THE PRIVATE HEALTHCARE SYSTEM

IN ROMANIA
General Information

November 2010, Bucharest

 Content
2

Introduction……………………………………………………………………………………. 3

Terminology …………………………………………………………………………………. 4
Legal framework……………………………………………………………………………… 5
Medical services market……………………………………………………………………. 6
Public Romanian Healthcare System…………………………………………………………. 7
Private Romanian Healthcare System………………………………………………….…….. 8
Private Outpatient Medical Center in Romania……………………………………………….. 9
Distribution ………………………………………………………………………………… 10
Most important outpatient medical center in Bucharest…………………………………….. 11
Private outpatient specialized clinics………………………………………………………... 13
Private hospitals in Romania………………………………………………................................... 14
Synoptic table private hospitals in Romania and Bucharest………………………………… 19
Private hospital location by map………………………………………………………………20
The major private healthcare companies 2009………………………………………………...21
Public and private insurance system…………………………………………………………….22
Sources of revenue………………………………………………………………………………24
Comparative prices for available medical services in private hospitals in Bucharest……………25
Observations…………………………………………………………………………………….26
Conclusions………………………………………………………………………………………..28
Apendix
List of hospital regulations
The most frequent chances of developing diseases in Romania
The major pharmaceutical companies in 2009 Pro EAST Consulting 2010
 Introduction
3

 This study provides general information on the Private Healthcare System in Romania in terms of both its
current level of development and its future evolution. It is updated monthly.

 The study’s methodology is centered on the following criteria: type of medical unit; medical specialty;
number of beds; location; names and nationality of the shareholders and affiliation with any medical
companies. New hospital construction projects are classified according to; amount of investment; number of
beds; location; expected launch date and the names and nationalities of the shareholders.

Pro EAST Consulting 2010

 Therminology
4

 The various private medical units in operation today can be defined as follows:.

 Outpatient Medical Centres (for diagnosis and treatment): are policlinics that provide multi-disciplinary
ambulatory medical services. They are currently equipped with laboratories for blood and fluid analysis and
will eventually be equipped with diagnostic imaging devices (CT, Rx, ultrasound or MRI)
 Outpatient Specialized Clinics: are medical centres that specialize in a single medical discipline or ailment
such as Ophthalmology, Plastic Surgery etc. They are equipped with the required laboratories and will
eventually acquire the diagnostic imaging devices needed in support of their respective speciality. Patients can
remain hospitalized at the clinic for a maximum of 24 hours.
 Specialized Hospitals: are classified as hospitals but with a single principle specialty and as many as two
adjacent specialities (eg.Obstetrics and Gynaecology). Patients can remain hospitalized for periods of greater
than 24 hours. These are hospitals and are therefore equipped with an ICU and Emergency Room services. A
classic example would be a Obstetrical and Gynaecology Hospital.
 General Hospitals= provide the full range of medical services for several medical specialities including the
following units; ER, Outpatient, Internal Medicine, Surgery ICU, and eventually Maternity. General Hospitals
are fully equipped with laboratories and radiology devices.

Pro EAST Consulting 2010

 Legal framework
5

 All Hospitals, Medical Centers and Outpatient Clinics, both private and public, are governed by and must
operate in accordance with Romanian law (specifically Law 95/2006 as last updated on 07 Oct 2009).

 In addition, the construction and operation of hospitals in Romania are governed by the Ministry of Health
(Order – OSMP 914/2006 last updated by1030/2009) Please refer to Appendix 1 for more detailed
information.

 Last but not least, all medical and non medial units of a hospital must be compliant with, and
managed in accordance with, the standards of the European Union.

 Medical Services provided by either Public or Private medical units in Romania are VAT exempt.

 Romanian legislation permits the establishment of Private General Hospitals and Medical Clinics under Law
No 31/1990. This legislation equally applies to private sector companies.The Administrator and at least
one third of the Board of Directors must be qualified doctors. There is no such restriction on shareholders.

Pro EAST Consulting 2010

 Medical Services Market
6

 The Government of Romania currently allocates 4,7 % of GDP to the Healthcare Sector which is very low
when compared with the average percentage of GDP allocated in East Central European (6,7% of GDP)
or Western Europe (9,8% of GDP).

 The market for private medical services is estimated to have been 430 million Euro in 2009; a 35%
increase over 2008. The rate of growth for 2010 is projected to be at least 20%.

