Race against time to save Romania’s health system

Romania’s boy-faced health minister Vlad Voiculescu is used to quickly turning ideas into action.

Before his appointment, he smuggled cancer drugs into his home country from Austria for patients who couldn’t otherwise get a hold of them. He left work to help transport victims of a nightclub fire out of the country when local hospitals became overwhelmed. He set up a summer camp for children with cancer whose lives were spent almost entirely in hospitals.

Now he has just a few months to get things done from inside the very system he has called self-serving.

“The first word that comes to mind when I think about the health system is feudal,” Voiculescu said a month after entering office. “A feudal system is less about good or bad people. It’s more about the system and about safeguarding privileges.”

Voiculescu’s selection in May, amid a scandal over diluted hospital disinfectants that cost his predecessor the job, brought hope to patients frustrated by years of widely documented corruption and a poorly funded and managed health system. 

Vlad Voiculescu, the Romanian health minister

The 33-year-old economist-by-training with no political affiliation or deep ties to government is part of an interim administration appointed by the Romanian president last November. The former prime minister and his cabinet were forced out after a Bucharest nightclub fire left 64 dead and protesters accused authorities of ignoring fire safety violations in exchange for kickbacks. Voiculescu and the rest of the temporary government are around until general elections this November.

He is already the third health minister in the fledgling temporary government: The first was yanked hours after being named when pictures of him posing as an underwear model came to light. The second lasted six months until the disinfectant scandal broke.

The challenges are formidable: The country’s health care system falls far behind the rest of Europe on issues ranging from life expectancy to rates of preventable deaths to doctor pay, according to a European Commission 2016 scorecard and other reports. While only 4 percent of Europeans overall report going without a medical need tended to, that number is 10 percent for Romanians.

A month into Voiculescu’s tenure, he blocked the routine appointments of 60 hospital managers and called for a shake-up in a system where bribes are so entrenched the government once considered regulating their use.

But some key players don’t take Voiculescu seriously because his tenure is expected to be so brief. And for everything he has done, it’s far too little for some in an overwhelmed system.

The Romanian Chronic Patients’ Alliance accuses him of handling crises but ignoring broader policy failures — like access to life-saving medicines. In mid-July, a cancer patient who had sued the government to get free access to a drug died days before the court ruling, the patient group said. The national medicines agency had recommended making the drug free months earlier, but the government hadn’t passed laws to make the measure effective in time for the patient.

“Things have gotten worse. We are talking about avoidable deaths that no one is responsible for,” Cezar Irimia, president of the patients’ group, told POLITICO. 

Voiculescu’s team acknowledged the failure but said it is working with what it has: limited resources, a burdensome bureaucracy and decades of problems.

The ‘feudal-in-chief’

The problems frustrate Voiculescu.

I’m the feudal-in-chief in this system: I can just award 200 million lei [€45 million] to whatever I want,” Voiculescu told POLITICO in early July, as his car sped from meeting the prime minister to a ceremony at the presidential palace. “If I think that we need one state-of-the-art hospital in my parents’ town, I can just do it.”

“And it’s all legal.” 

Voiculescu has decried that power, as well as the culture of tipping, essentially a system of bribes expected by many doctors and nurses in exchange for giving patients timely access to care. It’s a major reason many Romanians put off or forgo treatment, according to the Commission report. He calls the tipping illegal and agrees that it keeps patients from health care.

His “feudal” comments drew the ire of Gheorghe Borcean, the president of the Romanian College of Physicians, who responded that the lack of resources was the problem. Doctors and nurses in Romania tend to earn much less than their peers in other countries, and often have to work with old or limited equipment.

However, the relationship between the two men has evolved, with Borcean telling POLITICO that Voiculescu’s aim to reform the administration of hospitals was welcome.

“I hope he manages to do it and that he does not fall prey to the different interests surrounding hospital administration,” he said

Bucharest buyers’ club

Voiculescu first made headlines in 2012, after media depicted his initiative to import cancer drugs that were not available in Romania because drugmakers and distributors felt they were priced too low. News outlets told the story of how Voiculescu had convinced a local pharmacist in Vienna, where he was working as a banker, to sell him a cancer drug to send to Romania for the child of an acquaintance.

