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Romania's drug market expenditure was RON8.42bn (US$3.05bn) in 2009. Out of the 20 Central and Eastern European (CEE) countries analysed by BMI, this figure positions Romania seventh in terms of market size, However, per-capita spending on pharmaceuticals of just US$141.9 in 2009 places Romania 14th in the region for this indicator and reflects the limited funding available for high-value innovative drugs. The long-term prospects for Romania's attractiveness to pharmaceutical companies are dependent on the implementation of proposals for healthcare reform, which is expected to be completed by the end of 2010. While there are significant downsides to the proposals, BMI believes they are necessary to ensure the long-term financial sustainability of the healthcare in Romania, which will ultimately benefit the pharmaceutical companies operating in the country. While Romania's predominantly publicly-financed healthcare service has been chronically underfunded for many years, action will be forced as a result of extensive budget deficits in the healthcare system that have built up over the last two years. Worryingly, the last trimester of 2009 was financed with credits from the 2010 budget, and many had feared that the entire 2010 budget would only last until July. While Romania's healthcare system faces immense challenges in the short to medium term, it is unlikely that the provision of medical services will collapse due to budget shortfalls. In January 2010, a source at the Romanian College of Physicians reported to the Canadian Medical Association Journal (CMAJ) that funding for the healthcare budget would only last until mid 2010, and that the system was facing imminent collapse. At the time, Romania's minister of health, Atilla Cseke, did not dispute the suggestion. Paradoxically, the fact the country's healthcare system has been so chronically underfunded over the last decade makes it less likely that continued funding shortfalls will push the system over the edge. In the short term, Romania's health minister hopes total collapse will be prevented with more efficient use of existing funds, the elimination of waste and introduction of co-payments. However, in the long term BMI believes that only more substantial funding changes will avert failure in the medical services sector. Reduced revenues from the country's National Health Insurance Fund (CNAS), which is primarily financed by wage contributions, have been hit extensively as Romania went through a recession in 2009 and suffered from higher levels of unemployment.