Most palliative care services are offered free at the point of delivery to patients and families. Around nine non-governmental organisations (NGOs) provide services, eight of which are not for profit and are dependent on a combination of private and public funds. The government funds seven palliative care services. Palliative care day centres are not included in government funding. Medication is provided through government funds regardless of whether the patient receives care in a hospital unit, nursing home or at home.

Specialist nursing equipment for home care is also provided free by most hospice services. The National Company of Insurance provides funding for general home care nursing which may cover part of the patient’s palliative care needs. The system of insurance in Romania is described by Melina Dumitrescu in an interview in 2001:

‘The insurance system is something very recent. During the communist time the population was used to the idea that health care is free, so it was entirely subsidised by the government. And the country is now starting to, well not now, but has been in an attempt of improving healthcare by the reform of the system. It started on a German basis I think, of a German model of insurance, but it is still moving forward very, very slowly and it has, till now it has only involved the primary care, which is that given by the family doctors. Hospitals are still in the position of being globally funded from the insurance but they are not encouraged in any way to be efficient, to…raise their standards, and to be economic, to be cost-efficient actually…the National House of Insurance…seem to be prepared to start financing these services, only the legal framework is incomplete for that. It means there is no proper clearly defined package of services provided [for] hospices.’¹¹

In a second interview in 2004, Melina Dumitrescu provides an update on the state of palliative care funding in Romania at that time:

‘Well, finances are obviously the most important issue at this point because we’ve developed so much and our services are, the costs of our services are about 1.4 billion lira? I’m not sure how much that is in pounds, our project for the whole year is about 300,000 pounds and it’s getting more and more serious for us as a…financing issue, we were truly hoping that the government would get more involved in supporting the palliative care services which didn’t happen, very precisely the only way of getting some of the money…is from the house of health insurance for the home-care services but this only leads us to about 0.1 of our budget for the past year so that’s next to nothing… because we are the first such unit in Romania and there are discrepancies between interpreting the law, between the Ministry of Health and the court on how to, to establish this unit, whether it should be part of a foundation or a separate entity, this is still something which brings a daily challenge.’¹²

No palliative care unit/teams are employed by the National Health Care System¹³. The problems related to the funding of services are highlighted by Mariana Pernea:

‘We have to limit, and we are now in a dilemma: we still have a great number of requests and we [do not know] how to deal with them. We have no money to enlarge our team but we are not able also to close the door in their face and say we are not capable to deal with the patients…and we do not have enough support from the authorities, from the government…’¹⁴

In 2002, palliative care was accepted as a medical sub-specialty - a major achievement for the discipline according to Daniela Mosoiu:

‘…the big step forward was establishing a good relation with the Ministry of Health and with the National College of Doctors, and succeeding to get palliative care approved as a medical special - sub-specialty actually it was - or a fellowship, I don’t know what would be the equivalent, because that was the first time when they officially recognised it is medical care, so it’s not social, it is, medical palliative care is medical, so that was I think the major step when it was recognised in November 1999.’¹⁵

Since 2002, the Ministry of Health has accredited 10 national palliative care trainers and supported the development of national standards of palliative care¹⁶ as described in this interview with Gabriela Baila, Director of Nursing at Hospice Casa Sperantei:

‘So we try to set up standards that will be easy to - not easy but not impossible - to achieve for everybody in the country. I mean it’s impossible to have this service on a national level to start with, and then it will be important to have better, the best standards for everybody.’¹⁷