The effect of economic crisis on local public services, Health-the end

The effect of economic crisis on local public services Health: the end of quality care? The situation from Romania: 

The effect of economic crisis on local public services Health: the end of quality care? The situation from Romania Viorel ROTILĂ, PhD, Lecturer Department of Sociology and Philosophy, University of Galati Director of the Centre for Research and Social Development „ Solidaritatea ” President FSSDR Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Prior specification: 

Prior specification The presentation is mainly based on the problems identified during a two-year survey (2009-2011) on the quality of professional life and migration trend of the medical staff in the health sector . Financed by the European Social Fund through Operational Human Resources Programme Development Sector 2007-2013 Invest in people! 2 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Prior specification: 

Prior specification The survey was carried out by the Centre for Research and Social Development „ Solidarity ” on the project PROFESSIONAL TRAINING FOR MEDICAL STAFF - Improving the quality of healthcare services through professional training and education of medical staff, managers and other categories from the system, in the South - East , ID 36663, financed by the European Social Fund through Operational Human Resources Program m e Development Sector 2007-2013 . Financed by the European Social Fund through Operational Human Resources Programme Development Sector 2007-2013 Invest in people! 3 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

I. Health in the context of local public services : 

I. Health in the context of local public services 4 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

1.Local public services in Romania: 

1. Local public services in Romania Constitutional principles underlying the establishment and operation of local government : eligibility authorities/ deconcentration of public services; local autonomy; decentralization of public services. 5 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

2.Financing healthcare services in the context of decentralization and fusion: 

2. Financing healthcare services in the context of decentralization and fusion Financial base for hospitals - contracts with Health Insurance Fund ; The hospital sector in Romania consumes approx. 50% of the National Health Insurance Fund ; Investment funding from local budgets. 6 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

2.Financing healthcare services in the context of decentralization and fusion: 

2. Financing healthcare services in the context of decentralization and fusion Direct budget allocations from central and local authorities, which finance specific activities, such as: • emergency assistance ; • support services for specific diseases ( through national health programs ); • training and research activities ; 7 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

3. Negative factors of influence on local government incomes are:: 

3. Negative factors of influence on local government incomes are : a . D EMOGRAPHIC : • employment decrease due to migration ; • reduction of natural population growth ; • decreasing number of youth ; • large „ rroma ” community with illegal forms of housing who benefits of services from the city hall but does not contribute to the local budget . 8 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

3.Negative factors of influence on local government incomes are:: 

3. Negative factors of influence on local government incomes are: b. ECONOMIC : • unequal development of different regions; • economic crisis ; • unemployment. 9 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

3.Negative factors of influence on local government incomes are:: 

3. Negative factors of influence on local government incomes are: c. SOCIAL : • lack of cooperation between institutions • excessive politicization of public functions • corruption at local level 10 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

3.Negative factors of influence on local government incomes are:: 

3. Negative factors of influence on local government incomes are: d. P OLITICAL : • delayed approval of state budget law - discrepancy in costs ; • the existence of special funds ; • perpetuation of bad debt ; • excessive politicizing - funds assignment on political criteria . 11 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

4. Health in the context of local public services: 

4. Health in the context of local public services The situation before the decentralization of the health care system : a ll healthcare units under the Ministry of Health ; s ome services transferred to local level: e gg . nurses school . 12 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system: 

5. Decentralization of the health care system a. The objectives of decentralization – the transfer of skills regarding the administration and management of health units with beds to local authorities as follows: the decentralization of 370 public hospitals from a total of 433 in Ministry of Health network ; the establishment at the local authorities of their own management structures of taken over healthcare units . 13 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system: 

5. Decentralization of the health care system the merging or re-orientation of 182 health units of the 433 (111 health units suggested to be merged) ; after re-orientation, 4804 beds came out of the medical syste m; the reduction of the number of beds for efficient delivery of health service s; the development of a system classification of hospitals, based on competence s; an assessment of patient satisfaction on the quality of medical services . 14 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system: 

5. Decentralization of the health care system b . Positive effects of decentralization : the increasing interest for investments in units – sometimes; quicker solving of problems; adapting services to local needs; the resource allocation as needed; making the local authorities become responsible towards their electors . 15 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system: 

5. Decentralization of the health care system c . Negative effects of decentralization : limited administrative capacity (lack of experience ); lack of clarity and predictability in payments transfer; financial allocations on political criteria; M . D . , F., Constanta : If the manager is from another political party than the mayor, there are no funds for the hospital. 16 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system: 

