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Record deficit of Health Fund. Higher expenditures than estimated and half of budgeted subventions

de Mariana Bechir , 11.9.2017

The deficit of the Nc (FNUASS) reached a record high of ROL 1.564 billion at the end of July, according to the budget implementation in the first seven months.

Not because the amounts collected in the main revenue chapter (health insurance contributions) were below expectations but first because the state paid only a small part of the subsidies promised under the budget law.

Of the total promised amount of ROL 2.815 billion, only ROL 0.779 billion have been transferred from the state budget to the Fund in the first seven months. That is, about half of what was due, equally distributed, to the first semester.

The deficit, estimated at a surrealistic level of only ROL 0.4 million, was similar to the one obtained last year (ROL 1.074 billion at the end of June, compared to ROL 1.155 billion total deficit in 2016).

In fact, July alone recorded a deficit of nearly ROL 490 million, equivalent to one-third of the total deficit for the first seven months.

*

  • (in billion lei)    2013    2014    2015    2016    Forecasted in 2017 budget     Situation at the end of July
  • Revenues
  • Insurance contributions
  • Subsidies
  • Expenses
  • Goods and services
  • Deficit

*

Physician Mihai Negrea (photo), a specialist in health management, told cursdeguvernare.ro that “the situation is already felt in the market as suppliers already have very big difficulties in receiving payments.”

And, if you look closely, nobody makes any purchases in hospitals. If they have scheduled to buy CT systems, for example, they keep the money in their accounts, even if it has been budgeted for this year, to see how they manage to maintain within the available amounts.

Everybody expects the budget amendment because there are a lot of spending committed until the end of the year,” Mihai Negrea said.

They only purchase equipment (CT, MRI, etc.) and other goods through the national programs run by the Ministry of Health, but hospitals stick only to consumables.

Subsidies – granted only to cover salaries in public health system

Subsidies are granted to cover the income of the medical staff from the public system. Normally, salaries should be ensured from the revenues obtained from tariffs of the medical services settled by the National Health Insurance House to hospitals.

Technically, they appear in the chapter of “Goods and Services”, which do not seem to be significantly distorted. Total expenditures, as we can see, are greatly exceeded by the estimate – 17.060 billion, compared to the 28.809 billion lei provided in the budget for the whole 2017.

The remainder needed to cover salaries is ensured through a chapter called “Transfers” where ROL 3.342 billion have been forecasted but ROL 2.920 billion had been already consumed by the end of July, which means that the excess would be huge by the end of 2017.

According to physician Mihai Negrea, “the payroll in hospitals is currently 120% of the revenues invoiced to the House”.

“If subsidies were not given, they would not have money for salaries. When Victor Ponta issued emergency ordinance        35 (raising by 25% in August 2015 the salaries of all employees from the public health sector, not just doctors and nurses), the payroll in a hospital was somewhere at 60% of the total revenue. There have been two more increases since then and we should keep in mind that bonuses have increased exponentially,” Mihai Negrea explained.

If subsidies were not granted and tariffs increased to cover salaries, the price of medical services in Romanian state hospitals would become to compete with the prices abroad.

The House’s costs would increase though much more, because if it were to modify the tariffs, it would also have to settle the services in the private network in the same way. It would be huge amounts, impossible to fund from the contributions paid for health insurance.

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