REGIONAL ECONOMIC FORUM MOLDOVA 2025

19th Edition – Vatra Dornei, July 9–13, 2025

Thematic Panel:

Health and Medical Services in the Moldova Region

Speaker:
Dr. Răzvan Vulcănescu – Executive Director of PALMED (Employers’ Association of Private Medical Service Providers)

Presentation topic:
Public-Private Mix in Romanian Healthcare. A European Partnership Model for Equity, Efficiency, and Balance

Dr. Răzvan Vulcănescu, executive director of PALMED, spoke at the Moldova 2025 Regional Economic Forum about the structural imbalances affecting Romania’s healthcare system. Chronic underfunding, lack of regional equity, and the absence of a coherent strategy were among the key points of his speech.

“We have an underfunded system running on emergency mode”

According to the data presented by Dr. Vulcănescu, Romania allocates only 6.3% of its GDP to healthcare, compared to a European average of over 9%.

“The system is funded at around 6.3% of GDP – extremely low. And within this 6.3%, only 0.3% goes toward investments. The rest are current expenses, mainly salaries.”

Moreover, over 1% of this funding comes from additional patient contributions – out-of-pocket payments, private insurance, or subscriptions.

This means that Romanian patients pay out-of-pocket nearly twice as much as the European average in relation to the services they receive.

Dysfunctions in Service Contracting

One of the most severe imbalances mentioned was the way the National Health Insurance House (CNAS) sets the contracted budgets.

“We have a total CNAS budget of around 53 billion lei. The official estimate of actual needs is nearly 60 billion. That means an annual deficit of 7 billion – systemic and recurring.”

The consequences are direct: hospitals and clinics – public or private – provide services beyond the budgeted limit, yet receive no real financial compensation for them, leading to chronic underfunding, waiting lists, staff shortages, and professional demotivation.

“Transparency is a slogan, not an institutional practice”

Dr. Vulcănescu also criticized the lack of predictability in public healthcare policies.

“Each year, we get semiannual or quarterly contracts. No one knows what happens starting in July. Providers must operate without knowing what they’ll receive for the services they deliver.”

This uncertainty hinders the development of medical infrastructure, discourages investment, and ultimately affects patients who face limited access to treatments or diagnostics under “frozen” contracts.

Dr. Vulcănescu advocated for recognizing the role of private partners, often overlooked in public strategies.

• The private sector provides over 70% of laboratory and imaging services (MRI, CT, etc.);

• In outpatient care, over 50% of services are delivered by private clinics;

• During the pandemic, private hospitals provided ICU beds and treated thousands of COVID patients in partnership with the state.

“It is unfair to stigmatize the private sector. We’re not talking about luxury clinics, but about units covering what the state can no longer manage.”

Severe Regional Inequities in Moldova: “Some counties lack 2–3 essential specialties”

Dr. Vulcănescu specifically highlighted the territorial inequalities in the Moldova Region.

• Moldova has the lowest density of specialist doctors per capita;

• Some counties completely lack essential specialties (endocrinology, pediatric neurology, child psychiatry);

• Access to reimbursed imaging investigations is limited to 5–10 patients per day per provider, regardless of actual demand.

“If you live in a rural area, it’s easier to get to a hospital in another county or abroad than to access an MRI in time.”

This reality discourages local economic development, impacts birth rates, quality of life, and the region’s attractiveness for investors.

PALMED’s Proposed Solutions: National Pact and Functional Decentralization

At the end of his speech, Dr. Vulcănescu outlined several strategic directions.

1. Adoption of a national health pact, supported by all political parties and assumed for the long term;

2. Reform of CNAS through digitalization, decision-making transparency, and multi-year contracts;

3. Regionally differentiated budget allocations to close development gaps;

4. Regulation of public-private partnerships to ensure real complementarity.

“We can no longer talk about healthcare only during election campaigns. We need a functional architecture built with all stakeholders – from policymakers to providers and patients.”

Dr. Răzvan Vulcănescu’s speech at FERM 2025 was a lucid and well-grounded diagnosis of the Romanian healthcare system, as well as a call for reform based on realism, data, and dialogue. Underfunding, territorial inequities, and strategic uncertainty are the major obstacles to a healthy Romania. And the solutions – already proposed – need only political will and administrative coherence to become reality.