% in 2013 to 19.7% in 2023. This is projected to increase further to 30.6% by 2050 (Eurostat, 2023[2]). As more people live longer, the burden of chronic diseases and the demand for long-term care (LTC) will rise. The population size is also expected to decline in the next ten years, although at a slower rate, reaching around 18.1 million by 2030. Like many OECD countries, Romania needs to adapt the health system to the needs of its ageing population, while ensuring the fiscal sustainability of the health system. The declining population poses a risk to the financial stability, as the pool of tax revenues may potentially shrink.
In 2023, more than half (54%) of the Romanian population were living in rural areas, where access to healthcare and basic needs is reportedly more limited than in urban areas (OECD, 2025[3]). The country is large with hard-to-reach areas where geographical and meteorological constraints in winter hamper timely and effective interventions. This underserved population includes the Roma communities – the largest minority group in Europe – that represent about 9% of the total population, and they are primarily located in rural and underserved regions (OECD, 2022[4]). Limited access to care in rural regions and by vulnerable populations are one of the longstanding issues encountered in the Romanian healthcare, which the country aims to address mainly through improving logistic and workforce capacity (see Section 4.2 in Chapter 4).
2.1.3. Romania has made progress in maternal and infant mortality over the past two decades, but there is still room for improvement
Maternal deaths during pregnancy or childbirth in Romania have seen an improvement in the past decades. Maternal mortality rate fell (by about 40%) from 29.0 deaths per 100 000 live births in 2001‑2003 to 17.1 deaths in 2011‑2013, and then stabilising at 17.2 in 2021‑2023. Yet, it remains above the OECD average and more than three times higher than the neighbouring EU5 average (Figure 2.2 Panel A). Likewise, infant mortality has seen a substantial decline (by 68%) over the last decades but remains significantly above the OECD average. Infant mortality rate dropped from 17.5 deaths per 1 000 live births in 2001‑2003 to 9.1 deaths in 2011‑2013, down to 5.5 deaths in 2021‑2023 (Figure 2.2 Panel B).
High infant and maternal mortality rates partly reflect issues with access to effective primary care and emergency care, particularly in hard-to-reach areas that suffer from geographical and meteorological constraints. In some regions, adverse weather conditions in winter cause delays in response time, as access to emergency care is only possible by emergency helicopter, ultimately leading to high infant mortality rates (AHEAD, 2022[5]). Romania is currently investing in new neonatal intensive care units and modernising existing ones to curb high infant mortality rates. With the National Recovery and Resilience Plan (NRRP) funding, the country will purchase equipment for 12 mobile neonatal intensive care units, 200 current and additional beds, and establish eight regional training centres for critical neonatal patients. However, the country needs to complement these strategies by improving access to emergency care, particularly with ambulance services in regions where geographical and meteorological constraints hamper effective and timely intervention. In addition, reproductive health programmes and services, prenatal education, pregnancy monitoring and early child development must be improved.
Notes: For Panel A: 1. Latest data from 2020‑2022. 2. Latest data from 2018-2020. For Panel B: 1. Latest data for 2018‑2022 2. Latest data for 2019‑2021. 3. Latest data for 2020‑2022.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en.
2.1.4. The leading causes of death are cardiovascular diseases and cancer
Ischaemic heart diseases were the leading cause of mortality in 2022 and represented about 19% of all mortality cases (OECD/European Observatory on Health Systems and Policies, 2025[7]). This was followed by cancer (17%) and stroke (13%). Lung cancer was the most frequent cause of mortality among cancer sites (see Section 3.2 in Chapter 3). Mortality due to ischaemic and cerebrovascular diseases was comparably higher than in most OECD countries, signalling issues in acute care provision and intervention (Figure 2.3).
1. 2022 data. 2. 2021 data.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en.
To address the persistent gaps in cardiovascular outcomes, the government adopted the 2024‑2030 National Strategy to Fight Cardiovascular and Cerebrovascular Diseases, which prioritises prevention, early detection, and improved care pathways. Recent policy steps, such as the adoption of the Stroke Action Plan for Europe and expansion of the national acute stroke programme (including a new interventional registry), aim to streamline emergency pathways and improve referral to rehabilitation services, but their impact remains to be seen.
2.1.5. High avoidable mortality and associated risk factors call for better health infrastructure and public health policies
Romania has one of the highest rates of avoidable mortality compared to OECD countries, signalling persistent challenges in public health and the healthcare system. Mortality from preventable causes – which can be avoided through effective public health and primary prevention strategies – was equal to 251 deaths per 100 000 population, above the OECD average of 145 deaths and the neighbouring EU5 average of 179 deaths (Figure 2.4 Panel A). Similarly, mortality from treatable causes – which can be avoided through healthcare interventions, including screening and treatment – was the highest among OECD countries, with 179 deaths per 100 000 population (Figure 2.4 Panel B). This clearly highlights that there is room for improving the effectiveness and timeliness of healthcare delivery. Romania aims to address these deficiencies by modernising the outdated healthcare infrastructure and by investing in medical equipment and upgrading healthcare facilities through NRRP (see Section 2.2).
