The flu vaccine could be reimbursed for uninsured individuals too. What is changing in the healthcare system

The Romanian College of Physicians (CMR) and the National Health Insurance House (CNAS) agreed, during discussions held in September, on a series of changes to be introduced in the new framework contract for the healthcare system. The changes concern general practice, outpatient specialist services, and hospitals.

Flu vaccine to be available to uninsured individuals as well

One of the accepted proposals concerns access to the flu vaccine. Any general practitioner will be able to dispense it to insured patients. Additionally, CMR and CNAS have agreed to begin efforts, together with the Ministry of Health, to extend reimbursement of the flu vaccine to uninsured individuals as part of a preventive programme. This measure forms part of CMR's proposals for strengthening prevention within the healthcare system.

Online appointments as an additional option, not an obligation

Regarding the e-Sănătateamea platform, CMR has requested that online appointments remain merely an additional option for patients and doctors, alongside existing methods — telephone, in-person, or through practices' own systems. Use of the platform will not be a mandatory condition for service contracting, and doctors will not be required to manually enter into the platform appointments made through other means.

Greater role for general practitioners in prevention and screening

The role of the general practitioner in prevention and oncological screening will be strengthened. Patients must have unrestricted access to paraclinical and imaging investigations; examples include the ability for general practitioners to recommend a Low-Dose CT scan for patients at high risk of lung cancer.

General practitioners will also be able to assess the FRAX score for individuals at risk of osteoporosis. In addition, a once-in-a-lifetime Lipoprotein A measurement is provided for individuals aged 30–49 at risk of cardiovascular disease.

Assessment of chronic diseases through case management

General practice will be able to carry out patient assessments for several chronic conditions in accordance with current guidelines: arterial hypertension, dyslipidaemia, type 2 diabetes mellitus, chronic kidney disease, bronchial asthma, and COPD. For chronic kidney disease, a clear pathway will be established — initial assessment, monitoring, and precise criteria for referral to a nephrologist based on the level of risk.

Payment for locum doctors and improved access in underserved areas

Locum doctors will be paid for all services provided beyond the 20/24/28/32 limit. Furthermore, general practitioners who also hold a second clinical speciality will be able to enter into a contract with the Health Insurance House for both specialities, following a model similar to that used in palliative care, whilst adhering to working hours and maximum workload norms. The aim is to make more efficient use of resources and increase access to specialist care, particularly in areas with a shortage of doctors.

Biannual settlement and more flexible timescales for investigations

The settlement of medical services will be carried out biannually rather than quarterly, which will facilitate the reimbursement of a greater volume of consultations with general practitioners.

For outpatient specialist services, the fixed three-working-day deadline for investigations will be replaced with a flexible timescale, averaging five working days, adapted to the volume of activity, the complexity of the investigation, and clinical priority, with exceptions for complex cases and comparative analyses. Outpatient providers will be able to retain their contract with the Health Insurance House when changing their legal form, provided they maintain their location, staff, and service delivery conditions.

Extended therapeutic education and higher point scores for children's consultations

The therapeutic education service, previously intended solely for patients with diabetes, will be renamed "Therapeutic, Nutritional and Healthy Lifestyle Education for the Prevention and Management of Metabolic Diseases" and extended to patients with prediabetes, obesity, dyslipidaemias, hyperuricaemia, and other metabolic conditions.

The point score for consultations with children under 4 years of age will increase to 21.6 points per consultation. For certain consultations in cardiology, endocrinology, pneumology, paediatric pneumology, and rheumatology, the score will be 14.4 points, with an allocated time of 20 minutes.

Changes to hospital funding

The contracting of hospital services will change: the algorithm based on the number of beds will be replaced by a transparent and unified system founded on case volume. The allocation of funds to hospitals will be based on the activity history from the previous year, with a guaranteed budget level at least equal to that previously achieved.

The Romanian College of Physicians states: "The new funding model will be grounded in an analysis of local care needs and the complexity of cases treated, thereby ensuring fair remuneration genuinely aligned with medical activity carried out. At the same time, in order to ensure the quality of medical practice and improve operational efficiency, the maximum number of hospitalisation contracts in which a single doctor may be active will be reduced from three to two."

All of these changes concerning general practice, outpatient specialist services, and hospitals are to be included in the new framework contract.