Estimated private
medical services in Romania
600

500

400

300
Value in millions Euro
200

100

0
2008 2009 2010

Pro EAST Consulting 2010

 Public Romanian Healthcare System
Classification
7

Primary Health Care Units provide:

 General medical and ambulatory services.
 General diagnostic services including laboratory analysis of blood and fluid
 Outpatient clinics but without an operating theatre of specialized investigative labs.
Secondary Health Care Units provide:

 Outpatient Medical Centres and Outpatient Specialized Clinics

 General or Specialized Hospitals . These hospitals have various departments and operating rooms for both basic and
specialized medical services. These specialties would include cardio surgery, neurosurgery, microsurgery, and oncology.
 Both Primary Health Care Units and Secondary Health Care Units are located in the locality in either a city or a town
Tertiary Health Care Units are:
 University Hospitals located in a major city or Regional Hospitals that are regional in scope (ie they service one or more
of the 42 counties that make up Romania).
 They include Institutes (eg. Contagious Disease Institute) and Hospitals that offer higher learning or a specialization.

Pro EAST Consulting 2010

 Private Romanian healthcare system classification

The Romanian Private Healthcare System is organized as follows:

 Individual doctor’s ambulatories

 Outpatient Medical Centres (diagnosis and treatment)
 Outpatient Specialized Clinics (specialized medicine)
 Hospitals: both General and Specialized.

 All the Private Medical Centres and Private Hospitals are locally based; that is, they do not service an entire
county.
 None of the University Hospitals are Private.
 None of the existing Private Hospitals specialize in Emergency Care.

Pro EAST Consulting 2010

 Private Outpatient Medical Center
9

 Private Medical Centres first started to appear in 1995, primarily in the larger cities.The
majority functioned as local diagnostic and treatment centres.

 Multidisciplinary Outpatient Medical Centres focus on diagnostic services and treatment. They are
equipped with laboratories and a radiology unit (Xray, CT, Ultrasound). Eventually their imaging
units will expand to include MRI.

 Specialised Clinics. These medical clinics provide medical services of one speciality plus laboratories
and eventually imagistic unit. The majority of the Specialized Clinics established during the past few
years are specialized in the following medical disciplines: Obstetrics, Gynaecology and Fertilisation,
E.N.T (ORL), Ophthalmology, Plastic Surgery, General Surgery, Orthopaedics, Oncology,
Proctology, Radiology Imagistic, Phlebology, Rehabilitation , Stomatology. See slide 13

Pro EAST Consulting 2010

 Distribution
10

 Private Outpatient Medical Centres and Specialized Clinics are distributed throughout Romania but are
concentrated in cities with populations over 150.000;

 There is a high concentration of private Medical Centres and Specialized Clinics in the capital city of
Bucharest. The number of multi-discipline Outpatient Medical Centres located in Bucharest (100) is
equal to the number of such Centres located throughout the Rest of Romania (97).

 The major players in the healthcare sector are currently the following companies:

