The Impact of Directive 2011/24/Eu on the Romanian Health System

The present study tackles the provisions of Directive 2011/24/EU from the perspective of its estimated impact on the Romanian healthcare system as a whole. The analysis is carried out both in relation with the present state of the system and considering its chances for reform, in an attempt at suggesting the best solutions in our view. We did not intend a mere analytical rendition of the legal text; instead, we focused on what was relevant from the perspective of its impact, approaching the technical provisions and the ones which we considered as having minimum impact in a compendious manner. Stress was laid especially on the provisions which correspond to the “national sensitivity” in the field, considering that we have been, for many years, witnesses or actors in a debate on the reform of the healthcare system. To this effect, we have considered both issues pertaining to principles applicable to a healthcare system, insomuch as the directive mentions them, and the functional mechanisms which should be taken into account. Since Directive 2011/24/EU is not a singular gesture made by the European Union institutions, being preceded by normative acts and numerous resolutions of the European Union Court of Justice, the study starts from framing this directive in the judicial context and analyses the way in which it produces effects at national level. Even though it is not a complex approach to the Union’s juridical mechanisms, we consider that their introduction is sufficient for the understanding of the applicable juridical context. The analysis of the provisions of the Directive is structured on two parts: an approach to the introductory text which underlies and explicates the interpretations that should be given to the directive and the approach to the legal text itself. Some of the provisions that we have tackled in the analysis of the foundation are not discussed again in the part dedicated to the articles of the Directive. This is not the case for some delicate aspects, such as the prior authorisation, which we tackle more thoroughly in the second part. As previously stated, we insisted on presenting and analysing the provisions of the Directive which have a significant impact on the way of functioning of the Romanian healthcare system, as the transposition of these provisions in the national law is actually one of the reform measures announced. To put it otherwise, we consider that a large part of the healthcare system reform measures already made official, are, in fact, either results of the obligation to transpose the provisions of the Directive in the national law (e.g., amendments to the malpractice legislation, a more complex approach to the patients’ rights, etc.) or anticipations of its effects (e.g., specifications for a basic healthcare services pack, modifications at the wage scale level, etc.). This approach allowed us to suggest alternative reform variants, with their foreseeable effects, indicating every time the best solutions in our view.As the provisions of the Directive must be made part of the national legislation by 25 October 2003, at this moment, the national provisions are being drafted. Therefore, we consider that the present study is, first and foremost, a framework for the debate with respect to the identification of the best legislative solutions, in accordance with the multiple interests involved, i.e., those of the citizens, patients, healthcare employees, as well as those of the Romanian State.