Overview

Life expectancy has recovered after the COVID-19 pandemic, but Romania continues to face health inequalities and a high burden of preventable mortality

Life expectancy in Romania improved steadily before the COVID-19 pandemic, then declined by 2.7 years during 2020–2021 before recovering to 76.6 years in 2023. Significant disparities persist by gender, education and geography, with men and people with lower educational attainment experiencing substantially shorter life expectancy. Cardiovascular diseases remain the leading cause of death, accounting for nearly 54% of all deaths in 2023, while mortality from preventable and treatable causes remains among the highest in the European Union, highlighting ongoing challenges in prevention, early diagnosis and access to effective care.

Romania’s health system is based on a centralized social health insurance model with broad benefit entitlements and a growing focus on digitalization

Romania operates a mandatory social health insurance (SHI) system centred on a single National Health Insurance Fund, which pools contributions nationally while district health insurance funds purchase services locally. The Ministry of Health and the National Health Insurance House jointly determine the benefits package, while uninsured individuals also receive access to a relatively extensive minimum package, particularly in primary care and selected hospital services. Recent policy efforts have focused on strengthening planning capacity, improving health information systems and advancing the National Health Digitalization Strategy 2024–2030 to modernize healthcare delivery and data management.

Health expenditure has increased but remains among the lowest in the EU, while out-of-pocket spending continues to create financial barriers to care

Health spending in Romania has risen over the past two decades, reaching 5.7% of GDP in 2022, but remains well below the EU average. Public sources finance most health expenditure, although out-of-pocket payments still accounted for over one fifth of total health spending in 2022. Pharmaceuticals and dental care are major drivers of household spending, contributing to a high level of catastrophic health expenditure, particularly among poorer households. Despite efforts to expand coverage, around 11% of the population remained outside the SHI system in 2023, which may be linked to Romanians living abroad but still officially resident in the country.

Workforce shortages and uneven service provision continue to challenge healthcare access, particularly outside major urban centres

Although Romania trains a relatively large number of health professionals, sustained migration of physicians and nurses to other European countries has created shortages in several specialties and regions. Access to primary care remains uneven, with shortages of family physicians and limited out-of-hours services leading many patients to bypass primary care and seek treatment directly through emergency departments and hospitals. Regional disparities in healthcare infrastructure and workforce distribution continue to affect access and contribute to inefficient patterns of service utilization.

Recent reforms focus on strengthening management capacity, expanding coverage and shifting care towards more efficient and preventive models

Health system reforms in recent years have aimed to improve governance, increase population coverage and strengthen human resources. Measures include substantial salary increases for health professionals to reduce emigration, expanded entitlement to services for uninsured populations, incentives for preventive care in primary care settings, and investments through the National Recovery and Resilience Plan (NRRP). Ongoing reforms also seek to improve quality measurement, strengthen health system management, reduce corruption risks and shift care away from hospitals towards ambulatory and preventive services to improve efficiency and health outcomes over the long term.