Family doctors threaten protests, retirement following budget cuts

Family doctors in Romania express dissatisfaction with the National Health Insurance House’s proposal to reduce the budget for family medicine by 30%, which will be in effect from 1 February, and are threatening to protest and even retire in retaliation.   Around 100 family doctors from Mure? County already protested for two hours on Tuesday in front of the Prefect’s Institution, Agerpres reported. They have formally requested the retention of tariffs for medical services at the levels established in the last quarter of 2023.   Approximately 4,000 family doctors are over 65, with some expressing a preference for retirement if the proposed 30% reduction is implemented. “The underfunding is drastic, and it is very difficult to sustain our practices – we cover absolutely everything, staff salaries, contracts, invoices, cleaning staff salaries”, a doctor said.   In addition to the protests, older doctors are contemplating retirement, potentially exacerbating the existing staff shortage crisis in family medicine. Alternatively, the option of patients covering costs is being considered. The National Health Insurance House (CNAS) management argues that the institution’s budget is constrained and must be equitably distributed among all healthcare providers.   Health Minister Alexandru Rafila said additional funds will be granted during the budget rectification.   Prime Minister Marcel Ciolacu assured that “no medical offices will be closed”. He hopes that the newly appointed CNAS president, a family doctor, will initiate negotiations with her colleagues.   MP Oana Cambera, vice president of the REPER party, highlights that these cuts impact medical staff and “have a profoundly negative effect on patients, especially those with moderate and low incomes”.CNAS published last week in the decision-making transparency process the value of points per capita and per service in primary healthcare and the value of points per service in specialist outpatient healthcare.The value of the points calculated by CNAS is as follows: for the point per capita - 7.7 lei; for the point per medical service in primary healthcare - 6.2 lei; for the point per medical service in specialised outpatient healthcare units - 3.3 lei.Bucharest-Ilfov Association of Family Doctors president, Dr. Sandra Alexiu, pointed out in a press conference on Monday that "very hard to bear decreases" are proposed for family medicine and for the specialist outpatient units.She explained that if the contract with CNAS is not extended, consultations are paid for, referral notes - hospitalisation, compensated prescriptions, medical leave cannot be issued. "Whenever there have been such situations, we have provided emergency care," said Sandra Alexiu."The publication in decision-making transparency of the draft rules of the framework contract for 2024, which propose much lower values of services for family medicine and outpatient medicine, has as an immediate consequence the drastic decrease in the income of the practices after 1 February 2024. Together with the additional and burdensome tax changes expected in 2024, the increase in inflation and the introduction of new control mechanisms and sanctions, these will generate decreases of up to 50% in the invoice values of our practices, which will bring primary and outpatient medical care to the brink of collapse," family doctors from Bucharest and Ilfov say in a press release.