OUTCOMES OF PRIMARY CARE REFORMS AND THE NEW CHALLENGES FACING ROMANIA

1
OUTCOMES OF PRIMARY CARE REFORMS ANDTHE NEW
CHALLENGES FACING ROMANIA

• Dr. George Haber
• President of Romanian Society of General
  Practicioners and Family Medicine

2
Development outcomes and goals

• rural service and infrastructure
• child health
• health system performance
• population and reproductive health

3

• Health care reforms in Romania started late
  compared with other Central and East European
  countries.
• Unfavorable socioeconomic circumstances.
• The power of the hospital.

4
GOALS

• To improve the quality of general practice in
  Romania.
• To stimulate the development of Family Medicine
  teaching in our country, the necessary skills,
  and up-to-date clinical knowledge.

5
OUTCOMES

• Fast access to care when it is needed.
• High quality healthcare system, improving access
  is now a top priority for Romanian health policy.
• The impact of advanced access on continuous care,
  a higher priority for many people.
• Resistance to change.
• Set up a system to monitor the performance of
  primary care organizations and are intended to
  reflect the progress of primary care.

6

• There are many factors for example geographic,
  financial, socioeconomic, educational, cultural,
  technological known to have an influence on how
  pacients access services, the interplay of these
  factors can be very complex, and access must be
  evaluated in the context of differing perspective
  health needs.

7

• The greater health problem of deprived community
  are threatened by lack of available local primary
  care.
• Secondly, one can try to maximize the output of
  existing resources by exchanging, the skill mix
  of professional teams.
• Thirdly, one can try to target resources at
  under-served areas and/or vulnerable or
  underserved population group.

8

• Improve specific aspects of access for example
  continuity of care.
• Needs based equity is very difficult to measure,
  and adaptation with geographical and also within
  different sociocultural and economic subgroups.
• Services around locally defined needs appears to
  be effective in improving access for marginalised
  groups.

9

• The Romanian GPs, do not have the answer to the
  problems currently facing rural health, so there
  is need for the development and support of health
  teams with diverse skills.
• In Romania the majority of the population, is
  located in rural areas, where there may be a lack
  of basic health and they often have limited
  access to modern medical services.

10

• Rural health services requires proportional
  resources and fewer staff than urban health
  services.

11

• The health of rural people is affected by social,
  cultural and economics factors the major
  detriment comes from lack of resources and
  poverty.
• In Romania, the policy on rural practice and
  rural health contains strategies to assist the
  areas progress.

12

• A combined effort to change the historical
  inequities faced by rural and disadvantaged
  community is needed through affirmative action
  for rural people with respect to health care.

13
The outcomes and strategies proposed

• the necessary infrastructure for the
  implementation of comprehensive health care for
  rural, must be a high priority for Romanian
  Health Ministry.
• the status of rural doctors, needs to be elevated
  by a coordinative approach involving improved
  career projects education and trainings, and
  improved working conditions.
• the models of rural health services need to be
  evaluated and promoted in partnership with
  communities, and in cooperation with regional and
  national health authorities.
• the need for dedicated funding for the support of
  rural health care practicioners must be
  recognized.

14

• There are significant differences on how the
  health care system is organized and family
  medicine is practiced, throughout Europe.
• Reform of national health systems is a common
  feature in Europe, given the change in
  demography, medical advances, health economics
  and patient needs and expectation of the people.
  Primary care provides both more cost effective
  and more clinically effective.

15

• Europe has a variety of health care systems and
  diverse situations where care is provided by the
  GP. There are basic cultural and political
  differences in the societies and the populations
  the GP are serving.
• GP is a clinical discipline, which more than any
  other, is dependent on societal differences.
• The GP is the mediator between society and
  medicine.

16

• Tomorrows patient will be not the same as
  todays. New values, preferences and lifestyle
  are developing and providing a basis for the
  definition of new group identities.
• People have even higher expectations regarding
  the quality of life and the quality of health.

17

• Socio-economic health inequalities, particularly
  with regard to life expectancy are challenged by
  major demographic, epidemiological,
  sociocultural, scientific and technological
  developments.
• Considerable variation within the EU, by the type
  of healthcare system and the demographic changes,
  will have major implications for healthcare in
  many European countries.

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Population on age groups
19
Medical Personnel in some european countries
20
The Distribution of The National Health Budget
21
Results
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• In conclusion, a new legislative packet has
  recently been proposed by the Romanian Health
  Ministry addressing many primary health care
  issues. However, only a portion of this
  legislation deals with the underfunding of
  primary care programs.