Note: For Panel A: 1. 2020 data. 2. 2021 data. 3. 2020 data. For Panel B: 1. 2022 data. 2. 2021 data. 3. 2020 data.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en, based on WHO Mortality Database.
In 2021, 29% all mortality in Romania was attributable to behavioural risk factors such as dietary risks, physical inactivity, smoking and alcohol consumption. Dietary risks accounted for 16% of all deaths and exceeded the OECD average (10%), reflecting poor diet habits in the country (OECD/European Observatory on Health Systems and Policies, 2025[7]). The share of adult Romanians consuming at least five portions of fruit and vegetables per day is among the lowest compared to OECD countries, with only around 40%. Similarly, only one in five Romanians engaged in physical activity more than three times per week, among the lowest in EU countries.
In 2019 (latest year with available data), more than two‑thirds (67%) of Romanian adults were considered overweight or obese, compared to the OECD average of 54%. Adolescent overweight rates were also higher than in OECD countries, with one in four 15‑year‑olds reporting being overweight or obesity in 2022. To address poor diet habits in both general and young populations, the government has recently taken measures such as implementing taxation on sugar drinks and banning the sale of food products high in fat, salt and sugar in schools and nearby premises. In addition, family physicians are encouraged to provide individuals, both insured and uninsured, with annual preventive consultations, but uptake has been under the desired level (see discussion on riskogramme at the end of this section).
Tobacco smoking was responsible for 9% of all deaths in 2021, which was on par with the OECD average (10%) (Institute for Health Metrics and Evaluation, 2024[8]). Adult smoking rates in Romania (18.7% in 2019 – latest data available) were slightly lower than the average of neighbouring EU5 countries (19.3%), but well above the OECD average (14.8%) (Figure 2.5). The differences in smoking between men and women are significant, with men smoking around four times more than women. To control and reduce the use of tobacco products, Romania has taken important steps against smoking in the last ten years, including a total smoking ban in closed places, prohibition of advertising of tobacco and electronic cigarettes, and adding health warnings on smoking packs. However, the country does not require plain packaging for tobacco products, and the tax share of tobacco in 2022 was below the level recommended by the Word Health Organization (WHO) (Tobacconomics, 2022[9]). As a fiscal measure, the government has also implemented a three‑year gradual tax increase on tobacco products, over the period 2024-2026. Adolescent smoking has not changed between 2014 and 2022, with almost 23% of the 15‑year‑olds reporting having smoked at least once in the last 30 days. Yet, one in four 15‑year‑olds used e‑cigarettes or vapes in 2022, one of the highest shares among European OECD countries (OECD/European Observatory on Health Systems and Policies, 2025[7]). In 2024, the government extended existing tobacco control measures by banning the sale of e‑cigarettes, nicotine pouches, and heated tobacco products to individuals under the age of 18.
Note: Data refer to 2023 or nearest year. 1. Latest data from 2019. 2. Latest data from 2020‑2022. 3. Latest data from 2024.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en.
Alcohol use was responsible for 5% of all deaths in Romania in 2021, higher than the OECD average (3%) (Institute for Health Metrics and Evaluation, 2024[8]). In 2023, Romanian adults consumed 12.3 litres (equivalent of pure alcohol) per capita on average, which was higher than the countries in the same region, such as Czechia (11.2), Hungary (10.3) and Poland (10.0), and substantially higher than the OECD average (8.5 litres) (Figure 2.6). Alcohol consumption has been on the rise over the last decade, increasing by 30% between 2013 and 2023. The increase was particularly pronounced after the pandemic, with consumption increasing by 2 litres between 2020 and 2023. Romania also displayed high level of harmful patterns of drinking such as heavy episodic drinking (defined as drinking more than six standard drinks within a session). In 2019, 11% of the Romanian population reported heavy episodic drinking at least once a week, the highest proportion across OECD countries. Heavy episodic drinking was almost eight‑fold more common among men than women (20% vs. 3%) (Eurostat, 2024[10]).
Note: Data refer to 2023 or nearest year. 1. Latest data from 2022. 2. Latest data from 2024.
Source: OECD Health Statistics 2025.
Romania lacks a strong alcohol policy. The country has no national strategy in place to reduce harmful alcohol use and has so far only implemented a limited set of measures, such as alcohol excise taxes, regulations on alcohol advertising and sponsorship, and – more recently in 2024 – a ban on alcohol sales to those under 18. While brief interventions by family doctors and zero-tolerance rules for drink-driving are also in place, there are important gaps in the policy landscape given the alcohol-related burden in the country. For instance, alcohol can be purchased in petrol stations. To strengthen its alcohol policy and improve population health, Romania should envisage to undertake further actions recognised as effective and cost-effective (OECD, 2021[11]). Potential areas include applying fiscal measures (e.g. minimum unit pricing), strengthening penalties against drink-driving to reduce car crashes and injuries, regulating alcohol availability (e.g. petrol stations), strengthening marketing targeting children (for instance on social media), and improving the implementation of screening and counselling within primary care services for people who drink heavily.
