Center for Health Market Innovations (CHMI)

Programs

Primary Health Contracting in Romania

last updated Oct 11, 2011

Overview

Implementing organization: 
Government
Legal Status: 
Public-private partnership
Year Launched: 
1994
Stage: 
Existing/expansion stage

Funding

Primary Source of Funding: 
Government
Summary: 

In 1994 the Romanian government introduced a pilot scheme of output-based contracts for the provision of primary health services. The contracts were aimed at supporting efforts to develop the independent provision of primary services, to increase the share of health spending going to preventive care, and to improve access to health services, especially in rural areas.

Key program components: 

To help achieve these objectives, the scheme relied on output based financial incentives and competition between doctors for patients. Now, with modifications based on lessons from the pilot, the scheme has been extended across the entire country.

Lessons from the pilot led to some changes, however:

  • To reduce the complexity of the capitation, the number of age groups and rates was reduced.
  • Regulations on the capitation describe more clearly the services that need to be provided.
  • The threshold above which the capitation is reduced was set at 2,000 (3,000 in localities with insufficient family doctors).
  • A 100 percent bonus was added to the capitation for family doctors practicing in remote or low-income areas.
  • For vaccinations, fee-for-service payments were simplified (awarding all vaccinations the same number of points), and family doctors can claim payments for vaccinating patients not on their lists (such as children temporarily residing or attending schools in the doctor’s practice area).
  • Requirements for routine checkups are more clearly defined.
  • To reward effective intervention (rather than mere reporting of clinical activities of uncertain quality), more points are awarded for screening and detection of cancer and tuberculosis, but only after confirmation by a specialist physician.
  • An allowance based on the number of registered patients was introduced to cover all practice costs. This allowance is managed by the doctors, who have gained significant discretion over spending on staff and maintenance.
  • Rather than setting a cap on individual doctors’ fee-for-service payments, the new system splits the primary care budget into allocations for capitation, fee-for-service, and practice budgets.
  • The College of Physicians, established in 1997, has started to develop practice guidelines and requires doctors to participate in continuous medical education as a condition for periodic recertification. District level accreditation committees have been established, with joint representation from the College of Physicians and district insurance funds.
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