Contrasting Clustering in Health Care Provision in Romania: Spatial and Aspatial Limitations☆

Despite its over 26 years of continuous efforts to reform the health care system, Romania is facing serious problems in meeting population health care needs, mainly due to chronic underfunding of public health care units, shortage of medical personnel, lack of GP in rural areas. The economic crisis has deepened these problems, making the access to health care more difficult for disadvantaged or vulnerable groups of population. Poor health status of the population, the demographic aging, the large share of socio-economic dependent population and the high level of chronic diseases incidence all lead to increased health care need therefore healthcare costs. Health care activity is mostly based on the public sector and is financed from public funds; although private health services have had an extraordinary development recently, they are restrictive for the most of the population due to high costs and geographic location. Geographical distribution of medical personnel reveals major disparities among regions and in particular between urban and rural areas: less than 20% of the physicians (5,592 from 52,541 in 2012) are practicing in rural areas, 66% of the medical personnel being concentrated in six large cities while 5% of the rural communities have no doctor. Over 15,000 health professionals (30% of total) have left Romania since 2007 and about 40% of the medical graduates (2,500) are emigrating every year. By using quantitative and GIS techniques, this study is aiming to examine the spatial distribution of healthcare resources in order to point out the large rural-urban divide in health care provision and to highlight the deep territorial discrepancies related to supply of health services and potential population needs.