Lesson learnt from Romania Advantages Drawbacks/bottlenecks
Legal prerequisites to support mandatory health insurance - A compact legislative package allowing to introduce health insurance system with support of all power branches
- Ministry of Health initiative under the pressure of the community and health workers
- inconsistency, insufficiency, and contradictions (limitations on autonomy of health insurance fund and health providers)
- limitations on the authority of health workers' collegium
Contracting system for different type of services    
Inpatient services - Introduction of the DRG system starting from 2003
- Introduction of block contracts
- payment per bed-day (chronic patients)
- too large quantity of in-patient beds
Outpatient services - Division of primary and secondary ambulatory care fulfilled
- The differentiated system of payment for specialized care and para-clinic services
- Cooperation between doctors specialists and family doctors
- insufficient control over service provision that leads to increasing expenditures for health care payment
Family practitioners services - family doctor - doorway to the healthcare system
- complex national system of family doctors is introduced
- payment system for family doctors' work is developed including per capita payment for services
- introduction of private family medicine
- low payments for family doctors' work
- insufficient supply with health care equipment for family doctors
- insufficient motivation of family doctors to prophylactic works
- absence of benefit crediting to family doctors for procurement of healthcare equipment and premises
pharmaceuticals - introduction of card system for compensation of people's expenses for pharmaceuticals
- introduction of centralized system of procurement through the insurance system
- control and monitoring on the utilization of finances for pharmaceuticals
- - dissatisfactory cooperation with district houses
Set up functional autonomous institutions    
hospitals - hospitals received larger autonomy than before the reform
- the administrative board assigned the hospital manager
- possibility of receiving new sources of financing
- autonomous financial management is impossible
- limitations in changes introduction to hospital structure
- doctors are assigned exclusively by MOH's approval
family practitioners - enlarging sources of financing for health care provision
- competitiveness
- possibility for free choice of a doctor
- improving quality of health care
- doctor approaching the population
- financial problems at the beginning
- increasing reporting
New payment mechanisms and reporting system - per capita method of payment for health services is stimulating the doctor to actively involve the population
- fee for service and by DRG is stimulating the doctor
- differentiation of payment for treatment of chronic patients (by lower tariffs) of other categories
- reporting is being provided in real time
- opportunity for comparative analysis
- increasing the reporting documentation and reports
- opportunity to decrease the quality of health care with considerable increase of number of patients
- absence of stimulus to improve the nurses' work
Management information system creation of effective control system on healthcare provision and financing on the national level - incompleteness of the system, leading to creation of various district systems
- insufficient level of system's intellectuality
Human resources policy and training - retaining work places by means of re-specialization of district therapists and pediatrists
- expanding functions and powers of professional associations
- managerial training of family doctors
- creation of competitive environment among doctors
- скорочення посад медсестер
- несвоєчасна менеджерська підготовка керівників лікарень