 Romar (18 centers),

 Unirea Medical Center (12 ),
 Medicover ( 12)
 Medcenter ( 12 )
See slide 11

Pro EAST Consulting 2010

 Major private Outpatient Medical Centers in Romania

11
Name of the medical center Total no. of No. of No. of Cities ( Abbreviation*) Web adress
centers in centers in centers in
Romania Bucharest other cities
Ct, Is, Pl, Tm, Gl, Braila, Bz Branesti, Hd,
ROMAR 18 4 14 Roman, Tgv, Tg J, Gr* www.romar.ro
CENTRUL MEDICAL UNIREA 16 11 5 Cj, Ct, Pl, Tm* www.cmu.ro
MEDICOVER 12 5 7 Bv, Cj, Ct, Fcs, Is, Pl, Tm* www.medicover.ro
MEDCENTER 12 4 8 Bv, Cj, Fcs, Is, Gl, BM,Braila, Bz* www.medcenter.ro
HIPERDIA 12 4 8 Bv, Cj, Pl, Bistrita, SM, Turda, Tm, Gl* www.hiperdia.ro
GRAL MEDICAL 9 5 4 Pit, Sb, Cv, Pl* www.gralmedical.ro
MEDICAL CITY 9 1 8 Pit, Cv, Ct, Turda, Tm, Arad, Bc, Bz* www.medicalcity.ro
MEDLIFE 9 7 2 Cluj, Timisoara www.medlife.ro
POLISANO CLINIQUE 6 3 3 Sibiu www.polisano.ro
CLINICA MEDICALA ROMGERMED 5 5 0 Bucuresti www.romgermed.ro
MEDAS 5 3 2 Pitesti, Giurgiu www.medas.ro
PARAMEDICAL CENTER 5 0 5 Cluj www.cmpro.ro
CENTRUL MEDICAL ELIM 4 0 4 Pitesti www.elim.ro
POLIMED 4 2 2 Targoviste www.polimed.ro
EUROCLINIC 3 3 0 Bucuresti www.euroclinic.ro
SANADOR 3 3 0 Bucuresti www.sanador.ro
MEDSANA 3 2 1 Ploiesti www.medsana.ro
CENTRUL MEDICAL CLINIMED 3 0 3 Alba Iulia www.clinimed.ro
CENTRUL MEDICAL GALAMED 3 0 3 Constanta www.sfatulmedicului.ro
MEDICAL CENTER DIAGNOSIS 2 2 0 Bucuresti www.diagnosis.ro
MEDICAL CENTER PRO LIFE 2 2 0 Bucuresti www.pro-life.ro
BIOTERRA MED 2 2 0 Bucuresti www.bioterramed.ro
BIOMEDICA 2 2 0 Bucuresti www.biomedica.ro
CENTRUL MEDICAL IOWEMED 2 0 2 Constanta www.iowemed.ro
CENTRUL MEDICAL IRINA (EXPERT
MED) 2 0 2 Galati, Braila www.expert-med.ro
Pro EAST Consulting 2010
 Major private Outpatient Medical Centers in Romania
Continued slide 11

12
12

CENTRUL MEDICAL SOLOMED 2 0 2 Pitesti www.solomed.ro

CENTRUL MEDICAL BIOCLINICA 2 0
CENTRUL MEDICAL ACADEMICA 1 1
ALSAMED 1 1
ANAIS MEDICAL CENTER 1 1
ENDOCENTER 1 1
EXCELLENCE MEDICAL CENTER 1 1
MATEI BASARAB MEDICAL CENTER 1 1
MEDICLASS 1 1
SANYS MEDICAL 1 1
CENTRUL MEDICAL VICTOR BABES 1 1
CCENTRUL MEDICAL LUX-RO 1 0
CENTRUL MEDICAL ARTRIMED 1 0
CENTRUL MEDICAL MEDSTAR 2000 1 0
CLINICA MACTA (MEDICAL ALALYSIS) 1 0
CENTRUL MEDICAL MICROMEDICA 1 0
COMPLEX MEDICAL G&E&N 1 0
CENTRUL MEDICAL DR.LUCA 1 0
CENTRUL MEDICAL STRAUBING 1 0
POLICLINICA VISA MEDICA 1 0
CENTRUL MEDICAL MINERVA 1 0
Total: 176 79 97
2 Arad, Timisoara
0 Bucuresti www.academica-medical.ro
0 Bucuresti www.alsamed.ro
0 Bucuresti www.anais.ro
0 Bucuresti www.endocenter.ro
0 Bucuresti www.medicalexcellence.ro
0 Bucuresti www.cmmb.ro
0 Bucuresti www.mediclass.ro
0 Bucuresti www.sanysmed.ro
0 Bucuresti www.cdt-babes.ro
1 Botosani www.lux-ro.ro
1 Cluj
1 Constanta www.medstar2000.ro
1 Constanta www.chirurgieunc.ro
1 Neamt www.micromedica.ro
1 Oradea www.gen.ro
1 Pitesti
1 Rm.Valcea www.straubing.ro
1 Sibiu www.visamedica.ro
1 Timisoara www.cmminerva.ro

Note:* Alba Iulia= Ab I,Galati= Gl, Bucuresti = Buc, Giurgiu= Gr, Baia Mare= Bc, Hunedoara= Hd, Botosani= Bots,
Iasi= Is, Brasov= Bv, Neamt= Nt, Braila= Br, Ploiesti= Pl, Buzau= Bz, Pitesti=Pit, Cluj= Cj, Sibiu=Sb,
Craiova=Cv , SatuMare=SM, Constanta= Ct, Tulcea=Tl, Focsani= Fcs, Targu Jiu= Tg J, Timisoara= Tm,
Note: Last update October 2010
Source: internet, database