2.1.6. Romania has been increasingly embarking on public health and prevention, but actions fall short of the ambitions
Romania has been placing more focus on public health and prevention strategies through national plans and projects in the recent years. The national public health programmes established and funded by the Ministry of Health organise a range of activities concerning the prevention of common non-communicable diseases (NCDs) such as cardiovascular diseases and diabetes. The National Institute of Public Health plays a central role in co‑ordinating population-level prevention activities and supporting national health strategy implementation. It regularly conducts health promotion campaigns to raise awareness and improve health literacy on key behavioural risk factors such as obesity, alcohol and tobacco use, and physical inactivity. However, these efforts often fail to reach rural and remote communities. In 2020, the Institute launched a cardiovascular risk screening programme – financed by the European Social Fund – to introduce complex CVD risk assessments at the primary care level, including for vulnerable groups. The same year, the Institute also initiated the “PDP1” project in collaboration with the WHO and Norway, which focussed on strengthening preventive care at the community level. The project’s outcomes included regional health needs assessments, the development of community care guidelines, and the creation of training tools for doctors, community nurses, and health mediators (The National Institute of Public Health, 2023[12]).
As part of Romania’s NRRP commitments, a new contractual framework has been developed to introduce a pay-for-performance (P4P) scheme and reform primary care remuneration. Negotiated between the National Health Insurance House, the Ministry of Health, and key stakeholders, the framework prioritises preventive services by offering higher reimbursement rates compared to curative care. A central feature is the “riskogramme” – a screening questionnaire for adults that was rolled out more prominently in 2024. The riskogramme enables primary care physicians to assess patients aged 40 and over for a range of diseases and risk factors, including cardiovascular disease, cancer, diabetes, kidney disease, high cholesterol, alcohol and tobacco use. Primary care doctors performing an annual riskogramme to patients aged 40 and over started receiving P4P payments as of 2025. However, uptake has so far fallen short of expectations. Low health literacy among the target population and the programme’s opportunistic design cause limited participation, and the initiative has yet to demonstrate its full potential in improving preventive care coverage.
The National Health Strategy 2023‑2030 outlines plans to modernise public health services and make substantial investments in primary prevention, with a focus on reducing disease burden linked to key behavioural risk factors. The strategy aims to strengthen co‑ordination and integration of services through functional territorial networks for major chronic diseases, thus helping to reduce avoidable mortality. However, these ambitions are not yet matched by concrete actions or a sufficiently multisectoral approach to addressing the determinants of health. Significant gaps remain in tackling the country’s high levels of dietary risk, smoking, and alcohol use. Greater emphasis on sustained health literacy initiatives and long-term preventive measures is needed to support meaningful progress on NCDs.
Romania mainly leverages the funds coming from EU and other international projects to accomplish progress in public health and prevention, as the share of prevention in the health budget remains low. The country allocates a lower share of its health spending on prevention compared to OECD average (1% vs. 3% in 2023), which hinders the implementation of sustainable public health policies to address NCDs and their risk factors (see Section 4.1 in Chapter 4). The budget allocated to national public health programmes has stagnated over the last decade (RON 0.86 billion – EUR 0.17 billion in 2024), while the budget for curative health programmes has increased by 230% (to 12.20 billion – EUR 2.45 billion in 2024), according to the Ministry of Health. This raises concerns about the sustainability of public health policies. Reorienting the focus towards prevention will therefore require shifting a greater share of health budget and resources to public health activities, improving population health literacy, creating initiatives to nudge behaviours towards heathier choices (such as public campaigns, regulation on advertising and point of sales of tobacco and alcohol, and fiscal measures), and working closely with primary healthcare providers to further increase their role in health promotion and disease prevention.
2.1.7. Mental health disorders are a substantial cause of burden, but masked by low prevalence due to stigma and limited access to care
Mental health disorders are the second leading cause of years lived with disability in Romania, but the prevalence of mental health disorders was still substantially lower than in the OECD average in 2021 (16 099 cases vs. 13 254 per 100 000 population) (Institute for Health Metrics and Evaluation, 2024[8]). This comparatively low prevalence was also reflected in low self-reported depressive symptoms: only 4.1% of Romanians reported currently having depressive symptoms in 2019, compared to the OECD average of 6.6% (Eurostat, 2024[13]). Symptoms were more common in women, reporting three times more symptoms than men. Disparities are also striking in the Roma communities: Roma people are twice as likely to suffer from depression or anxiety as the general population (Robinson et al., 2022[14]).
The relative low prevalence of mental health disorders and self-reported depression can be linked to the limited access to diagnosis and first-line interventions at primary care level and stigma associated with mental illness. Mental health problems accounted for 12% of total unmet needs in the population (OECD/European Observatory on Health Systems and Policies, 2023[15]), and more than half (52%) were not able to seek care because it was too expensive. A further 36% reported avoiding care due to fear of doctors or treatment – nearly double the OECD average of 20%. Stigma remains a powerful deterrent: over 80% of people agreed that mental health patients are judged differently by society, and 53% felt that medical professionals also stigmatise these patients – the highest rate across OECD countries (Eurobarometer, 2023[16]).
