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Does anyone know about the Health system in Romania?

Hi - I am just hoping someone can let me know how the health system in Romania - I am coming to Romania next year but this question is about a Romanian friend I have.

She is heavily pregnant and is telling me the baby is in the wrong position and that a cesarian is necessary but that they will not perform a cesarian without the fee being paid up front. Would anyone be able to tell me if this is true? as to me it seems quite unlikely that they would not at least allow the mother to pay off the fee in instalments after the fact. But then paying for such things at all sounds completely alien to me, being used to the NHS in UK so perhaps I am being naive?

Any info on the issue would be much appreciated?

There are two possibilities. Firstly, she may be giving birth at a private clinic. In this case, as far as I'm aware, there is a fee that should be paid at the time of the operation (not sure if you pay first or get an invoice just after). I imagine it'd work much like is does in the UK.

The second possibility if that she's having the baby with the state service, equivalent to the NHS. Just like the NHS, this is 'technically' free. However, the doctors here are underpaid and have no equipment and little medication, so the usual practice is for the patient to 'pay' for the operation. This will including 'tipping' the various people who might take part in the operation; surgeon, midwife, nurse, anaesthesiologist - and the doctor will purchase the consumables he/she needs (such as pins, artificial joints, or whatever the operation requires). They'll also use the money for subscriptions to medical journals and attending symposiums and conferences related to their fields so that they can keep up-to-date with the latest in their specialisation. It also tops up their salary. All of this is illegal/unofficial, of course, but if they couldn't do it, there'd be no doctors in the public sector.

This is where the problem occurs. Most people see this 'payment' as a kind of bribe, and in a lot of cases it is. The problem is knowing which doctor uses this money for the above purposes and which just pockets the whole lot. I know that last year they started cracking down on this and so most decent specialists started preparing to move to other countries where they can earn a reasonable salary without having to beg the patients for money, which could lead to a massive talent drain in Romania. Another doc I know works in the UK for three months and earns enough that she can spend the rest of the year working in Romania without having to ask for these 'tips'.

So, if she's using the 'NHS', then she would definitely need some money up front.

Just by searching online a little, a caesarian at a private clinic costs about 1000 pounds (or more for some extra services, like single room etc) and includes food, analysis, consultancy, vaccinations, and so on. They'll be other costs throughout the pregnancy, but I guess as you said she's heavily pregnant she's already managed those. The 'free' state healthcare service will probably be (again, from browsing Romanian online forums) about 500 pounds for the operation itself, but they'll be a lot of extras here and there, you'll have to buy some of the medication yourself, tip the nurses and so on. I remember one friend telling me how she'd had one of her kids on the state, the other private, and in the end it didn't really make much difference financially.

If it's the state situation, they'd never accept to be 'paid later' as this would mean most people would do a bunk and never pay as there's no legal backing to the 'fee'.

Thank you - this is so helpful - I really appreciate your taking the time to tell me this xxx

You are right , in uk nhs the best system in the world, you would not get any where . even  u go to usa they will do the same as Romania but expect the worse in this country . i had little chance to dig out health system even in university hospitals, complicated ,secretive corruptive net work, and you can not talk to anybody one is language and other you donot know whom to approach.
Get some Romanian friend who knows the inside of that hospital where you plan to go.
Wish you good Luck
Dr Iqbal Qadir

This is very eye opening - thank you for taking the time to share your understanding of the system with me. Shame our government is trying to dismantle the NHS, I don't think people realise how much worse it could be!  x

PS sorry to be naive but what happens to the people who literally cannot pay? if they have a breach birth and can't possibly afford to get a cesarian? do they just have to try birthing the baby naturally and hope for the best? x

geetargirl wrote:

PS sorry to be naive but what happens to the people who literally cannot pay? if they have a breach birth and can't possibly afford to get a cesarian? do they just have to try birthing the baby naturally and hope for the best? x

I'd say they should have thought better of the potential costs before getting pregnant!  They will give birth, but it may be breach, or without epidural or other pain relief and with minimum service at the hospital.  It's definitely not a good situation to put oneself in.

I would agree with pretty much everything Maykal discussed.  No matter whether you're giving birth in the state or at a private hospital, you're going to need to pay someone for their services.  I agree with also with Maykal's comment about the state doctors "payment" being viewed as a bribe, particularly because such payments are not openly posted anywhere unlike with a private doctor/hospital.  You're expected to inform yourself on how much to pay (bribe) the doctor, the anesthesiologist, the nurses and assistants, the person that brings food. 

Having been through the childbirth process twice here, the first a state hospital and the second at a private hospital, the difference is remarkable....and the price came out about equal!  At least with the private doctors/hospital, we were treated much much better, had much nicer conditions in the hospital, and all the costs were upfront and transparent.  Whereas at the state hospital, we had to slip each person a sum of money and yet we were still treated pretty awfully and my wife had to stay in a room with 2 other mothers and their infants.  After that experience, we always avoid the state hospitals for anything serious.

Although somewhat off the topic, for the previous commenter that suggested the same thing happens in USA; that's an utterly ridiculous statement.  Nobody has to to take a bag of money with them to the hospital in the US to be treated or to give birth, you'll just get a nice big invoice in the mail from the hospital to settle. I'd have to doubt he has any actual experience in the United States, just as he has next to zero experience in Romania.

Romaniac

Many thanks for sharing your own experiences on this issue, it is really valuable and I appreciate it. x

Those who can't pay still get treated. If they are genuinely recognized as poor, the surgeon will usually waive his 'fee'. One doctor I know sometimes gets paid in country wine, chickens and cheese by the poor from the countryside.

However, as Romaniac states, the level of service will be different. For example, if you have money, and you need a broken leg pinned, you can afford to go to a good surgeon (yes, you basically choose your own surgeon here) who has reinvested some of his money in training and keeping up to date with procedures and who'll also procure the hardware for the operation at a better cost than you could buy it privately. If you have no money, you'll get the worst surgeon (because he'll be the one who has no other operations to do as nobody goes to him) and he'll use hardware harvested from cadavers...

Well I'm all for recycling...! thanks for your reply and further insight - my friend is indeed genuinely without money so I am wondering if she would actually be considered poor enough to be treated for free and is not telling me this part x

Is she trying to tap you up for the cash, then?

Maykal wrote:

Is she trying to tap you up for the cash, then?

yup! some of it at least x

I thought that may be the case. Unless you know this person personally and really well, I'd be wary of lending her the money. You might even find out she's making the whole pregnancy story up!

It's quite a common 'business' here to befriend people online in other countries and then lay some hard times stories on them, hoping their sympathy will lead them to an offer of financial help.

Yeh thanks it's OK - I do know her personally - we have worked together in the past and will be again next year- I know she is definitely pregnant and to be honest don't mind helping her out every now and then - but am happier having an idea of the bigger picture with regard the health system. To be honest it seems quite likely it's based on some truth but that she needs the money for something else. I had thought that if I were going to help her I would say I'd pay the hospital directly but now it sounds like that is a dodgy option as well! x

Yes, it'd be pretty much impossible to pay the hospital directly (unless she has gone private, but that's unlikely if she supposedly poor). You'll just have to transfer the money to her account and hope for the best. Maybe she's just exaggerating a little (perhaps about the need for the C-sec) to up the cost. A straight forward birth is as little as 800 lei.

If she's just asking for a couple of hundred Euro, and you can afford never to see the money again, ok. If she's asking for more, and/or after receiving it, starts coming up with more excuses for asking for more money, then I'd definitely reassess. Even knowing someone doesn't guarantee anything here...

Yeh I agree - thanks for your thoughts x

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