Pro EAST Consulting 2010

 Private Outpatient Specialized Clinics
in Bucharest
13
The most common medical specialities for private Outpatient Specialized Clinics (with or without surgical units) are listed below.
The restriction of a maximum 24 hours hospitalization is applicable to all.
 Obstretics, Gynecology and Fertilisation 22
 ENT (ORL ) 19
 Ophthalmology (with surgery) 16
 Labor medicine 12
 Plastic and reparatory surgery 11
 General surgery 9
 Imagistic (CT, MRI; eventually PET-CT) 9
 Orthopedic (without surgery) 8
 Proctology 8
 Rheumatology 5
 Dermatology 4
 Radiology and interventional cardiology 2
 Diabetic and nutrition diseases 2
 Phlebology 2
 Rehabilitation Therapy 2
 Stomatology, Implantology - minimum 50
TOTAL NO. OF BRANCH MEDICAL CLINICS IN BUCHAREST 178

Pro EAST Consulting 2010

 Private Hospitals in Romania
14

 Private hospitals arrived on the scene in 2005 – 10 years after the first private Outpatient
Medical Centre opened in Romania.
 The main reasons for this extraordinary delay are:
 - the long term investment required to undertake such a project and
 - the absence of a robust private heath insurance system. The system that currently exists
requires further development and diversification.

 There are currently only 23 private Hospitals in Romania ( including the maternities and
obstetrical and gynecology hospitals) with a total capacity of 1194 beds. This capacity is
very little compared to the current demand for medical services. Many patients with the
financial means go abroad or elsewhere in the European Union for medical treatment.
 5 of the existing 23 private Hospitals are located in Bucharest (estimated population 3,5
mil.).
 The rest are located in cities with a population between 150 000 - 350 000.
 While located in a specific city, their area of service is the entire surrounding region (see slide
20)

Pro EAST Consulting 2010

 Private Hospitals in Romania
15

 Of the 23 private Hospitals currently operational in Romania, 14 are General Hospitals and 9
are Specialized Hospitals.
 7 out of 9 private Specialized Hospitals are specialize in obstetrical & gynaecology
 None of the private hospitals specialize in other high demand, high priority medical
disciplines such as:
 oncology and surgical oncology
 emergency room /emergency surgery
Just one specialized hospital is specialized in cardiology surgery.

 Since 2008, several health care companies have announced their intention to construct
new private hospitals. There are plans to build 12 new private Hospitals – all in Bucharest
– by the year 2013. This new construction would increase existing bed capacity from 281
beds to 1276 beds . This represents an estimated investment value of 317 million Euros
(slide 18).

Pro EAST Consulting 2010

 Private hospitals in Romania
16

Hospital type No. City/Area of Shareholders

Crt. of Romania
No. Hospital name beds Nationality Affiliation or Member of a Group/Chain
IFC, Cristescu Mihaela Gabriela, Nicolae
Bucharest- Marcu, Mihail Marcu, SGAM Eastern Great Britain/France/
1 Life Memorial Hospital General 112 South Europe (Societe General) Romania Medlife

Bucharest- Germany/
2 Euroclinic Hospital General 100 South CMU / Eureko Group Holland CMU / Eureko Group
CMU ,,Arcul de Triumf” General Bucharest- Advent International Investment CMU = Unirea Medical Center
3 Hospital 9 South Found(80%) ,Mr. Enayati Germany
Bucharest- Becico Victoria, Munteanu Codrut,
4 Munposan Hospital Branch (Surgery) 35 South Sangiorzan Anton Romania No
Guset Grigorie, Jivan Adrian, Miclea
5 Genesys Hospital General 45 Arad-West Iulius, Paiusan Lucian Romania Accipiens

6 Laser System Hospital General 11 Arad-West UNK Romania Laser System Medical Center SRL
Bacau-North-
7 Palade Hospital General 22 East UNK Romania Palade Hospital Ltd
Branch (Surgery of
Cardiology and Orthopedic
8 Clinicco Hospital prosthesis) 35 Brasov-Center UNK Romania No
Oradea-North- Adrian Maghiar, Doru Maghiar si
9 Pelican Hospital General 80 West Ovidiu Cacuci Romania No

10 Arcadia Hospital General 220 Iasi-East Fiterman No

11 Polisano Hospital General 50 Sibiu-Center Vonica Ilie, Vonica Daniela Romania Polisano
Suceava-
12 Bethesda Hospital General 48 North-East UNK No
Targu Mures-
13 Nova Vita Hospital General 126 Center Virgil Mailat Romania No
Timisoara- Marinescu Eva, Bratu Ioan, Bratu
14 Brol Hospital General 40 West Tatiana Romania No
Timisoara-
15 Athena Hospital General 70 West Konstantions Giatras Greece No
Pro EAST Consulting 2010
 Private hospitals in Romania
Continued slide 16
17

