Article in the international perspective column of JAVA, highlighting healthcare and vascular access in Romania

1. I N T E R N A T I O N A L P E R S P E C T I V E
Health Care in Romania:
Highlights and Future Direction
by Sheila Hale, BSN, RN, CRNIÒ
, VA-BCÔ
T
his article highlights health care in Romania, which is
predominantly in the public sector, under the auspices
of the Ministry of Health (MoH). Romania is in the
southeastern region of Europe, approximately the size of Ore-
gon. It covers an area of 238,000 km2
(92,043 square miles).1
It is bordered by the Black Sea, and is between Bulgaria and
Ukraine, but also bordered by Hungary and Serbia to the
west and Moldova to the east (see the Figure).1
Romania’s estimated population was 21.6 million in July
2015 and its capital city is Bucharest.1,2
Romania has a unitary,
semipresidential republic government with 41 counties. Its
independence from the Ottoman Empire was recognized in
1878 and the republic was established in 1947.1
Romania
joined the European Union in 2007 and is the seventh most
populous European Union state.1
The median age of residents is 40.2 years, and the birth rate
is 9.14 births/1000 population (growth rate of À0.3%).1
Life
expectancy at birth in 2013 was 74 years (total population),
which is slightly higher than other European and Central Asian
countries.1,2
Major ethnic groups include Romanian 83%,
Hungarian 6.1%, Roma 3.1%, Ukrainian 0.3%, and unspeci-
fied 6.1%. The official language is Romanian, but other
languages in common use include Hungarian and Romany
(Gypsy).1
The gross domestic product (GDP) per capita in Romania
was US$19,700 in 2014.2
Its GDP composition is primarily
in the services sector, followed by industry and agriculture.
The World Bank classifies Romania’s income group as
upper-middle.2
In 2013, the World Health Organization,
European Region, determined Internet use among Romanians
was 49.8%.3
Health Care
Romania has a universal health care system much like other
countries such as Canada, and health expenditures equaled
5.3% of GDP in 2013.4
The MoH is responsible for public
health care in Romania. The state is obliged to fund public
hospitals and clinics, as well as pay for medical examinations,
surgical interventions, and postoperative care. The universal
health care coverage is funded by a mandatory pay-roll tax.
There is a growing trend of private hospitals and partnerships
in Romania. The Joint Commission International accredits 1
private hospital in Bucharest: Spitalul Baneasa Regina Maria
Reteaua Privata de Sanatate.5
The leading cause of death in Romania is cardiovascular dis-
ease.6
Chronic diseases in Romania include diabetes, which is
a major health issue with a rate of 8.4% per total population
and 17% incidence of impaired glucose intolerance.6
Accord-
ing to the World Health Organization, diabetes is the fourth
leading cause of death in Europe. Obesity is another major
health issue, with 1 in 3 Romanian men being classified as
overweight. One in 4 Romanian women are overweight and
1 in 10 is obese.6
The regulatory body for nurses (along with the MoH) in
Romania is The Order of Nurses, Midwives and Medical
Assistants in Romania (OAMGMAMR), which mandates the
professional requirements of nurses, medical assistants, and mid-
wives.7
This organization is responsible for the creation of rules
and standards of practice for nurses, midwives, and medical assis-
tants. Without a membership certificate from OAMGMAMR,
nurses, medical assistants, and midwives cannot legally practice
their profession.7
In 2014, OAMGMAMR became a member
of the International Council of Nurses.7
Vascular Access
In Romania, physicians usually insert all central venous cath-
eters (CVCs), including peripherally inserted central catheters,
using ultrasound and fluoroscopy to aid in the insertion and
tip confirmation (D. Tomescu, personal communication,
November 7, 2015). Nurses and doctors place peripheral intra-
venous access devices and nurses provide the routine care and
maintenance of all CVCs. CVC insertions are considered a
sterile procedure and the Centers for Disease Control and Pre-
vention (CDC) guidelines are followed informally, with intention
to make them formal: “We are planning to translate the CDC
guidelines into Romanian, and I plan to ask the Romanian senate
of the National Society for Anesthesia and Intensive care to
adopt them as national guidelines and to start implementing
them” (D. Tomescu, personal communication, December 5,
2015). In major hospitals there are local guidelines, but overall
there is no standard in place. Currently there is no vascular
access specialty organization in Romania, although there is
2016 j Vol 21 No 1 j JAVA j 27

