Context
Diabetes is one of the public health priorities in Romania, with increasing incidence, from 321.2 cases per 100 000 population in 2011 to 397.2 cases per 100 000 in 2019 (INSP, 2020), and prevalence, from 3% in 2011 to 3.9% in 2019 (WHO – HFA, 2020). However, prevalence data reported to the WHO are based on family medicine physicians’ records, which seem to underestimate the real number of cases. The National Institute of Public Health (NIPH) reported prevalence of 6.0% in 2019, based on the cases reported by diabetes and metabolic diseases specialty offices (INSP, 2020). This higher prevalence figure could also indicate that diabetes is discovered in an advanced stage of the disease when patients report to hospitals to treat complications. According to the estimates from the Romanian Diabetes Forum (https://www.forumdiabet.ro), about 70% of diabetes cases are diagnosed in later stages of the disease and 40% of the cases do not comply with the treatment (Forumul Român de Diabet, 2019). Mortality from diabetes is also a matter of concern, having increased from 9.9 cases per 100 000 population in 2011 to 12.9 cases per 100 000 population in 2019 (INSP, 2020).
Impetus for the reform
The Romanian Diabetes Forum (which is a dialogue platform gathering several professional and patients’ associations that was initiated in 2019 by the Romanian Society of Diabetes, Nutrition and Metabolic Diseases with the support of the Romanian Association of International Medicine Manufacturers) has organized several consultations on prevention and early detection of diabetes with the medical community, patients’ associations, authorities, experts, and the pharmaceutical industry. At the beginning of 2020, the Law on prevention and early detection of diabetes was submitted to the Parliament, and on 13 November 2020, it was promulgated by the Romanian President (Forumul Român de Diabet, 2019).
Since the implementation of the reform is conditioned on the issuance of the secondary legislation, the Romanian Diabetes Forum remains committed to further action.
Content of the reform
The main purpose of this law is to improve prevention and early detection of diabetes, but also to raise awareness and to encourage a healthy and responsible lifestyle in the population. The main tool provided by the law is the National Programme for Diabetes Prevention, which will be approved by a Government Decision every four years. This will include measures for primary prevention and reduction of risk factors, measures for early detection of persons at risk, and measures to avoid progression of the disease. The Programme will be financed by the Ministry of Health. The Law also establishes the National Diabetes and Pre-diabetes Registry as a component of the Electronic Information Health Insurance Platform.
The Law offers the prerequisites for an interagency and intersectoral collaboration, setting tasks for health providers, district health insurance houses, integrated community centres, local authorities, and the Ministry of Education (Parlamentul României, 2020).
At the time of writing (September 2020) the secondary legislation has not been issued yet.