Crt. Hospital type No. City/Area of Shareholders Affiliation or Member of

No. Hospital name of beds Romania Nationality a Group/Chain
Mociran Mihaela,
Chertif Costache
Mociran Mihaela
Pop Calin Florin
Baia Mare- Pop Coriolan
16 Euromedica Hospital General 40 North West Sasaran Mircea Romania Euromedica Hospital S.A.
17 Eva Clinic Branch (Obstetric-gynacology) 35 Brasov-Center UNK UNK
Bistrita _
18 Sanovil Clinic Branch (Obstetric-gynacology) 30 North-West UNK UNK Sanovil Clinic S.R.L.
Constanta
19 Isis Medical Center Branch (Obstetric-gynacology) UNK South-East UNK UNK Isis Medical Center S.R.L.
Cluj
20 Gynia Hospital Branch (Obstetric-gynacology) 34 North-West UNK UNK Gynia S.R.L.
Cluj
21 Hipocrate Hospital Branch (Obstetric-gynacology) 7 North-West UNK UNK Hipocrate Impex S.R.L.
Advent International
CMU Regina Maria Investment Found(80%) CMU = Unirea Medical
22 Hospital Branch (Obstetric-gynacology) 25 Bucharest South ,Mr. Enayati Germany Center
Ion Marius Rusa, Ion
Sebastian Lutescu, Ioana
Lutescu, Florian Dantes,
Constanta Dan Mugurel Raica, Rucni
23 Euromaterna Hospital Branch (Obstetric-gynacology) 20 South East Asan, Rafael Ron-El. Romania Euromaterna S.A.
Total 1194

Pro EAST Consulting 2010

 Private Hospital – New Projects to 2013
18
Investmen No. of Hospital Time limit
Company name Hospital type Localization Shareholders
t mill euro beds surface Nationality
Branch (surgery) 80%Advent International,
CMU 10 Bucharest 2011 Enayati, 3Pi Germany/Romania
General 80%Advent International,
CMU 25 Bucharest 2011-2012 Enayati, 3Pi Germany/Romania
General (cardiology, ortopedy) Georgeta and Robert Stefan

Gral Medical 25 100 9000 sqm Bucharest 2012 Romania

Medicover General 50 200 12900 sqm Bucharest 2013 ABC Medicover Holding Sweden
Medicover General 10 75 UNK Bucharest 2011 ABC Medicover Holding Sweden
Medsana General 24 150 Bucharest 2010 Athens Medical Centre Greece/Germany
Medlife si Dermastyle Dermatology and estetical surgery 3 1500 sqm Bucharest 2010 Medlife si Dermastyle France/Romania
General Erghin Hagicalil, Liliana
Romar Medical 25 UNK UNK Bucharest 2012 Hagicalil Romania
Elim General 50 120-150 UNK Bucharest/Pitesti 2012 Mrs. Dumbrava Romania
General(cardiology,oncology, in vitro 10000 sqm Medicana Group
Medicana fertilisation) 30 100 land Bucharest UNK Turkey
Sanador General 50 100 14000 sqm Bucharest 2010 Florin Andronescu Romania
General IFC, Cristescu Mihaela
Gabriela, Nicolae Marcu,
Mihail Marcu,SGAM Eastern
Medlife 15 150-200 UNK Bucharest UNK Europe (Societe General) France/Romania
Total Bucharest 317 995-1075

Total investment

hospitals in Romania 0
Total general 317

Source: articles from online press , internet.

We present just the public announced projects. Pro EAST Consulting 2010
 Synoptic table private hospitals in Romania
and Bucharest
19

2010-2013
(new 2010-2013 ( existing private
2010
projects) hospitals+future projects)
Romania
No. of hospitals 23 12 35
No. of beds* 1194 995 2189

Bucharest Out of which Out of which Out of which

No. of hospitals 5 12 17
No. of beds* 281 995 1276
Note: *Not all the future hospitals have reported the number of beds

Pro EAST Consulting 2010

 Private hospital location -
existing and new projects untill 2013
20

Pro EAST Consulting

 The Major Private Healthcare Companies
The private medical services market estimated
at 430 mil euro in 2009

