The Social Health Insurance (SHI) scheme was introduced in Romania in 1999 and represents the health care system's main source of funding and is managed by the National Health Insurance House. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends five including Medical devices, Dialysis, and Homecare services showed ascendant trends and four including Dentistry and Emergency services showed descendant trends. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. 4Department of General Surgery 2, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania.
3Faculty of Cybernetics, Statistics and Economic Informatics, University of Economic Studies, Bucharest, Romania.2Roche Romania Ltd., Bucharest, Romania.1Department of Public Health, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania.Ciprian-Paul Radu 1,2, Bogdan Cristian Pana 1 *, Daniel Traian Pele 3 and Radu Virgil Costea 4