Study reveals CNAS tariffs fall short of real hospital costs

A recent study titled 'Transparency of Money in Romanian Medical System' (second edition) reveals a financial gap where tariffs reimbursed by the National Health Insurance House (CNAS) fail to meet the actual costs of hospital services. This gap impacts both public and private healthcare providers' ability to ensure patient access to necessary medical care.

The study points to a significant funding issue due to differing mechanisms in financing public and private hospitals. More than half of the CNAS income for public hospitals is influenced by salary payments, a factor separate from and independent of the payments for medical services. This allows public hospitals to receive substantially more funding, an advantage not shared by private hospitals.

In 2025, the National Unique Fund for Social Health Insurance (FNUASS) allocated 16.9 billion lei for salaries, surpassing the 14.87 billion lei for public hospital services. Meanwhile, private hospitals performed 2.31 million day hospitalizations, nearly 40% of the national total, yet remain disadvantaged by the current funding model.

Cristian Hotoboc, a prominent voice in the report, stated, "Public and private sectors are complementary." He stressed the need for fair competition, noting, "Performance needs fair competition with unitary rules."

To address these disparities, the study proposes recalculating hospital service tariffs to better reflect actual costs and gradually eliminating the separate salary influence mechanism, suggesting a transition period of three to four years for these changes. The study advocates for funding neutrality across the healthcare system, promoting 'same payment for the same service' regardless of whether the provider is public or private. It further recommends assessing provider performance based on patient outcomes and service quality.