21
Largest private healthcare companies owners of hospitals and outpatient medical centers
Company/Web address Turnover 2009 General manager/Phone
No. (mil. € ) Employees
crt. 2009 2008 2009 2008 Shareholders
IFC, Cristescu Mihaela Gabriela, Nicolae
MED LIFE Marcu, Mihail Marcu, SGAM Eastern
1 www.medlife.ro 26 21,2 990 844 Mihail Marcu 021/2226415 Europe (Societe General)

2 CENTRUL MEDICAL UNIREA www.cmu.ro 13,7 10,9 700 350 Wargha Enayati 021/2229294 Enayati family, Advent International
MEDICOVER
3 www.medicover.ro 11.6 12,8 NA 428 Marina Otelea 021/3191699 ABC Medicover Holding (Sw)
GRAL MEDICAL
4 www.gralmedical.ro 10.7 10 430 371 Robert Serban 021/3230004 Robert and Georgeta Serban
HIPERDIA
5 www.hiperdia.ro 10 9,3 224 251 Tiberiu Roth 0268/473608 Southeast Europe Equity Fund
SANADOR
6 www.cmsanador.ro 9,7 9,4 450 400 Doris Andronescu 021/3230260 Doris Andronescu
CENTRUL MEDICAL ROMAR
Liliana Hagicalil 021/3310301 Else Comp. Ltd., RC2
7 www.romar.ro 9 10,6 503 447

8 CLINICA POLISANO www.clinicapolisano.ro 8,8 4,9 262 160 Dan Rosca 0269/234486 Ilie si Daniela Vonica
EUROCLINIC
9 www.spitaluleuroclinic.ro 8 6,6 341 258 Catalin Popa 021/2006800 Eureko
MEDCENTER
10 www.medcenter.ro 7,2 10 470 510 Florin Balanica 021/2424477 Medicarom
MEDSANA BUCHAREST MEDICAL Athens Medical Group of Companies
11 CENTER www.medsana.ro 5,9 6,2 373 373 Vassilis Chaniotis 021/4087800 (Greece)
Ares Life Sciences, Merrill Lynch Global
12 EUROMEDIC ROMANIA www.euromedic.ro 5,4 NA 549 414 Anca Petca 021/2224111 private Equity
CENTRUL MEDICAL MED-AS 2003
13 www.medas.ro 4,5 NA NA NA Simona Ateia 021/3102138 Simona Ateia
Source:Oficiul National al regsitrului Comertului
Note: * Advent International Investment Fund bought in February 2010 80% from CMU stocks
Pro EAST Consulting 2010
 Public and Private Insurance System
22

 The NATIONAL HEALTH INSURANCE HOUSE (hereafter called NHIH) is the national health insurance plan
for the country. All citizen’s insured under the NHIH plan are entitled to healthcare services at any public
institution (ie medical centre or hospital)
 All private Hospitals are entitled to sign agreements with the National Health Insurance House which afford
partial reimbursement of medical costs for diagnostic and treatment services provided to patients covered
under NHIH.
 The contract regarding the conditions applicable to the NHIH plan – including coverage and levels of
compensation – is reviewed by the Romanian Government. It can be said that patients covered under the
NHIH plan but treated at a Private Hospital are generally entitled to partial reimbursement of the costs of
their diagnostic and treatment services.
 For the year 2010, the average reimbursement provided for under the NHIH for surgery is 350 euros. The
specific amount reimbursed to a Private Hospital for a surgical procedure is governed by the contract
negotiated between the specific Hospital and the NHIH. Such contracts are negotiated annually.
 The private healthcare insurance system in Romania is still at the start-up stage. Even though there are a
number of renowned Health Insurance Companies competing in the Romanian Market (eg. Generali Group,
Allianz, BCR, AIG, BCR, ING Insurance and Adorama), the Healthcare Insurance products on offer are very
basic such as ‘medical check-up insurance. The absence of a more robust and substantial Healthcare
Insurance program is considered the main reason why there are currently only 23 private hospitals for a
population of over 20 million.

Pro EAST Consulting 2010

 Public and Private Insurance System
23

 We predict that the Private Healthcare Insurance market will expand and become far more developed
starting in the year 2010 when another 12 Private Hospitals will become operational (see slide 18).

 It is noted that all announced new hospital construction projects are located in Bucharest. This will result in
disproportionate regional levels of service.

