Essay Prevention Is Better Than Cure

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“Half of the resources provided by CNAS is consumed by hospitals, which treat only 10% of the total population,” he says.

“Half of the resources provided by CNAS is consumed by hospitals, which treat only 10% of the total population,” he says.

Total health expenditure is difficult to measure because the records of private expenditure are incomplete, notably with regard to fees charged by private providers and informal or ‘under-the-table’ payments made in the public sector, but according to the available data, from 2000 to 2005 total health expenditure as a percentage of GDP increased from 4.1% to 4.4%, considerably lower than in most European Union countries.

Mandatory health insurance was introduced in 1998, and became the main financing mechanism for health (the rest is made up from general tax revenue) but for Stafie social health contributions are too low and too many people are exempt from these contributions for it to be effective.

He gives equal weight to a health-care tradition that puts too much emphasis on treatment.

“As doctors, we were taught to treat a disease, not to prevent it,” he says, adding: “That’s what we learned at school and for 20 years that is what we have been doing!

But after the fall of Communism in 1989, major health system reforms began and by 1998 a decentralized social health insurance system had been established.

Health reforms in the 2000s aim to shift the focus to prevention, but this is still a work in progress.There must also be interventions for policy and environmental changes.” He adds: “To effectively address noncommunicable diseases, collaboration is required within and beyond the government sectors.”Suciu does her best to alert patients to the dangers of sedentary lifestyles, smoking, and eating foods that are high in salt, sugar and fat content, but such warnings have their limitations: “Most of my patients do not follow my advice regarding prevention,” she says.When it comes to our health, prevention is much better than cure.Dr Maria Suciu, a general practitioner based in the western city of Arad, says: “The amount of money we receive from the National Health Insurance House is very small and we cannot equip our office.” Suciu says that she is unable to carry out even basic diagnostic procedures such as measuring blood sugar and cholesterol levels.She estimates that it would cost €30 000 to equip her office for such tasks with a minilab, and with that equipment 40% of the noncommunicable diseases she sees could be managed much better over the next 10 years.The focus on treatment, especially tertiary (hospital) care, rather than prevention and early detection at the primary health care level is reflected in the government’s health expenditure too, which focuses narrowly on hospitals at the expense of primary health care.For Dr Liviu Stafie, at the Regional Health Insurance House (Casa Judeteană Iasi de Asigurări de Sănătate or CNAS) in the city of Iasi, this focus on hospitals is one of the biggest problems Romanian health care faces. Ioana Gheorghe (not her real name), 75, who lives in the western city of Timisoara went to her general practitioner twice complaining she felt poorly. In his opinion, my condition was perfectly fine for my age.” She had her first stroke shortly thereafter, and then a second following a period of hospitalization.Gheorghe is one of a growing number of Romanians struggling with the debilitating effects of cardiovascular disease – especially heart disease and stroke – which now accounts for an estimated 60% of all deaths in the country, making it far and away the leading cause of death in this nation of 21 million in south eastern Europe.Popescu, a former president of CNAS, shares Stafie’s despair over funding, noting that only a small portion of the population pay these contributions.“The rest of the population does not contribute because of various exemptions.


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