​Dan is chronically ill and receives two compensated prescriptions every 3 months: one for hypertension, written by his family doctor, and one for diabetes, written by the clinic’s diabetologist. Both of Dan’s doctors have decided that as of February 1st, they will no longer sign a contract with the health insurance company and will work on their own. Dan now pays 240 lei at the pharmacy for two compensated prescriptions. From next month, if his doctors no longer work with CNAS, he will pay the full cost of the drugs in the pharmacy – 1,200 lei. In addition, two more consultations will be paid for – a family doctor and a diabetologist, which are now free.

Reimbursed prescriptions and referral vouchers, for issuing which family doctors are ridiculed, are the policyholder’s gateway to the system

The withdrawal of family doctors and outpatient specialists from the contract with the NHSHU will mean that they will write only uncompensated prescriptions, which the patient will have to pay in full – he will pay a one-time cost of the consultation and prescription, in the doctor’s office, and then he will pay for the prescription in full at the pharmacy.

We are talking about a difference of hundreds of lei, which many patients cannot afford. Also, talk about people who have invested in health insurance all their lives.

Dan has two chronic illnesses but is not retired, working full time. However, he says he won’t be able to afford the costs if there are no more covered prescriptions. Thousands of patients from Romania will be in his situation.

In addition, with the closure of doctors’ contracts with CNAS, the referral vouchers issued by the family doctor to doctors of other specialties or for medical tests and paraclinical studies also disappear. Although CNAS’s monthly limit often runs out quickly and patients have to wait months for tests, for some of them who cannot afford to pay out of pocket, it is the only way to access medical tests.

Although GPs have often been derided or stigmatized in recent years as “just prescribing and referring”, they are essentially the gateway to the system for insured patients. They are at risk of disappearing with the termination of the contracts of family doctors and outpatients with CNAS.

Doctor’s consultation / Photo: Ngampol Thongsai / Dreamstime.com

The closure of CNAS contracted offices will put even more pressure on already overcrowded hospitals. Only a small percentage of patients will afford the costs privately

The role of family and outpatient medicine is also to solve some cases and take pressure off hospitals.

According to the College of Physicians, 70% of medical cases are resolved in primary care facilities and specialized outpatient clinics and do not lead to overcrowding in hospitals, which are also in high demand.

“This polyclinic serves 200,000 patients. 200,000 patients will remain on the streets,” says Dr. Ligia Moshneaga, a family doctor at Policlinica Vitan, the largest in Bucharest.

According to the College of Doctors, the immediate risks of the protest of family and outpatient doctors are the depopulation of the first contact system due to the mass closure of offices.

“Pre-hospital medicine is a source of budget savings, not costs,” Rodica Tenesescu, president of the National Society of Family Medicine, said yesterday after the first conversation with CNAS management.

In general, patients would either come to the doors of hospitals that are already overcrowded — and where, in theory, you are admitted either as an emergency or by referral only — or they would migrate to the private system, where only a fraction can afford it. And, most likely, those who can afford it are already subscribers of private clinics.

Protest of doctors in front of CNAS headquarters / Photo: Inquam Photos – George Călin

We are looking for a solution: on Thursday, doctors are negotiating with the Medical Insurance Fund

The rates proposed by the CNAS are lower than last year and GPs and outpatient specialists (polyclinics) are threatening to stop signing contracts with the House of Health Insurance from February 1, which could mean they will not provide consultations by appointment from next month, but only for a separate fee.

Some of them even say that they will close their offices and go to work in a private system.

On Thursday, representatives of doctors are negotiating with the management of the Hospital Company in search of a solution. The delegation representing doctors at the negotiations is headed by the president of the College of Doctors, Daniel Coriu. The delegation that will negotiate with CNAS also includes Dr. Hindrovel Dumitra, family physician and general secretary of the College of Physicians, and Dr. Cosmin Alexandrescu, president of the Professional Association of Outpatient Physicians.

The main dissatisfaction of doctors – both family doctors and outpatient specialists – is not necessarily that they are poorly paid, but that CNAS wants to pay them less than they were paid last year.

Incomes for both family doctors and outpatients are set to fall this year compared to the second half of last year, when they rose, according to CNAS proposed amounts published last week in transparency decisions for doctors’ services.

How much will the amounts coming to the offices decrease:

At family doctors:

• The cost of a point per capita decreases from 12 lei in 2023 to 7.7 lei in 2024

• The cost of points for a medical service will decrease from 8 lei in 2023 to 6.2 lei in 2024

Outpatient (polyclinic) specialist doctors:

• The cost of points for a medical service will decrease from 4.5 lei in 2023 to 3.3 lei in 2024

• Outpatient doctors do not receive money per capita

Photo: Dreamstime.com, Inquam Photos

Read also:

• How much does a family doctor and polyclinic specialist earn? How much truth is there in the doctors’ protest?

• VIDEO Protests of doctors. Pretzels and toilet paper were brought to the door of the Ministry of Finance / And the employees of the Anti-Discrimination Council started protests

• Doctor’s riot: CNAS staff want patient to call to confirm they’ve been to the doctor – police stupid idea / You’ll end up consulting your fortune tellers, numerologists and astrologers

• Family doctors and outpatients will be able to consult for a fee from February 1, if CNAS does not increase the established tariffs / Rafila: I am at the Ministry of Health / Reaction of NSKU

• Rafila about family and outpatient doctors who can no longer provide inpatient consultations: I am at the Ministry of Health, negotiations and contracts are being concluded with CNAS

• CNAS will start negotiations with family and outpatient doctors in 3 days: “We have a limited budget, but we are making every effort to guarantee access to medical services”

• “Cholaku, we want to work, not repurpose!”. Dozens of doctors protested in front of the largest polyclinic in Bucharest

• How much a family doctor or outpatient doctor will receive from CNAS in 2024 for each patient and each medical service