If you are an expat in Romania and suffer from a chronic illness, your treatment options and healthcare expenses will depend on your level of health insurance. You will be able to sign up for the national system, as long as you are paying contributions into it. These will be deducted from your salary if you are working in the country.
However, authorities, such as the World Health Organisation (WHO) and the European Health Consumer Index, consider the public healthcare system in Romania to be one of the weakest in Europe. It faces significant challenges, and we advise that you do not rely on it if you suffer from a chronic illness.
Most expats opt for private health insurance to cover any chronic conditions.
How does the Romanian healthcare system work?
Once you are resident, and as long as you are paying contributions into the system, you will be entitled to state health insurance under the national health insurance house (NHIS), known as Casa Naţională de Asigurări de Sănătate (CNAS). You may also be entitled to free healthcare if you are a widow or a war veteran, or if you are disabled and on a low income.
Your employer will register you with the NHIS once you have been given your tax ID number. However, you should check that your deductions are actually being made, as expats have reported difficulties in this regard.
The Romanian healthcare system and chronic illnesses
The WHO estimates that non-communicable diseases (NCDs) account for 92% of all deaths in Romania. Cardiovascular diseases are the most common, followed by cancer, respiratory diseases and diabetes.
According to the European Commission report on the state of health in Romania, the country had the highest death rate from preventable and treatable causes in the EU up to 2019. Romania has among the lowest life expectancy in the EU, although it has risen by four years since 2000. It is estimated that around half of all deaths in the country can be attributed to behavioural risk factors. Obesity rates are increasing, but tobacco use – a contributory factor to a number of NCDs – is on the decline.
Mortality rates from preventable and treatable causes are among the highest in the EU. Health authorities suggest that improved public health and prevention policies, increasing the role for primary care and improved access to services, could see a reduction in premature mortality.
Health spending in Romania is currently the lowest in the EU, on a per capita basis and as a proportion of the country’s GDP (5% in Romania, compared with 9.8 % in the EU). Publicly financed health spending (79.5 %) is commensurate with the EU average at 79.3 %. There is a low rate of out-of-pocket payments, but informal payments, i.e. bribes, are common.
The national healthcare scheme does cover chronic illnesses to some degree. If you are registered and choose to access this scheme, you will find that it covers the following:
- Medical services for acute conditions or flare-ups of chronic illnesses
- Medical services for chronic illnesses, including active monitoring for chronic illnesses with a major impact on illnesses with a high cardiovascular risk, type two diabetes, bronchial asthma, chronic obstructive pulmonary disease and chronic kidney disease
There are chronic illness advocacy groups at work in Romania, such as COPAC (the coalition of organisations of patients with chronic diseases in Romania) in Bucharest. Their role is to represent the patients’ perspective in dialogues with national decision-making and legislative authorities at a national and local level.
They aim to work towards improving access to information for patients with chronic diseases, and monitoring the implementation and performance of national programmes.
The country has a National Diabetes Programme. Anyone who has diabetes, regardless of age, is eligible for free insulin and medication. Children up to 18 years old can receive 100 test strips per month. Once you are 18, if you are on insulin treatment, regardless of the type of diabetes, you will receive 100 test strips every three months. If you need more, you will need to pay (it costs approximately €15 for 50 strips). Insulin pumps are covered by the programme, but there is usually a waiting time, and most people do not use them. However, if you do get one, all materials (including infusion set and syringes) will be free.
Applying for disability/sickness benefits
Romanian employees are entitled to pay for up to five days of sick leave with a compensation of 75% of salary. Benefit for incapacity to work (concediu medical şi indemnizaţie pentru incapacitate temporară de muncă) is paid to employees who are legally resident in Romania if they suffer from ordinary illnesses or have accidents outside working hours. The benefit is paid to replace an income that you can no longer receive due to illness.
The maximum duration of sick leave is 183 days or up to 18 months for serious illnesses. Compensation is provided by the state for sick leave exceeding five days.
You will need to have contributed to the social health insurance system for at least six months over the last 12 calendar months.
You can also claim benefits if you have to stop working to care for your child (concediu medical şi indemnizaţie pentru îngrijirea copilului bolnav).
Private cover for chronic illnesses
If you have private health insurance, check with your provider to see whether you are covered for treatment for your chronic illness within the private sector. Some policies do not cover pre-existing conditions.
The private healthcare sector in Romania is substantially better than the public scheme, with more modern facilities and no shortage of personnel.
Arad has a breathing method practice, which uses the Buteyko method for treating asthma and other respiratory illnesses, and there are others in Bucharest.
You will also find private provision for treating diabetes, although specialists tend to be confined to the larger cities. Similarly, you will find specialists in arthritis, but again, these will mainly work in the more urban areas.