Author
Beneficiaries of international protection have the right to benefit from health insurance under the conditions provided by the law for the Romanian citizens.[1] Persons suffering from mental health problems, including torture survivors and traumatised persons also have access to treatment in the same conditions as Romanian nationals.
Challenges in practice include lack of awareness of how the Health Insurance House (Casa de Asigurări de Sănatate, CAS) works and what it entails. Therefore, NGOs play a key role in assisting beneficiaries of international protection to overcome all the practical obstacles, which would be insurmountable without this type of support.
For 2023, information was provided by CNRR[2] and IOM Romania.[3] CNRR states that beneficiaries of international protection receive superficial support in terms of access to health services. From the counselling activities that CNRR carried out in 2023, in most cases it was found that beneficiaries are not fully aware of how to access this right. For beneficiaries of international protection who are not working, access to health services is extremely difficult. Also, in hospitals, beneficiaries who speak rare languages do not have access to an interpreter, often interpreting through acquaintances. Moreover, there have been cases when family doctors refused to register beneficiaries of international protection. IOM highlighted that they support beneficiaries of international protection by paying for medical services / purchasing medicines / covering the (partial) cost of medical insurance through the project budget (e.g. InterACT- Active participation and integrated assistance for migrants in Romania, a project implemented by IOM in partnership with AIDRom). However, the amount paid is not always sufficient to cover the needs of the beneficiaries, especially those with chronic health problems. IOM also underlined that the communication with doctors is hampered by the language barrier. It is therefore necessary to accompany beneficiaries to doctors’ offices and to provide an interpreter. In such situations it is essential that doctors are also willing to work with an interpreter.
This is confirmed by JRS Romania regarding Region 2. Moreover, the contribution that must be paid by BIPs who do not work to access state medical insurance is very high (approximately RON 1,800 (EUR 361) / year). When one subtracts rent from the non-refundable aid received by BIPs, they already do not have money left for food, or medical insurance. Under the AMIF funded project for Region 2, until funding ended in October 2023, BIPs were supported with payment of their health insurance for 6 months. Medication costs are also very high. The situation of BIPs that are not in the integration programme, that have finished it or other similar situations is also critical.[4]
Beyond the financial aspect, JRS Romania highlighted that BIPs suffer from the general deficiencies of the Romanian medical system, as also faced by Romanian nationals. The referral to the specialist can take 3/6 months or even more, and most BIPs cannot afford to pay for a consultation with a specialist doctor at private clinics, so they have to wait for these very long periods of time. JRs also highlighted that family doctors regularly refuse to register BIPs.[5]
The JRS representative in Rădăuţi reported difficulties regarding the identification of family doctors. Family doctors refuse to register beneficiaries of international protection, including children, because they have to register patients for at least six months and are afraid that beneficiaries will leave Romania. Beneficiaries who decide to stay for long term have family doctors. For the ones who have no health insurance ICAR Foundation is covering the costs of medical consultations and treatment if necessary.
Another reported issue is related to health insurance. Persons who do not earn an income are obliged to pay state health insurance for 12 months, which equals 6 gross national salaries, irrespective of the date of filing the declaration.[6] An annual health insurance (valid for 12 months) costs the equivalent of six gross minimum wages, which was 2,550 RON/ €520, and 10% (social insurance contribution rate for health), that is 1,530 RON/ €310.
NGOs may reimburse the cost. The payment of one month of health insurance triggers an obligation to pay for the entire year in order to access health services. If beneficiaries stop paying health insurance, they enter into debt. If they commit to stay for six months, ICAR Foundation may pay for their health insurance.
In Galaţi, within the project implemented by JRS on integration it is possible to pay for the state health insurance for a maximum of 6 months. It was reported by the JRS representative that for medical consultations and laboratory tests it is necessary to submit a written order from the primary care doctor, the family doctor. Because it is hard to identify medical doctors for beneficiaries, this task is performed by the medical doctor of IGI-DAI. The situation was the same in 2023.[7]
LADO/ASSOC mentioned that beneficiaries do not encounter problems in the health system if they pay for their health insurance. The only hardship is caused by the lack of knowledge of Romanian. It was emphasised that the ASSOC representative offers support to beneficiaries in finding family doctors [8]
IOM Romania reported the following issues faced by beneficiaries of international protection in relation to the health care system:
- Inadequate understanding of how the health insurance system works;
- Lack of financial resources needed to pay for the social health insurance;
- Even if they are insured, there are treatments and investigations that are not covered by the state health insurance and must be paid for by the beneficiaries;
- High waiting time for certain investigations
- Linguistic and cultural barriers.
IOM Romania further acknowledged the important role of NGOs implementing integration projects, in supporting beneficiaries in accessing health services.[9]
AIDRom reported that sometimes language barriers in healthcare lead to miscommunication between the medical professional and the beneficiary of international protection. AIDRom also pointed out that family doctors are reluctant to register foreigners.[10] This was still the same in 2023.
In Giurgiu, it was reported by the AIDRom representative that through the project in which they were partners with Global Help. MyRo they also provided medical assistance to beneficiaries up to 850 RON/ 173 EUR, which could also have included the reimbursement of health insurance. However, in the last two years they had not covered such costs, because beneficiaries were either not interested or they were employed. The appointment of family doctors was not an issue as the medical doctor employed by the ICAR Foundation was also a family doctor and beneficiaries were registered with her.
[1] Article 20(1)(g) Asylum Act.
[2] Information provided by CNRR, 15 January 2024.
[3] Information provided by IOM, 4 January 2024.
[4] Practice based observation by JRS Romania, April 2024.
[5] Practice based observation by JRS Romania, April 2024.
[6] Article 180(3) Fiscal Code.
[7] Practice based observation by JRS Romania, April 2024.
[8] Information provided by LADO/ASSOC, 3 February 2022.
[9] Information provided by IOM Romania, 19 February 2022.
[10] Information provided by AIDRom, 14 January 2022.