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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.
The contribution rate is approximately 5.2% (of income) for an employee, 5.7% for an employer and less than 11% for those who have their own business,” Popescu says.
“If we want to follow the European level of expenditure on health, other mechanisms must be found to assure the budget of the CNAS is sufficient.” Popescu notes that there has been talk of introducing co-payments as a way of making up the shortfall in funds, but believes that this will have limited impact. Popescu says that one suggestion to close underperforming units could assure additional resources for the performing hospitals and for general practitioners who struggle on shoestring budgets.
“All in all, we have stayed at the level of cancer prevention via mass media campaigns and periodical check-ups of women for the early detection of cervical pre-cancer lesions,” says Popescu.
Romania has the highest mortality rate for cervical cancer in the WHO European Region, despite the fact that the deaths from cervical cancer can be substantially reduced by screening programmes with referral for treatment services.
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.Vaccination against the human papilloma virus (HPV), the main cause of cervical cancer, is an option to further reduce incidence.However, currently due to the inefficiency of the screening programme “detection of cervical cancer is delayed and cervical cancer is diagnosed in advanced stages,” Popescu says.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.This represents one of the highest levels of cardiovascular disease in the 53-country European Region of the World Health Organization (WHO).For Dr Irinel Popescu, head of the Surgery and Liver Transplantation Centre at Fundeni Hospital, Bucharest, the epidemic of cardiovascular disease is to a large extent driven by lack of awareness among Romanians regarding the importance of diet, exercise and giving up smoking.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.