2. great interest in establishing such an organization (D. Tomescu,
personal communication, November 7, 2015).
Home Health and Community Care
The MoH has announced reforms in health care to enhance
the efficiency, quality, and accessibility of the system.8
There
is especially a need for health care in the disadvantaged,
remote, and isolated communities of Romania. Another goal
is to reduce the high number of inpatients by improving outpa-
tient services.8
The Romanian National Health Strategy, “Health for Pros-
perity,” is a commitment from the Romanian government to
promote health.9
This is accomplished by creating community
centers where the population has access to basic, cost-effective
health care services. Primary, secondary, and tertiary preven-
tion services; home health care; and palliative care as well as
specialty care and school health care will be offered.9
The
goal is to promote healthy lifestyle choices. The MoH has an
initiative to establish community nurses and health mediator
professionals to assist in this endeavor.9
Summary
Romania’s current health care climate boasts reform and
changes, from the public sector to private, in areas of home
health care, community care, and vascular access. There is also
a trend toward less inpatient care and more care provided on
an outpatient basis in community centers. Vascular access in
Romania remains primarily in the domain of physicians
because nurses are still considered doctors’ assistants. However,
if the CDC guidelines become the national standard, perhaps
vascular access can gain momentum, moving into step with
other countries, where nurses and other disciplines insert CVCs.
Acknowledgment
The author thanks Dana Tomescu, MD, PhD, Associate
Professor, Department of Anesthesia and Intensive Care, Carol
Davila University of Medicine and Pharmacy, and Head
of Anesthesiology and Intensive Care Department, Fundeni
Clinical Institute, for providing much of the information
contained in this article.
References
1. Central Intelligence Agency. The world factbook. 2012-
2014. https://www.cia.gov/library/publications/the-world
-factbook/geos/ro.html. Accessed November 27, 2015.
2. The World Bank. Data, Romania. 2014. http://data
.worldbank.org/country/Romania. Accessed November 27,
2015.
3. World Health Organization. Romania: country indicators.
http://www.who.int/medical_devices/countries/rou.pdf.
Accessed December 3, 2015.
4. World Health Organization. Romania: data and statistics.
http://www.euro.who.int/en/countries/romania/data-and
-statistics. Accessed December 3, 2015.
5. Joint Commission International. JCI-accredited organiza-
tions. http://www.jointcommissioninternational.org/about
-jci/jci-accredited-organizations/?c¼Romania&a¼Hospital
%20Program. Accessed November 27, 2015.
6. Changing Diabetes Barometer. Diabetes facts and figures
in Romania. http://www.changingdiabetesbarometer.com/
Figure. Map of Romania.
28 j JAVA j Vol 21 No 1 j 2016

3. diabetes-data/countries/Romania/fact-sheet.aspx. Accessed
November 27, 2015.
7. Order of Nurses, Midwives and Medical Assistants in
Romania. Who we are. http://www.en.oamr.ro. Accessed
December 3, 2015.
8. Export.gov. Health care resource guide: Romania http://
export.gov/industry/health/healthcareresourceguide/romania
084309.asp#P25_2872. Accessed December 4, 2015.
9. Onofrei L. The Romanian national health strategy-2014-2020:
health for prosperity-community medical assistance.
J Integrated Care. 2014;14. URN: NBN:NL: UI:10-1-11623.
http://dx.doi.org/10.1016/j.java.2015.12.003
Copyright Ó 2016, ASSOCIATION FOR VASCULAR
ACCESS. Published by Elsevier Inc. All rights reserved.
2016 j Vol 21 No 1 j JAVA j 29