 Country Wide - 27 private hospitals in Romania – population 20 million ( 1 hospital for 740.740 inhabitants)
 In Bucharest - 16 private hospitals – estimated population 3,5 million (1 hospital for 218.750 inhabitants)
 Rest of Romania - 11 private hospitals - population 16 ,5 million ( 1 hospital for 500.000 inhabitants)

 Even though the ratio of hospitals to number of inhabitants is very low compared to other parts of Europe, the new private
hospitals will in fact offer medical services in speciality areas that are seriously under represented today and for which
services are severally lacking. These new hospitals will provide medical services in the high priority areas of cardiology,
oncology and major surgery.

Pro EAST Consulting 2010

 Sources of Revenue
24

 The main sources of revenues for the Private Healthcare System are:
 Patients paying directly to the hospital
 Patients with Corporate medical coverage (often included as part of the compensation
package offered to employees of multinational companies). Corporate coverage may be
valid for one service provider (as chosen by the employer) or for any Private Medical
Centre up to a certain financial limit.
 Patients with Individual Healthcare Insurance. Both types of healthcare subscriptions are
valid only in an clinics network. (example: Unirea Medical Center subscription can be used just in
the company network clinics and hospitals)

 The partial reimbursement offered under the National Health Insurance House , (eg 350
euros per surgical procedure.)
 Private insurances (limited services)

Pro EAST Consulting 2010

 Fee Schedules for Private Hospitals located in Bucharest.

25

MEMORIAL LIFE EUROCLINIC REGINA MARIA MUNPOSAN

HOSPITAL (General General Hospital Gynecology Surgery Hospital
Hospital) HOSPITAL( UMC)
Hospitalization fee/day 78 EUR double 79-121 EUR (regular) 100 EUR 40-110 EUR
149 EUR single 212 EUR VIP
Specialist visit 25 EUR 22 EUR 25 EUR 22 EUR
Professor visit 55 EUR 33 EUR 30 EUR 55 EUR
Radiology – mammography 44 EUR 62- 80 EUR 20-34 EUR 10- 17 EUR
CT abdominal 68-120 EUR 117 EUR 61- 120 EUR
Abdominal ultrasound 39 EUR 50 EUR 42 EUR 22 EUR
Apendicectomy 620 EUR (without 1707 EUR (included 1000-1200 EUR 500 EUR (without
hospitalization fee) hospitalization fee) hospitalization fee)
Laparoscopic cholecistectomy 1098 EUR (without 1527 EUR (included 1200-1600 EUR 700 EUR (without
hospitalization fee) hospitalization fee) hospitalization)
Physiological birth 1902 EUR (without 1707-1829 EUR 1516 EUR
hospitalization fee) (included
hospitalization fee)
Cesarean birth 1342 EUR (without 2376 EUR (included 1760 EUR
hospitalization fee) hospitalization fee)
Mammoplasty 976-1951 EUR (without 2583 EUR (included 3000-4000 EUR
hospitalization fee) hospitalization fee)

Pro EAST Consulting 2010

 Observations
26

 The actual growth enjoyed by 10 of the 13 major private healthcare companies in Romania falls within this
range (see slide 21).
 Some of the companies that opened Outpatient Medical Centers and Specialized Clinics in Bucharest and
elsewhere in Romania now plan to expand and construct General or Specialized Hospitals.
 Medlife, Eureko, Nova Vita San and Fiterman are the four companies that have to date opened private
General Hospitals with more than 100 beds. They are located in Bucharest (2), Targu Mures and Timisoara
(see slide 14).

Pro EAST Consulting 2010

 Observations
27

 The public healthcare system is developed throughout Romania and includes all the medical
centers and hospitals categories (slide 5). The hospitals units are generally located in old
buildings and the medical equipment is inadequate in many hospitals. The medical staff has
high level qualification. The same professors and doctors are working also in the private
system .

 The medical fee structures applied by the various private hospitals in Bucharest are essentially
identical. The differences are not significant. The single exception is Munposan Hospital – a
small surgical Hospital that caters to patients from the Middle East.

Pro EAST Consulting 2010

 Conclusions
28

 The varioius legislation governing the delivery of healthcare services is relatively new and has been drafted
to respect UE standards.
 The Romanian Public Healthcare Sector is under financed. The Government allocation of just 4% of GDP is
grossly insufficient.
 The Private Healthcare sector is under developed. To meet current and future market demands, the private
sector’s further development must be accelerated.
 The Private Healthcare sector is much more developed in Bucharest than the Rest of Romania. This may lead
to disproportionate levels of service throughout the country with rural areas being disadvantaged. Given
the high concentration of start ups planned for Bucharest in the coming two years, this disportionate access
to private medical services is likely to occur sooner than later..
 There is currently a substantial void of Specialized Clinics or Specialized Hospitals in high priority
specialties such as; general surgery, cardiology,oncology and oncology surgery, emergency services. After
2012, there will be a number of Specialized Hospitals that will focus on one or more of these priority
services.
 The private hospitals are not connected to the 112 emergency number (911 in USA). None of the Private
hospitals are specialized in Emergency Care.
 The number of beds in private hospitals will double over the next three years from 1194 beds in 2010 to
2000 beds in 2013.