The mental health system remains highly reliant on institutional care and pharmacotherapy, with scarce services available in community and primary care settings, especially in rural areas (see Section 3.3 in Chapter 3). While family physicians do screen for depression during preventive consultations, this alone is not enough. Further steps are needed to build an effective primary care‑led mental health system, expand access to early diagnosis and psychosocial interventions, and reduce the significant social and structural barriers that currently prevent people from seeking care.
2.1.8. Increasing suicide rates calls for greater attention
Between 2012 and 2022, suicide rates decreased considerably by 45% to 8.4 deaths per 100 000 population but remained below the OECD average (10.7). With the pandemic, mortality rates due to intentional self-harm were particularly on the rise in adolescents and elderly: between 2020 and 2021, suicide rates increased by 26% among young aged between 15‑19 (Eurostat, 2025[17]). In 2020, almost half of Romanian young people reported having suicidal thoughts at least once in the last six months (UNICEF, 2022[18]). Similarly, the suicide rates increased among those aged 85 and above, with a 25% increase between 2020 and 2021 (Eurostat, 2025[17]). These rates may be underestimated because of underreporting, as some cases were reportedly entered as accidents in Romania (Civic Labs, 2023[19]). There are no current standalone policies to address suicide in general and vulnerable populations (see Section 3.3 in Chapter 3).
2.2.1. Romania’s social health insurance system offers a comprehensive benefits basket to almost 90% of the population, but only one‑third of the population finances it
Romania has a social health insurance (SHI) system with compulsory health insurance based on the principle of solidarity. The SHI system provides a comprehensive basic benefits package to 89% of the population, which is the second lowest rate of population coverage for a core set of services in OECD countries (Figure 2.7). The basic benefits basket covered by the SHI includes a large variety of services, but they may not be covered in full, and patients may be entitled to co-payments for certain services. It includes preventive healthcare services, ambulatory care, hospital care, medical emergency services, dental care, medical rehabilitative services, perinatal medical services, home care nursing, pharmaceuticals and medical devices (Vladescu et al., 2016[20]).
Note: Data refer to 2024 or nearest year. 1. 2021-2023 data.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en.
In 2024, 11% of the population was not covered by the SHI, consisting of people living abroad, people without identity documents or not registered in the social security system (mainly the Roma communities living in rural areas), and informal or self-employed workers. Those not registered in the social security system or not holding an identity document are mainly from the Roma communities, and only 54% of Roma reported being covered by the SHI (ERGO Network, 2022[21]). The uninsured have access to a minimum package of benefits (OECD/European Observatory on Health Systems and Policies, 2023[15]), which includes life‑threatening emergencies, treatment for infectious diseases, care during pregnancy, primary care services, screening recommended by family practitioners as well as consultations, examination, day hospitalisation for cancer detection in case of suspicion. In particular, the primary care services provided to uninsured individuals have been aligned with the basic level of coverage offered to insured persons since January 2023. Furthermore, since July 2024, the paraclinical services recommended by family physicians are covered for uninsured individuals, as well as the services related to the detection of cancer in case of suspicion, treatment, monitoring and evaluation of oncological conditions. The costs of treating uninsured people are covered from the state budget. Although the minimum benefits package has been expanded for the uninsured in recent years, Romania needs to step up efforts to expand population coverage and thereby improve access to equitable care – including end-of-life and mental healthcare – for all population groups to build a more resilient health system.
The SHI system is funded by mandatory social insurance contributions made by working residents. There are historically a number of exemptions from SHI contributions. First, vulnerable population groups (including unemployed people, retired people and people on social benefits) are exempted. Second, specific population groups – such as pregnant women, people with disabilities or chronic diseases, as well as children and students aged under 26 – are financed from the SHI contributions of the working population. Last, employees from some sectors are exempted from wage‑based contributions. Hence, contributions to the National Health Insurance Fund (NHIF) were paid by only one‑third of the insured people (specifically, 36%) in 2020. This raises the question of sustainability of financing of the national health insurance system in an ageing society, especially during periods of economic downturns. To address under-funding and to improve the fiscal sustainability of the SHI, Romania has started to eliminate the tax exemptions for certain categories of workers (e.g. agriculture, construction, and food industry) since 2023. Additional reforms introduced in 2025 further reduced these exemptions for other groups, a step expected to expand the contributor base in the coming years (CNAS, 2025[22]).
