The ill medical system

The attention of the public is increasingly concentrated on the intentions announced by the acting minister of Health to reorganise the medical system. His opinions, which oscillate between firmness, intention and simple suggestion, refer either to completely dismantling, or to reorganising the present county health houses, which would leave without jobs some 4,000 employees, which could also be transferred to the future 8 regional sanitary authorities. All these projects bring to actuality many organisation problems, extremely detrimental to the medical protection of population. Because of this, the Romanian state finds it increasingly harder to cover the financial needs of the current medical system.

The arguments brought by the Health minister are precise and undisputable. But the intended organisational changes require a large-scale study of social impact, in order to avoid any other problems.

The absence of such a social impact study favours complicate discussions. For instance, the opponents of the acting minister blame the flaws of the medical system exclusively on the state, which they conceive as some sort of absolute owner, in a permanent conflict with regional and local structures. This is the context for the recent intervention of the president of the Romanian College of Pharmacists, who explained the problems that exist in the supplying of medicines through the fact that the Romanian state owes almost EUR 1 bln to pharmaceutical companies, a sum resulting from the long delays in paying the medicines provided to the population on the basis of compensated or free prescriptions. But isn’t the delayed payment also a consequence of the exorbitant, speculative prices of these medicines? There are many other opinions which go even farther and evince organisational problems in many other directions, with effects on the general health state.So, when it comes to criticism, everybody is right.

The flaws –organisational, or moral, legal or of another nature – are so pressing today that they cannot be disputed anymore. But each such critical opinion stops at just one separate, isolated issue. And the virulence of the criticism is so strong that it loses from sight the large picture. In the medical system, like in any other sector, a reforming intention cannot be put into practice if it is unilateral and neglects the system, in its entirety. The complementariness of reforming efforts is the only way to overcome any crisis. Revamping the current medical system is impossible in the increasingly obvious – absence of the medical personnel. A reasonable system of salaries paid by medical-sanitary units is, thus, more than necessary, in the context of any reform. Plus, restoring the medical system is impossible without supplying hospitals with the full complement of medicines and sanitary materials they need. This desideratum, in turn, requires correct and reasonable relations between the producers and resellers of medicines and other sanitary products. The reasonable target of these reports implies an optimal system of transport and a national pharmaceutical industry, the only capable of diminishing the exorbitant costs sustained by Romania today through the massive imports of medicines. And the chain of this strict and objective determination may continue.This chain of determinations may continue with arguments in favour of an exhaustive analytical synthesis and of a prospective study, precisely so we can adapt – starting today – to the exigencies of the future. This is the big problem of Romanian governments in their succession similar to each other. They all take into consideration exclusively the present moment, hence their inability to pinpoint the real causes of either failures or successes, no matter how seldom do they happen. The lack of this prediction capacity of our rulers led to the chaotic privatisation of the Romanian pharmaceutical industry. Following these privatisations, our national production of medicines largely ceased. The import of medicines took immense proportions and their prices exceed those in the EU, compared to the average income in Romania. The premises of the former pharmaceutical companies have turned into stores, shops or night clubs, and their lands now host buildings unrelated to public health. All these beneficiaries of chaotic privatisations – the importers and dealers of medicines and other sanitary products, along with the owners of buildings and lands which previously belonged to Romanian pharmaceutical producers – frequently accuse the Romanian state of – they say – obstructing the EU practices and the principles of market economy. But when the Romanian state was asked – also by the EU – to respect the European policy of instating profit taxes in the case of medicines, the same “pro-Europeans” oppose and resort to strike.Precisely such contradictions between the rulers of Romania, with their organisation problems, and the “pro-Europeans” only with regard to maximising profit, the medical sector agonises between life and death. The recent enforcing of co-payment for the medical treatment in hospitals deepens the health crisis in a country like Romania, where over 50 pc of the population is affected by poverty. Romania will continue having the lowest life expectancy in the EU.

We have the highest child mortality in the EU and a high incidence of cardiovascular, lung and kidney diseases, diabetes, cancer, AIDS and – of late – even Alzheimer. When they are either in power or in opposition, Romanian politicians accuse each other for the chronic underfinancing of the health system, although – for the last 18-20 years – neither of them was able to increase the percentage of the GDP allocated to the medical system above 2 pc – 2.5 pc. When they are in opposition, almost all politicians accuse the fact that granting funds from the budget mainly reflects the political colour of counties and managers, ignoring the constitutional imperative of the equal access to health for all citizens. But as soon as these accusers take the power, they act the same way as their predecessors. This is the reason for many hospitals lacking medicines, modern equipment and medical devices, and especially the medical personnel, which was forced to emigrate by the most severe wage discrimination.Discrimination is commonplace in the medical sector, and it is so pressing that it even threatens the well-meant measures, which are however deprived of a sense of perspective. Such examples are the organisational initiatives envisaged by the Ministry of Health, about disbanding many structures operated by the Ministry in the present counties and firing thousands of employees, on grounds that the Parliament plans to transform the existing counties into 8 or 10 regions. But it would be logical, natural that these changes envisaged for the medical system follow, instead of preceding the new regionalisation of the country.

The temporal inversion of these initiatives is – according to a popular expression – an example of “chasing one’s tail.” Because of these frequent measures, without perspective, the pretended reformers of today see themselves forced to restart their efforts again and again, ignoring both the precedents and the consequences of their action. The apparent evolution is thus only a continuous involution which soon ends in catastrophe. The negative demographic index is a severe warning of this catastrophe.

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