The media attention yielded more patients in similar straits, so Voiculescu created a website linking patients and volunteers willing to bring drugs into the country. Some 400 people signed up. The network didn’t make a profit: It charged patients full price and nothing more.

More publicity pressured the government to invest in bringing needed quantities of cancer drugs back on the market in 2013. Two years later, HBO Romania aired a documentary about the network. It’s been likened to the Dallas Buyers’ Club of AIDS activists importing then-illegal drugs into the U.S. in the 1980s, recently portrayed in a Hollywood movie.

“I believe in these little islands of good, which keep getting bigger when people rally around good causes,” Voiculescu said over a late lunch across the street from the health ministry in Bucharest. It was 5 p.m. and he said it was his first bite all day.

As health minister, he plans to set up a system to monitor when drugs supplies are running low, and improve pricing policies so that necessary medicines are available at Romanian pharmacies and hospitals. For expensive cancer medicines and other innovative drugs, he has joined Bulgaria and other countries in the region in an initiative to negotiate prices together.

Despite his efforts, Voiculescu knows he remains unpopular with some groups, in particular the pharmaceutical industry and some health care professionals.

“No one calls me: no pharma people, no hospital managers,” he told POLITICO during that late lunch. “They think I am here for a short time.”

Worms in intensive care 

Months after the hospital disinfectant scandal, which included the apparent suicide of the CEO of the company making the chemicals, new problems keep arising.

In July, a doctor filmed  worms ebbing from a patient’s wounds in the intensive care unit to highlight conditions in a Bucharest burn hospital. In the same hospital, a month earlier a woman had died after a transfusion of the wrong blood type.

A few days later, Voiculescu called his advisors for a 9 p.m. meeting to discuss whether to shutter the hospital.

“I can close it, but I want to be presented with options of why I should do one or the other,” he said the next day in Bucharest. He has said several times he makes decisions based on carefully weighing the evidence, which is often unavailable in a system set up for the minister to do what he wants without it, according to Voiculescu.

He wound up closing the transfusion unit out of concern that shutting the entire hospital would unfairly push staff out of jobs and deny treatment options to burn patients. Earlier this month, the ministry announced that it found transfusion units in more than 130 hospitals were functioning without authorization and ordered emergency measures to make them compliant within three months. Patients in need of transfusions largely must be redirected to other units.

That dire situation had been ignored for years, according to the minister.

“It’s unacceptable that six months after Colectiv, we have not learned anything,” he said after the scandal at the burn hospital, referring to the Bucharest nightclub fire that exposed serious management and hygiene issues in many hospitals and sparked protests that toppled the prior government.

Voiculescu plans to revamp hospitals with new performance criteria for managers, mandatory reporting of hospital infections and taking into account patient satisfaction surveys.

With just three months left at the helm, he hopes to lock in these and other changes via executive order. The powers help him in the short term but he is painfully aware that they are the same ones that gave predecessors unchecked authority and opportunity for corruption.

“If someone has an interest or a friendship, then a lot of money goes towards some hospitals,” he said during a July TV interview. “And this is the key for how investments were made in hospitals.”

Six-month mission

Voiculescu’s team is unconventional, by Romanian government standards. He assembled his cabinet by tapping several friends to maximize his limited time on the job.

His crew of mostly young professionals — economists, doctors and former journalists — seem more like a tech startup team than bureaucrats meant to occupy the old-fashioned, dark desks in the massive, Communist-era health ministry building. A chaotic atmosphere reigns at times over their offices in downtown Bucharest, where staff come and go frequently. 

Most of them plan to leave as soon as Voiculescu does, which worries the ministry’s Secretary General Livia Stan, who as a public servant will stay on after November’s elections and who pleaded with some of them on a hot Friday afternoon to think bigger.

“You have to stay in the system to change it from inside,” she said.


12 August, 2016