2.2.2. The Romanian health system operates at national and country levels, but its governance remains highly centralised
The key authorities in the Romanian health system are the Ministry of Health (MoH), the National Health Insurance House (CNAS), the National Authority for Quality Management in Healthcare (ANMCS), and the National Agency for Medicines and Medical Devices of Romania (NAMMDR). Professional organisations are represented at the national level by five organisations, namely the College of Physicians, the College of Dentists, the College of Pharmacists, the Order of Nurses and Midwives, and the Order of Biochemists, Biologists and Chemists. The MoH is responsible for stewardship, policy development, regulatory framework development, and management of the health system, overseeing the activities of the National Institute of Public Health (INSP), the National Institute of Health Services Management (INMSS) and NAMMDR. The MoH is demonstrating strong leadership in policy and practice to align with the National Health Strategy. It receives a public budget allocation from the Ministry of Finance and distributes it to other authorities. CNAS is the public payer which contracts with health providers (e.g. hospital, family doctor, ambulatory specialists); it administers and regulates NHIF. ANMCS is a key body created in 2015 under the authority of the government and the co‑ordination of the Prime Minister. It asserts regulatory functions regarding the accreditation and monitoring of health establishments, with the primary aim of improving patient safety and quality of care. INSP, INMSS and NAMMDR are subordinated to the MoH, with their own roles. INSP is in charge of health promotion, health status evaluation, surveillance and control of communicable and non-communicable diseases, including the management of disease registries and the implementation of public health programmes. It provides technical and methodological guidance of the public health network, develops the methodology, tools and indicators for monitoring and evaluating public health services and programmes, such as health promotion and health education, and ensures an integrated information system for public health management. INMSS deals with training, continuing medical education, management and administration of health services, including the management of the diagnosis-related group system. NAMMDR is the competent national authority in the field of human medicines and medical devices.
The Romanian health system is organised at two levels: national and county2 (judet). The national level is responsible for setting and achieving general objectives in line with the principles of the government’s health policy. The county level is responsible for ensuring public health services provision according to the rules set by the central level, mainly through two main bodies. The district public health authorities (DPHAs) -representing the MoH at the county levels- are in charge of implementing national policies, developing local programmes, organising health structures, and reporting health statistics, among others. The district health insurance houses (DHIHs) operate for CNAS at the county level. Their activities consist, among others, in contracting with health providers and managing national curative health programmes.
2.2.3. Romania is investing in the modernisation of its healthcare infrastructure
The hospital infrastructure is outdated and struggles to respond to today’s care standards and needs. Some hospital buildings do not meet the required safety standards in the event of a fire or earthquake. Old buildings and equipment hinder the introduction and use of new technologies to perform modern surgeries due to suboptimal integration of intra-hospital circuits and logistical limitations, which is reflected in the low numbers of laparoscopic procedures compared to the OECD averages, except for laparoscopic cholecystectomy. In 2023, Romania performed 33 laparoscopic appendectomies and 26 laparoscopic inguinal hernia repairs per 100 000 population, rates substantially lower than the OECD and neighbouring EU5 averages (Figure 2.8).
Note: Data refer to 2023 or nearest year.
Source: OECD Health Statistics 2025.
Romania is taking measures to address the outdated hospital infrastructure. Through the NRRP investments, the country plans to renovate 3 000 family doctor cabinets and 160 hospital infrastructures (Box 2.1). Some of the main goals include implementing measures that safeguard against fires, structural damage, and seismic events, and upgrading microbiology laboratory equipment to reduce healthcare‑associated infections and enhance patient safety in healthcare facilities. In 2022, the government created the National Agency for Development of Health Infrastructure which oversees major public health infrastructure projects and facilitates access to health infrastructure investments. The agency is also responsible for the efficient allocation of hospital resources by transferring hospital beds to other services such as day care and long-term care beds in accordance with the needs identified by the Regional Health Services Masterplans (RHSMs) (Box 2.1). In addition to renovation, Romania is currently investing in the construction of three new regional hospitals with the support of the European Investment Bank.
The National Health Strategy 2023-2030
The national healthcare reform strategy targets all levels of healthcare with a specific focus on diversification, co‑ordination, and modernisation of healthcare services. The reform is projected to take place until 2030. The objectives include strengthening and modernising public health and primary healthcare, involvement of the citizens, co‑ordination between primary care and hospital care, investment in health workforce, improving quality of care, achieving financial sustainability, and encouraging research for innovative sustainable care.
The National Plan for Resilience and Recovery 2022 – 2026
As part of the EU’s recovery strategy following the pandemic, Romania launched the National Resilience and Recovery Plan. The healthcare components of this plan consist of three reforms and two investments:
Reforms:
Increasing the capacity for the management of public health funds through a pilot programme to improve the quality and cost-effectiveness of health services, and the development of a new model of framework,
Increasing the capacity to undertake investments in health infrastructures,
Increasing the capacity for health management and human resources in health by improving human resources management skills, strengthening the workforce capacity to retain and motivate workers, and reducing vulnerabilities and risks of corruption in the health system.
Investments:
Development of pre‑hospital medical infrastructure to improve healthcare access for people in disadvantaged areas by investing in primary care practices including family physicians, mobile medical units, outpatient care units, integrated community centres and family planning offices,
Development of public hospital infrastructure with new infrastructure, medical equipment and devices, intensive care facilities for newborn and investment in equipment to reduce the risk of nosocomial infections.
