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Country Examples - Romania

Outpatient Dialysis Services in Romania — A Successful IFC Advisory Services
romania hospital


HNP Country Case Studies

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Between 2003 and 2005, Romania privatized dialysis services. Previously, inpatient and outpatient dialysis services were provided in about 40 public hospitals. Dialysis supplies were purchased by the National Health Insurance Fund (NHIF), and the equipment was purchased by the government and allocated to the hospitals. Funding difficulties and increasing demand for services had created a backlog of patients, and the facilities needed to be upgraded and expanded.

IFC’s Advisory Services helped the government: (i) revise and update national dialysis standards and practices and prepare legislation, including harmonization with European Union clinical guidelines; (ii) establish regional survey reporting of dialysis cost and prices; (iii) conduct cost analysis of dialysis; and (iv) create model tender documents.

The partnership was structured as a contract for dialysis services between the government and private service providers, who became owners. The Ministry of Health set prices, and the private operators were required to re-equip the facilities and provide about 200,000 outpatients a year with dialysis treatments at quality and service standards comparable to those of the European Union. The individual contracts, totaling €20 million per year, could be extended if the operator constructed a new facility within 18 months. All public patients were to receive free treatment, and the operators were to be reimbursed by the NHIF under specified fee schedules.

The Advisory Services project introduced transparency into government procurement processes. In 2004, NHIF conducted simultaneous tenders for eight dialysis centers, with strict prequalification criteria to ensure participation of experienced providers. Bidders were restricted to winning two centers to limit market concentration. Winning bidders were selected based on highest investment commitments. The average investment commitment in a center was $2 million, which was realized within 18 months after awarding the contracts. NHIF did not have to finance the modernization from public funds and there were significant operational cost savings to NHIF (estimated at about $4 million). The project improved patient services at lower cost to the national health system. The quality of services and patient satisfaction increased at lower cost because of the new standards, improved equipment and facilities, and more efficient organizational structure. Box 5.4: Outpatient Dialysis Services in Romania—A Successful Advisory Services Public-Private Partnership in Health

Sources: IEG review of Project Completion Report; Nikolic and Maikisch 2006; Maikisch 2007.




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