Healthcare: Study “Situation of medical staff” initiated

Friedrich Ebert Romania Foundation launched the study “Situation of medical staff in Romania”, made together with Syndex Romania, author Stefan Guga. The study makes a detailed diagnosis of the situation of medical staff , by analyzing the evolution of personnel in the health system, its geographic distribution and effects of recent salary policies.

Main results and conclusions of the study are the following:

• In 2020, over 350,000 people were working in the public and private health system in Romania, representing about 6.6% of employees. If we exclude the category “other types of medical staff with higher education”, for which data are available only after 2015, we see a significant increase of the medical personnel from about 270,000 before 2015 to 330,000 in 2020.

• However, despite the significant increase of medical staff in past years, Romania has a deficit for the number of physicians per 1,000 people, only 5 states (France, Belgium, Luxembourg, Great Britain and Poland) having in 2019 fewer physicians per 1,000 people than Romania. The situation is better in the case of medical assistants, but Romania does not excel in any way, despite the increase of 2010. Compared to the other European states and the important increase of the number of medical staff over the past decade do not explain why the health of Romania's population is sill poor compared to the other EU member states.

• At present, the shortage of medical staff is different from half a decade ago. One of the problems is the deepening of labor division between the public and private systems, visible especially in the almost total privatization of certain activities in the health system. In point of quantity, family medicine (today a private activity, to a great extent), was left behind the other medical services. Dentists, pharmacists and family doctors (especially after 2015) have a negligible presence in the public system, as they have been fully privatized – together they represent about 37% of the private medical staff, compared to 3% in the public system.

• Growing geographic inequalities between poor and rich counties and between large cities and the rest of the country represent a structural problem of the medical system. Rich countries have been the main beneficiaries of the increase of medical staff in past years, while poor areas have been facing stagnation and decline. Bucharest-Ilfov area has the highest average salaries and the highest number of medium health staff per capita; at the other end, counties like Calarasi or Giurgiu, have very low salaries and low number of health personnel. Even though there are a few exceptions, the general tendency is very clear: the richer a county is, the higher the number of medical staff in the public system. These geographic inequalities tend to become more serious in time. In fact, only in 13 counties we can see a slight increase of the number of physicians per 1,000 people since mid 2010s to the present, increases being predominantly visible in rich counties.

• The situation of medical personnel was the object of one of the most incisive public policy measures in recent past: law 153/207 which stipulated unprecedented salary increases in the public health system, meant to reduce emigration and eliminate the question of staff shortage. At macro level, law 153/2017 proved very efficient, reducing the emigration of trained health staff in a short period of time and even leading to an excess of personnel in capitals of rich counties. Salary increases did not solve the problem of staff shortage outside these developed urban centers, contributing to growth of territorial inequalities to some extent.

• Salary increases proved to be necessary but insufficient for solving the problem of personnel shortage in the public health system. Even though they are vital and mark important changes compared to the public policy of the last decades, the concrete case of salary rises and the potential case of investments in infrastructure also show the weakness in approaching a very complex problem, whose branches extend beyond the health system problem. They should be completed by other measures concerning the medical staff and the health system, and by a more ample strategy of curbing socioeconomic regional inequalities. Over the years, there have been talks about which might attract medical personnel in poor areas (commuting subsidies, service lodging, salary supplements), which were implicitly suggested in the latest public policy documents.

• But, an efficient, long term solution is not possible outside a more ample strategy to reduce growing socioeconomic inequalities. However there is a limit beyond which possible additional incomes offered to the health personnel in areas will prove to be insufficient, since the health staff are not blaming insufficient incomes but the lack of professional and personal opportunities similar to what developed urban areas can offer.

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