5. Decentralization of the health care system c. Negative effects of decentralization : political management of health units - these are caught in political games of interest; employment in the system through bribery - source of income for the political party representatives; the transfer of skills without being accompanied by an equivalent transfer of financial resources; 17 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Negative effects of decentralization:: 

Negative effects of decentralization : limited capacity to generate local income; reducing the number of employees, especially on the TESA (blue collared staff ); emphasizing the lack of staff; limitting staff salaries costs to 70% of the revenues of Health Insurance Fund (in terms of very small budgets ). 18 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

5. Decentralization of the health care system : 

5. Decentralization of the health care system d . Social dialogue in local health services A collective agreement at the group of units ; Concluded for the units under the Ministry of Health; They joined a part of the local health units; There is not a social dialogue mechanism for the local health sector. 19 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case Study: Conflict from Braila: 

Case Study: Conflict from Braila Period : September, 2010; Causes : the accumulation of stress factors which worked on employees: National 25% reduction of salaries; 20 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case Study: Conflict from Braila: 

Based on decentralization, Braila County Council decides: a dditional salary cuts; layoffs to reduce costs; m arging some health units; r educing the number of beds for patients. Case Study: Conflict from Braila 21 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case Study: Conflict from Braila: 

Case Study: Conflict from Braila Lack of staff in some departments; Poor budget due to unfavorable contracts with the National Social Health Insurance Unit; Lack of social dialogue ; Management based on political . 22 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case Study: Conflict from Braila: 

Effects: “Over 200 employees from Emergency Hospital of Braila County have started on Tuesday a spontaneous uprising. People took to the court to protest the dismissal decision and reducing salaries”. spontaneous strikes; Blocking the access to institution; Forcing entrance to the unit management; clashes with police . Case Study: Conflict from Braila 23 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case Study: Conflict from Braila: 

24 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity” Case Study: Conflict from Braila

Case Study: Conflict from Braila: 

Case Study: Conflict from Braila 25

II. Employees in the health system - from crisis and decentralization : 

II. Employees in the health system - from crisis and decentralization 26 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

PowerPoint Presentation: 

There is a definite negative influence of economic crisis on the quality of working life: the crisis is more severe when the staff satisfaction is lower. Insufficient financing. Quality of work 27 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

PowerPoint Presentation: 

Is determined by: Inadequate policy of the system; Lack of resources. It is accentuated by: Economic crisis; Fraudulent management . Leads to lower quality of working life through such factors as: Shortage of medicines and medical materials; Providing deficient technical equipment; Lack / insufficiency of protective materials. Quality of work 28 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

PowerPoint Presentation: 

Shortage of medicines and medical materials Providing deficient technical equipment At your job the working conditions are: 26,3%Very Dangerous 56,6% Dangerous 1,8% No answer Quality of work 29 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

PowerPoint Presentation: 

Lack / insufficiency of protective materials Quality of work 30 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

PowerPoint Presentation: 

Factors that cause dissatisfaction in the workplace: incomes (60% cumulative) ; heavy duty (35,6% cumulative); lack of time for family and for self (30,8% cumulative) work on public holidays (26,9% cumulative ). Quality of work 31 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Migration of health staff : 

Nurses migration P ush factors: Low salaries Heavy working conditions Limited career route P ull factors: Possibility of higher income Desire for professional achievement The degree of civilization Migration of health staff 32 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Migration of doctors: 

Migration of doctors 33 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

III. Quality of medical services: 

III. Quality of medical services 34 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Quality of medical services: 

Quality of medical services It is one of the factors that increases/ decreases trust in institutions; Indicator of life’s quality in the community Low due to migration of medical staff; insufficient funds; systemic deficiencies. R.M., w., Brăila : The quality in the health system lies in our health condition, if you’re tired you can easily fail. 35 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case study: Giulești: 

Case study: Giulești 36 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Case study: Giulești: 

Case study: Giulești 37

IV.Relations between employees from public health system and citizens: 

IV.Relations between employees from public health system and citizens Conflicting trends, accentuated by the economic crisis Absence of resources to treat patients; staff blaming for shortcomings; informal payments; Shortages triggered by the economic crisis; Mutual distrust . 38 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

The effects of EU accession on the health system in terms of local public services : 

The effects of EU accession on the health system in terms of local public services Easier migration ; The process of adapting to standards U.E. (where available) Structural Funds Investment in infrastructure; Investment in human resources; Exchange of experience . 39 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

VI. Another restructuring: draft of new law on health: 

VI. Another restructuring: draft of new law on health 40 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”

Conclusions:: 

Conclusions : 41 Federat ion “Health Solidarity” from Romania The Social Research and Development Center “Solidarity”