When in Romania
Natural products used in laboratory courses at the Iuliu Hatieganu University of Medicine and Pharmacy.
Ambulance sirens scream overhead as you are rushed to the hospital. Medications are administered, labs are drawn, tests are run, and interventions are made. As a patient, you are worried about your health, concerned about your recovery, but the cost of your medical care is no tangible burden. You live in a country with universal health care. This is the reality for patients in Romania.
This past summer, I spent 4 weeks on rotation in Cluj-Napoca, Romania, immersed in their culture and observing universal health care in action. Here is what I learned.
Universal health care benefits, challenges
The benefits of universal health care were immediately obvious to me: patients are afforded essentially free health care as long as they are treated at a public hospital. Ambulance service, medical care, and medications are all covered in full. However, patients do have another choice. Romania also has private hospitals that do charge patients for their stay and their care. The Ministry of Health pays the private hospitals at the same rate as the public hospitals, and the patients are responsible for the difference in the cost of their care. So why would a patient choose a private hospital? Public hospitals tend to use open bays to house their patients. One area may contain up to 10 beds lined up shoulder to shoulder. In contrast, private hospitals often place their patients in rooms that accommodate two, or patients may have an entirely private room. It is this difference and apparent luxury that steers some patients away from public hospitals.
Medication prices are consistent between institutions because it is the Ministry of Health that sets drug prices. While this ensures that prices remain low, it creates a unique challenge for Romania in terms of drug supply. European pharmaceutical manufacturers have the choice to sell their products to a variety of countries. Because the Ministry of Health sets the drug prices, the manufacturers are forced to accept that amount if they choose to distribute to Romania. However, that exchange is not mandatory. Romania often suffers from drug shortages of crucial medications, including heparin, because manufacturers will sell their entire supply to higher paying customers. Romania as a country may go months before they are able to replenish stock of a specific medication.
How training differs
Drug pricing and insurance coverage are not the only differences that exist between Romania and the United States. Pharmacy school in Romania begins directly after high school. It is a 5-year program that includes subjects such as organic chemistry, biology, pharmacology, and botany, and residency bears a faint resemblance to what we call a PGY1. In Romania, a clinical pharmacy residency is a 3-year commitment. However, those years can be split amongst a number of different hospitals and practice settings. Pharmacy residents are paid and managed by the Ministry of Health, not a single institution. Residents may practice at one hospital for a few months before moving on to the next. Any hospital may employ a resident so long as they provide adequate training and in turn, they are not responsible for supplying the salary. Despite this apparent benefit for hospitals to create positions for clinical pharmacy residents, that career path is far less traveled. Positions for clinical pharmacists’ post-residency are few and far between. A 400-bed public hospital in the heart of Cluj-Napoca only has one clinical pharmacist position. Pharmacy schools in Romania also do not push their students to pursue residency.
Natural medicine is widely popular in Romania and many patients choose to treat their ailments with teas rather than tablets. Because of this, student pharmacists must practice plant identification, extraction, and purification. Practicing pharmacists in Romania have mixed opinions on natural and homeopathic medicine. Some support and rely on natural remedies while others advocate for the use of manufactured drug products. Regardless of the methods or means, each pharmacist strives to provide their patients with a treatment that will produce an optimal outcome.
A shared commitment
International experiences often offer insight into people as individuals. In Romania, I gained insight into a different way to execute and manage health care. Nonetheless, one key similarity shined throughout my experience. Pharmacists around the world are truly committed to the care of their patients and are eager to see the profession of pharmacy evolve and advance.
Courtney Dawson is a final-year PharmD Candidate at the University of Iowa College of Pharmacy.