The Operational Health Programme financed by the European Commission (2021-2027)
The priorities of the operational health programme are to (1) increase the quality of primary care and preventive services, (2) adapt the rehabilitation, palliation, and hospitalisation services to the ageing population, (3) increase the effectiveness and resilience of the medical system, (4) invest in new hospital infrastructures, (5) encourage innovative approaches in medical research, (6) support digitalisation of the medical system, and (7) support research in the field of oncology and transplantation.
The government programme for 2023-2024
The priorities of the government programme focus on:
Resilience of the health system, safe access to good healthcare services quality for every citizen,
Strengthening the co‑ordination of the public health system,
Financing the health system by implementing budgeting to ensure a high degree of absorption of European funds dedicated to the field of health in the period 2021-2027.
The National Health Programmes
The national health programmes aim to prevent and treat diseases with serious consequences on the health of the population and with increased epidemiological risks (e.g. AIDS, tuberculosis). They are implemented and co‑ordinated by MoH, funded by state budget and NHIF. Four health programmes include:
Community public health programme,
Programme of the prevention and control of non-communicable diseases,
Child and family health programme,
Health administration programme and health policies.
Regional Health Services Masterplans
Financed by the European funds, the Masterplans identify regional needs and have analysed the capacity of service providers, human resources, equipment, as well as funding opportunities. They ultimately aim to ensure efficient use and allocation of healthcare resources by restructuring the health system based on regional needs and by shifting the care paradigm to primary care. The Masterplans have been recently published, but relevant actions have not yet taken place.
2.2.4. Romania’s health system still heavily relies on hospital services, despite the reforms to shift the focus to primary care and community settings
Romania’s health system is hospital-centric, with high numbers of hospital beds, high discharge rates, and high spending on hospital services. Specifically, Romania has 7.3 hospital beds per 1 000 population, compared to the OECD average of 4.2 and the neighbouring EU5 average of 5.8 in 2023 (Figure 2.9). This figure has increased over the last decade, with the hospital bed rates being markedly higher than most OECD countries, reflecting the over-reliance on the hospital sector for acute care provision. Meanwhile hospital discharge rate was 169 per 1 000 population in 2023, relatively high compared to OECD countries. Nearly half of the total health spending is dedicated to hospital activities (44% compared to 39% in the OECD average) (Chapter 4). Closely linked, the inappropriate use of emergency room services is high in Romania (Chapter 3).
Romania is committed to the transition from hospital-based services to primary care and community services, as stated in the National Health Strategy 2023-2030 and the Operational Health Programme 2021-2027. The country has also taken measures to strengthen prevention and screening within primary care settings, with the financial support ensured by the NRRP investments. This entails providing a “riskogramme” screening test (see Section 2.1), providing an annual preventive checkup for adults aged 18 and over (which was granted once every three years for people aged 18‑39, before 2023), and restructuring provider payment method to encourage family physicians to detect and follow-up patients with chronic diseases starting from 2024. The country has recently introduced a P4P scheme that rewards preventive activities at a higher rate and has increased the weight of fee‑for-service payments from 50% to 65% by reducing the share of capitation in remuneration in order to encourage disease management and prevention in primary care. Romania is also making effort to enhance the provision of primary and community care services by developing a network of about one hundred integrated community centres across the territory, along with the modernisation of diagnostic and testing facilities within these centres (see Section 3.1 in Chapter 3). But these actions should be underpinned by strong political commitment and reallocation of resources to primary care and prevention to build stronger, more resilient health system capable of meeting the needs of ageing population and future health challenges (further discussion in Chapters 3 and 4).
1. Data include only acute care and psychiatric hospitals. 2. Latest data from 2021-2022. 3. Latest data from 2016.
Source: OECD (2025[6]), Health at a Glance 2025: OECD Indicators, https://doi.org/10.1787/8f9e3f98-en.
2.2.5. Stakeholder accountability is improving, with increased patient engagement
The role of patient associations is gaining importance in the Romanian health system. Patient associations are being formally involved with health system stakeholders. They take part in various activities such as healthcare quality, health prevention, and supporting patients in legal suits. For instance, a representative of patient associations is nominated in the board of directors of ANMCS. Patient associations are also represented in the National Patient Safety Council, an entity created in 2021 with the objective to embrace patient safety culture among health professionals and patients, and to encourage research around quality of care and patient safety. At hospital level, patient organisations are represented in the ethics councils in each hospital. Patients have the possibility to fill in online patient discharge questionnaires to provide feedback about their experiences with public hospitals. The data collected by the MoH is then made publicly available. Another example of the patient empowerment is the participation of associations of chronically-ill patients (e.g. the Coalition of Organizations of patients with Chronic Diseases in Romania) in a project to develop a screening programme for cardiovascular risk factors, co-funded by the European Social Fund, as part of the Human Capital Operational Program 2014-2020.
