Building health system resilience in Romania: a consensus on policy priorities

Romania's healthcare system struggles with the EU's highest rates of treatable and preventable mortality and the lowest per capita health expenditure. Critical issues include unsustainable financing, an entrenched physician-centered model lacking institutional accountability, delayed digitalization, and inadequate clinical research capacity, necessitating structural and paradigmatic shifts. The objective of this study was to synthesize multi-stakeholder consensus recommendations for comprehensive reform of the Romanian healthcare system, focusing on financing, service delivery, and human resources. This manuscript details recommendations from a multi-stakeholder consensus conference organized in April 2025 by the Aspen Institute Romania. Participants addressed topics including financing, patient-centered hospital models, clinical research, health innovation, and the European Health Data Space (EHDS). Consensus recommendations include: stabilizing national health insurance funds (broadened contributions, multi-year budgets); shifting hospitals to patient-centered, institutionally accountable models (transparent allocation, digital integration, eradicating informal payments); equitable hospital reimbursement (unified tariffs); accelerated digital transformation (EHDS alignment, national Electronic Health Record); enhanced clinical trial capacity (personnel, infrastructure, regulatory efficiency); and exploring regulated dual practice, contingent on successful prior reforms. Key challenges include transforming hospital culture, promoting digital adoption, and navigating the complexities of politics and finance. These interconnected recommendations form a roadmap for transformative reform, crucial given the untenable status quo. Success requires sustained political will, stakeholder collaboration, investment, and robust governance to create a financially stable, patient-centered, equitable, and innovative system.