Medical system in Romania
Ukrainians are indeed entitled to the same medical care as Romanians, even despite the fact that they may not have working contracts nor the same tax burden.
With temporary protection Ukrainians are entitled to free urgent/emergency care.
Emergency care cases are considered those who pose a threat to life. In such cases Ukrainians can call the ambulance or go straight to an emergency care department.
For preventive care it would be useful to visit the website of the National Health Insurance House – Casa Naţională de Asigurări de Sănătate – cnas.ro where there is a published document, relevant up to date, regarding the access of Ukrainians to the medical system in terms of preventive care.
This document gives pathways on how to navigate the public medical system for preventive medical care for Ukrainians. The document is translated into Ukrainian and can be found here:
The main information that should be taken out from this document is the following:
- Point of entry into the social health insurance system starts from enrolling with a family doctor;
- To enroll with the family doctor the following documents are needed: temporary protection and the passport with which Ukrainian refugee crossed Romania’s border.
- It will take up to a week for the data to be registered in the medical database and after that the Ukrainian will be assigned a social health insurance number, which will allow him or her to be “visible” to all the public medical institutions.
- Family doctors then will be able to provide referrals to the registered Ukrainians for narrow specialists. These referrals are called biletul de trimitere and are of a specific CNAS template. Such referrals allow Ukrainians to get free consultations from narrow specialists (one referral is up to 3 consultations per specialist). Thing to keep in mind: narrow specialists can provide free consultations under such referral only if they themselves are in contract with CNAS.
- For a list of hospitals, laboratories, specialists who are in contract with CNAS you can click on the following link: http://cas.cnas.ro/casmb/map-county
- To understand if the insurance cap is still on for paraclinical and other procedures and to see the insitutions’ reporting, you can click the following link: http://www.casan.ro/pharmacy/home Please keep in mind that not all institutions update the reports daily, so it would be advisable to call the institution beforehand and find out if the insurance cap is still on.
- Referrals can be given out for consultations, procedures and services, paraclinical investigations and medicine.
- For some illnesses that require antibiotics or special treatment – a prescription or an e-prescription is given out by the doctor. These prescriptions are the only pathway to acquire such medicine from the pharmacies. Depending whether the diagnosis of the patient is classified as a chronical, acute or semi-acute illness – the prescription has a different duration of validity, which should also be taken into consideration when planning to obtain a certain medicine. More about this can be found in the guidelines for Ukrainians provided by CNAS.
Important moment to keep in mind: even if one institution runs out of insurance funds for reimbursement for paraclinical investigations or imagistic exams, there is always a possibility to search for other institutions where the funding is still in place. There is an informal rule that many Romanian citizens follow – to make paraclinical investigations through a referral for free of charge– it would be advisable to do that at the beginning of the month.
As mentioned above, the entry point to the public system is through enrollment with a family doctor. But even with a family doctor it is advisory to plan your consultations and paraclinical procedures beforehand, as there is frequently a waiting list to different narrow specialists and to certain procedures. Sometimes the waiting list for certain imagistic exams to be done through a referral can be up to 2 months.
Private system is much simpler but a much more expensive option. For private system you do not need a temporary protection, but just an ID. Due to financial costs, to schedule an appointment through private care can be easier and quicker. Private care may have some advantages in other exceptional cases.
In private medical care all payments are according to invoices.
In public medical care payments are through invoices if a procedure/service is not covered by CNAS or if the doctor is not in contract with CNAS. Otherwise, the family doctor and then later the narrow specialists can give official referrals for procedures/consultations and examinations which can be free of charge with correct planning.
Romanian medical institutions do not have an inhouse interpreter for Ukrainians. In majority of the cases doctors speak only in Romanian, but some speak English. There are cases of Russian-speaking doctors who are of a Moldovan origin. It would be advisable to ask at the reception of a clinic/laboratory/maternity hospital if they have a Russian-speaker amongst their personnel.
Not all clinics allow interpreters to be present during medical consultations without signing special consent forms from the patient. This is done to take the responsibility load off the medical institution in case of misinterpretation which may later have consequences and due to handling personal information and a third party knowing the medical condition of a patient, which is considered personal data. Similar is the stance regarding the translation of medical history, tests and any other medical data. Some hospitals demand official accredited interpretation before proceeding with any treatment (especially in cases of serious illnesses.
Nevertheless, a lot of clinics allow interpreters to accompany Ukrainian patients to facilitate the communication during the consultation. There were cases of refusal to provide Ukrainian patients with medical consultations if the Ukrainians knew neither English nor Romanian and had no interpreter accompanying them.
Romanian medical system and protocols regarding birth differ from the Ukrainian one. Doctor who assists in delivery is the one who is on shift at the maternity hospital. Romania has a reputation regarding a high percentage of Caesarean sections and a low number of natural birth deliveries. Postnatal care is completely opposite to the Ukrainian one. After delivery children are taken to a separate nursing room which sometimes may interfere with breastfeeding and the actual proper natural flow of the breastfeeding process.
Delivery takes place at state maternity hospitals and are free of charge. For private care section deliveries are not free of charge. Most maternity hospitals in Bucharest have Russian speaking doctors. Also, maternity hospitals can provide such services as gynecological consultations or examinations, colposcopy, imagistic examinations and others. All can be free of charge with an official referral from the family doctor. Regarding pregnancy medical surveillance and what is in the national protocol for pregnant women – all this information can be read in the guidelines provided by CNAS (https://cnas.ro/alaturi-de-ucraina/)
In case of emergency situations Ukrainians should call an ambulance. Emergency care is free of charge. Criteria and what is considered under the cap of emergency care (duration of services and treatment in an urgent case scenario) is also explained in the guidelines published by CNAS.
Another option is to reach the urgent care department of any public hospital on your own. There, the medical personnel after registering you (you should have an ID and/or temporary protection permit with you), will evaluate your medical condition and place you in the “red”, “yellow” or “green” zone. This is done to prioritize patients accordingly to the graveness of their medical condition at that instant in case if there is a waiting line for the aid.
Upon the discharge, patient is presented with an invoice for the acknowledgment how much this emergency care cost. This invoice will later be sent over for reimbursement from the State. The invoice is presented for acknowledgment reasons only.
Private medical care has their own individual schedule which is very easy to find out even through such apps as Google maps.
Pharmacies, in their vast majority, do not work after 20:00 on a working week day, on Saturdays they work for the first half of the day until 15:00 and on Sundays – they are closed. But in cases when pharmacies are situated in shopping centres, they usually work until the closing hours of the shopping centre and without days off. The only exception being – state holidays. During state and religious holidays, pharmacies do not work.
Maternity hospitals, state hospitals work without days off. Most hospitals both in public and in private care have emergency departments which work either 24/7 or late into the night.
Access to national medical programs are only eligible if a Ukrainian is enrolled with a family doctor and has received a unique health insurance number under CNAS.
Medical check ups for athletes are not free of charge. In Bucharest such targeted medical check ups can be done for athletes at the National Institute of Sports Medicine at the address: Bulevardul Basarabia, 37-39.
This project is funded in part by a grant from the U.S. Department of State. The opinions, findings, and conclusions presented in this page are those of the author(s) and do not necessarily reflect those of the U.S. Department of State.