Patients’ rights to information are governed by law, however the capacity of patients to navigate the health system is uncertain. Patients have the rights to information about their health and available treatments, to informed consent, to information about the range of available services and certain information about the providers (Vladescu et al., 2016[20]). To this end, starting from 2021, CNAS published the Insured’s Guide providing information about the health insurance system, benefits packages, rights and obligations of the insured. In particular, the guide describes how health services can be accessed and what services the patients are entitled to from each provider, including services available to the uninsured patients. Yet, patients report a lack of information about how to get diagnosed to enter in existing treatment pathways. Further, there is no evidence on how well-informed patients are about their rights and if the available information is seen to be useful. The country does not collect data about the level of health literacy.
2.2.6. Romania is taking steps to address corruption in the health system
Romania has historically had problems of informal payments in the health system, either linked to high level appointment, procurement of medical supplies, such as bribery of health facility managers to get lucrative contracts, or informal payments at the point of care delivery (OECD, 2024[23]; OECD, 2023[24]). In 2023, 9% of Romanians reported having to give an extra payment or a valuable gift to a nurse or a doctor or having to donate to the hospital (not including official fees) when visiting a healthcare setting, which is three times higher than the EU average (Eurobarometer, 2023[25]). Yet, recent data show that “under the table” payments in public hospitals are reportedly on the decline. Patient feedback mechanisms put in place since 2016 report a reduction in “under the table” payments in public hospitals from 4.3% in January 2017 to 1.7% in January 2024 (Graphs.ro, 2024[26]).
While Romania has taken cross-cutting measures to address corruption and promote integrity in the health system, there is room for improvement in strengthening integrity management in the Romanian health sector. Corrupt acts are increasingly getting prosecuted by the Romanian National Anticorruption Directorate. To tackle fraud and bribery in public procurement, a special IT monitoring system is in place for budget execution, monitoring contracts, suppliers, and payments from the public budget. Other measures have contributed to the reduction of informal payments, including doctor’s salary increases, increased education and awareness actions of both medical staff and patients. NRRP invests in the training of 3 000 health workers, including those working in the central administration, in de‑centralised institutions, in the management of healthcare units, and those providing direct care to patients. The trainings cover a range of integrity-related topics, albeit they have yet to be implemented. The training courses address the prevention of corruption and the resolution of conflicts of interest within the healthcare system, the protection of whistleblowers, and the transparency of public procurement in the healthcare sector. The reform also aims to increase transparency by sharing information on activities and results achieved, and through awareness campaigns. One notable initiative is the online publication of the monitoring and reporting of the progress in NRRP (https://monitorpnrr.eu/). These efforts are promising, yet further efforts are needed to strengthen integrity management in the Romanian health sector. The lack of co‑ordination, institutional capacity, and political engagement at high-level has hindered the adoption and implementation of the National Anti-Corruption Strategy measures in the health sector (OECD, 2023[24]). Expanding the scope of the National Anti-corruption Strategy based on an analysis of risks in the health sector is essential to improve integrity in the health sector. Such an analysis could support further reforms, such as developing a comprehensive anti-corruption policy for the health sector, incorporating integrity as a component of institutional performance, and implementing monitoring mechanisms for key processes such as allocation funds, appointments and medical input procurement. Increasing public awareness about the legal consequences of corruption, including informal payments, is also key to changing mindset and building integrity in the health system.
2.3.1. Routine data collection, standardisation and linkage present challenges, but Romania is making effort to reach international standards for data collection
Although health data is routinely collected in Romania, there are a number of inefficiencies in data collection, such as high degree of data fragmentation and duplication in data collection, which impair the quality and effective use of data. Romania has multiple co-existing information systems and parallel information flows due to inconsistent legislative reforms not envisioning overarching health information system (HIS) objectives. The HIS lacks a coherent and integrated data processing, suffering from a sharp division of the collection, reporting, and decision making processes. Three main entities operate data collection and processes. INSP is responsible for collecting, analysing, and disseminating data on the state of health of the population, used for statistical reporting, such as the Yearbook of Health Statistics and health-specific bulletins sent to policymakers and DPHAs directors. CNAS organises and administers the Health Insurance Information Technology (IT) platform, including the single integrated information system, the national health insurance card system, the national electronic prescription system, and the patient’s electronic health record system. ANMCS collects data from health service providers and organisation in the view of their accreditation. Due to various data flows, data collection processes are burdensome and inefficient, leading to low quality data (e.g. providers must report the same information to different institutions and in different formats; the data collected can be irrelevant for the decision making process). The Romanian HIS is lacking effective data validation mechanisms to ensure data quality, and qualified personnel in the field of medical statistics, to process raw data and use it for analytic purposes, resulting in the underuse of the collected data for public health decision making.
Romania collects administrative health data from hospitals and health practitioners, as well as census and population health data. Chronic disease registries are not yet operational, albeit the country is planning to implement registries for cancer and diabetes, among others, under the NRRP projects. The proportion of health data which is digitised and available at the national level for further processing is unclear. In 2023, around EUR 175 million was invested in information and communication technology (ICT) for health and social care – equivalent to EUR 0.9 million per 100 000 people, less than half the EU average – largely financed through the RRP and EU Cohesion policy funds (OECD/European Observatory on Health Systems and Policies, 2025[7]).