Pro EAST Consulting 2010

 Conclusions
29

 We estimate that the private insurance system will be more developed and diversified starting with 2012

 The healthcare private market is maintaining its growth trend 35% in 2009 and 20% in 2010

 7 out of top ten healthcare companies had a grow in turnover in 2009 compared with 2008 ( I will ad also
the percentage)

 The main sources of revenues for the private medical units are patients paying directly and subscription to
a medical chain units

Pro EAST Consulting 2010

 APPENDIXES
30

Pro EAST Consulting 2010

 Appendix no.1
List of hospital regulations
31

 The healthcare system in Romania is governed also by:

 In addition, the construction and operation of hospitals in Romania are governed by the Ministry of Health
(Order – OSMP 914/2006 last updated by1030/2009) which contains 47 pages of very specific rules
regarding internal structure, location and environmental impact.

 The design and construction of hospital buildings and installations must be compliant with Regulation NP-
015-97; the anesthesiology and intensive care units with regulation 1500/24 and the Emergency Unit with
regulation 1706/2 dated October 2007.
 1500/24 November 2009 (regarding the organization and the functioning of the units and the anesthesia
and intensive care departments in hospitals),
 1706/2 October 2007 ( regarding the management and the organization of the units and the emergency
room).

Pro EAST Consulting 2010

 Appendix no 2
List of Major Pharmaceutical Companies (2009)
32
Position Company/Group/ We b adre ss Turnove r( mil. €) Marke t share

2009 2009% 2008%

1 Sanofi- Ave ntis/ Ze ntiva 194,2 10,1 10,7 *
2 Hoffmann La Roche 174,2 9,0 7,3
3 Pfiz e r/ Wye th 126,6 6,6 5,2 **
4 GlaxoSmithKline 122,6 6,4 6,9
5 Novartis 114,0 5,9 6,6
6 Se rvie r 105,3 5,5 6
7 Me rck/ Sche ring Plough 85,2 4,4 3,7 ***
8 Ranbaxy 76,5 4,0 4,6
9 Astraz e ne ca 63,3 3,3 2,5
10 Abbott/ Solvay 52,1 2,7 N/A
11 Antibiotice Iasi 49,0 2,5 2,7
12 Bayer 48,4 2,5 2,5
13 Eli Lilly 44,6 2,3 2,2
14 Menarini 40,4 2,1 2,1
15 Labormed / O zone 40,0 2,1 New entry
16 KRKA 36,3 1,9 2,3
17 Activis 34,3 1,8 1,7
18 Johnosn & Johnson 30,9 1,6 1,6
19 Gedeon Richtel 27,6 1,4 1,5
20 Reckitt Benckiser 27,2 1,4 New entry
Total 1. 493,50 77,4
Sursa: Raport cegegim preluat de Ziarul financiar 7 mai 2010 Nota: Cegedim a furnizar vanzarile in lei si au fost transformate de ZF la un curs de 4,2 lei pt. un eur
* Cota de piata cumulata a companiilor Sanofi - Aventis si Zentiva; Datele sunt la preturi PPP, adica la iesirea din farmacii.
**Cota de piata doar pentru compania Pfizer
*** cota cumulata pentru Merck si Schering Plough. Aceste cote au fost calculate cumulat de ZF

Pro EAST Consulting 2010

 APPENDIX no 3
High Risk Diseases in Romania
33

 Between July 2007 - June 2008, the Ministry of Health completed an evaluation of the state
of public health. (Riscograma 2008 )

 A total of 11,104,655 persons were evaluated; 57,6% women and 43,4% men.

 The risk evaluation identified a total of 4,114,969 persons at risk of being further inflicted
with a disease (37% of the group surveyed).

 30% of the group or 3.323.156 persons were found to be at risk of developing mellitius
diabetes
 7% of the group or 805.989 persons were found to be at risk of developing cardiovascular
diseases
 6% of the group or 671.696 persons presented chances of developing oncologycal
diseases (cancer).

Pro EAST Consulting 2010