Romania has enhanced data standardisation, although interoperability remains constrained by the presence of disparate data systems and limited capacity. Regarding CNAS’s Health Insurance IT platform, Romania has adopted international coding standards for hospital service reporting (with the International Classification of Diseases ICD‑10 and ICD‑10‑AM and intends to move to ICD‑11). ANMCS’s datasets are structured on references, standards, and requirements. The National Health Strategy aims for modernisation of the HIS, with emphasis on information interoperability and digitisation, with initial efforts started within the framework of NRRP. Regarding health data interoperability, there is some evidence of data linkage, for instance between laboratories, DPHAs, family physicians and patients accelerated during the COVID‑19 crisis, but these remain limited (OECD/European Observatory on Health Systems and Policies, 2021[27]).
Romania is making efforts to reach international standards for data collection. The country contributes to international data collection, specifically to the OECD Health Data Questionnaire, the OECD/Eurostat/WHO-Europe Joint Questionnaire on Non-Monetary Healthcare Statistics, the OECD/Eurostat/WHO-Europe Joint Health Accounts Questionnaires, and the OECD Healthcare Quality Indicators and Outcomes questionnaire. To improve data collection and reporting around quality of care, a National Commission for Supervision of the Health Information system and Reporting to the OECD was created in 2019, functioning under ANMCS. This inter-institutional body, involving MoH, ANMCS, CNAS and the National Institute for Statistics, aims to unify the reporting process to international organisations.
2.3.2. Romania is enhancing its health information infrastructure, with the introduction of electronic health records and teleconsultation
In 2014, Romania introduced the electronic health record (EHR) system (Dosarul Electronic de Sanatate – DES) managed by CNAS. In 2021, 16 million EHRs (about 85% of the population) have been created with the co‑operation of healthcare providers and institutions, but only 12 000 were actually used and accessed by patients in 2023 (Adevarul, 2022[28]). Low level of actual use of EHRs is likely to be related to the low level of digital literacy in the country. In 2023, only 28% of the Romanians had basic or above basic digital skills, less than half of the OECD average (61%) (Eurostat, 2024[29]). On provider’s side, about 45% of doctors (mostly family physicians) have submitted EHR data. EHR data are available in reports and statistics in an anonymised form, and their usage is currently limited to administrative and accounting purposes, calling for better exploitation of EHRs for clinical reasons.
The use of telemedicine has quickly progressed due to the impact of the COVID‑19 pandemic and the movement restrictions. According to the 2022 Eurofound survey data, the proportion of Romanians who had teleconsultations with doctors during the first year of the pandemic increased from 22% to 30% between June 2020 to February 2021. On average across EU countries, this proportion raised from 30% to 39% (OECD/European Union, 2022[30]). However, Romania has not yet a secure dedicated platform for telemedicine. For instance, during COVID‑19, doctors used individual communication platforms such as WhatsApp, to provide medical consultations and send documents to the patients (e.g. prescription for medication). Since, telemedicine has been legislated (Chapter 3) and the elaboration of the specific quality management standards are in process of drafting. Romania does not yet regularly report data on the number of teleconsultations.
2.3.3. Romania is working on a national digital health strategy to leverage the potential of health data
To date, Romania has legislations and policies related to health data governance, but the country has not yet adopted an overarching national health data governance strategy. Romania’s health data governance consists of laws which include provisions on patients’ data privacy and security safeguards, as well as cross-border co‑operation in the processing of personal data for health-related purposes that serve the public interest. As a member state of the EU, Romania applies the EU General Data Protection Regulation (GDPR), regarding personal data processing requirements and protections. There are opportunities to clarify how, when, and with what controls data access should be provided for care, public health, innovation, and health system operations. In practice, personal health-related data are not yet effectively accessible or used for research and public interest purposes, and there is a lack of training for staff on their responsibilities regarding privacy and digital security. Romania has not yet adopted a national health data governance strategy, albeit this is in process. A new digital health strategy was submitted for a public consultation by the end of 2024, and a working group is being established to develop a masterplan for implementing the strategy. This new strategy will include creating a National Agency for Digital Health to oversee data pooling, analysis, dissemination, standard setting, and telemedicine development, as well as establishing a National Observatory for Health Data to support digitalisation and collection of data. It also seeks to expand and consolidate the social health insurance information platform to enhance data management, streamline expenses, and improve insured individuals’ access to healthcare services.
Strengthening health data governance will require providing guidelines on training and skills development (e.g. in privacy and security measures) to improve the capacity and training of health and IT workforce, conducting tests for potential security breaches, and enabling data access for research and public interest purposes, for instance by developing standard data sharing agreement for disclosing data. Further progress is also needed to enable and facilitate cross-border data sharing and participate to the European Health Data Space, promote the use of common data formats, quality assurance and data interoperability standards in line with the European Health Data Space. Encouraging the co‑operation between organisations processing personal health data, including in the public and private sector is also essential. The process of developing such co‑ordination started with NRRP which allocates EUR 442 million for the development of an integrated eHealth and telemedicine system.
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