Medic24 Analysis: How Emergency Ordinance No. 36 of June 30, 2025 Impacts Romania’s Healthcare System

We created this analysis to support our colleagues in the system – especially family doctors, but also all those managing teams, budgets, and clinical responsibilities. Our goal is to provide clear insights into the current context and offer a practical foundation for balanced decision-making during a period of increasing pressure on the healthcare system and its professionals.

What does Emergency Ordinance 36/2025 actually stipulate?

Emergency Ordinance No. 36/2025, regarding measures related to publicly funded personnel, caps the hazard allowance for dangerous/harmful working conditions at 300 RON gross per month and reduces additional vacation days granted for working under such conditions. The legal act was published in Official Gazette No. 613, Part I, on June 30, 2025.

The measure applies to all employees paid from public funds, including medical staff working in public healthcare units. According to the Government’s statement, this cap comes into effect on July 1, 2025 and will remain in place until December 31, 2026. Additionally, the extra paid leave granted for working under dangerous or harmful conditions has been reduced to 3–5 working days per year, compared to a previous maximum of 10 days. The Government justifies these changes as part of a prudent fiscal-budgetary policy aimed at correcting the excessive budget deficit, considering the significant increase in public sector wage spending over recent years.

It is important to note that this ordinance is part of a broader austerity package designed to reduce public expenditures. Estimates suggest that capping the hazard allowance at 300 RON could generate savings of approximately 1.345 billion RON for the consolidated general budget in 2025. The rapid growth of public sector salary expenses (an increase of around 24% in 2024, reaching a record ~164 billion RON) has prompted the adoption of such temporary cost-reduction measures to maintain the country’s financial sustainability. Romania has committed to gradually reducing its budget deficit from nearly 8% of GDP in 2024 to under 3% by 2031, which explains the government’s current turn toward austerity policies. Within this context, healthcare – although considered a priority sector – was not exempted from fiscal adjustment efforts.

Recent Developments in Romania’s Healthcare System

In recent years, Romania’s healthcare system has undergone significant transformations, both positive and challenging. On one hand, there has been a sustained effort to increase the earnings of medical professionals. Through the Unified Salary Law (Law No. 153/2017) and subsequent adjustments, the salaries of doctors and nurses have seen substantial increases, especially in 2018 and 2022, as part of efforts to stem the emigration of healthcare workers to other countries. These pay raises culminated in early 2024 with a new agreement between the Government and healthcare unions, granting a 15% base salary increase in two stages (March and June 2024).

As a result, public spending on salaries reached record levels in 2024, driven in part by reforms under the National Recovery and Resilience Plan (PNRR), which aimed to address pay inequities in the public sector. While these wage increases helped slow down the emigration of medical professionals, they did not fully halt it. Between 2010 and 2022, nearly 23,000 doctors requested documents to practice abroad, highlighting the scale of this professional exodus. After a slight decrease during the pandemic years, the number of doctors considering emigration rose again, with over 1,000 requesting departure certificates in 2022 alone. This context underscores the fragile balance within the system: despite wage growth, dissatisfaction with working conditions and infrastructure continues to fuel staff departures.

On the other hand, healthcare spending as a share of GDP remains among the lowest in the EU, while chronic issues such as the shortage of professionals in certain specialties and regions, outdated hospital infrastructure, and inefficient management have persisted. These challenges have been compounded by general austerity measures that impacted the healthcare sector. In late 2023 and early 2024, authorities imposed a hiring freeze in the public sector, making it harder to fill vacancies in hospitals and public health institutions.

Furthermore, in March 2025, Emergency Ordinance No. 9/2025 came into effect, prohibiting the extension of employment for staff who had reached retirement age, even if they were willing to temporarily forgo their pension. Following union pressure, the measure was postponed. According to the Prime Minister at that time, it will not be enforced this year. OUG 9/2025 became “infamous” for its unintended consequences in the healthcare sector: hospitals suddenly found themselves without essential doctors (especially in rural areas, where emergency shifts heavily relied on retired physicians still in practice) and without experienced nurses, deepening the already critical staff shortages. Unions warned that, with hiring frozen and experienced specialists being forced into retirement, the healthcare system risks imminent collapse unless short-term flexible solutions are implemented. These developments highlight the tension between the government’s fiscal targets and the healthcare system’s operational realities.

On the investment and structural reform front, however, there is also positive news. The healthcare funds allocated through the National Recovery and Resilience Plan (PNRR) promise to modernize Romania’s medical infrastructure. In 2025, efforts intensified to build new hospitals and upgrade existing facilities.

According to the Minister of Health, Alexandru Rogobete, PNRR-funded investments are “picking up speed” – with hundreds of millions of RON allocated to reduce nosocomial infections, equip neonatal intensive care units, and start construction on new hospital facilities. Additionally, efforts are being made to overcome bureaucratic bottlenecks to ensure these infrastructure projects are completed according to the established timelines (with 2026 as the target year under the PNRR calendar). The Ministry of Health maintains that these reforms and investments will significantly improve the Romanian healthcare system by increasing safety and quality of care. Thus, the current healthcare context is shaped by a dual dynamic: on one hand, severe budget constraints requiring short-term sacrifices; on the other, the promise of medium- and long-term improvements through strategic investments and efficiency-focused reforms.

The legitimate question that arises is: will the Romanian medical system show enough resilience so that these long-delayed investments finally produce tangible results? Will there still be enough doctors to operate the advanced equipment finally procured with EU funding? Will nurses and caregivers still be there to work in the new hospital buildings?

Impact of the New Measures on Medical Staff

The cap on the hazard allowance for dangerous and harmful working conditions at 300 RON gross per month has immediate and tangible consequences on the income of many healthcare employees. Before the ordinance, medical staff working in high-risk environments (such as clinical laboratories, infectious disease wards, radiology and medical imaging departments, emergency medicine, etc.) received an allowance of up to 15% of their base salary, capped at 1,500 RON gross per month.

This meant that employees with higher salaries could receive several hundred or even over a thousand RON monthly to compensate for exposure to hazardous conditions. With the allowance now capped at a fixed 300 RON, the monthly income of these healthcare professionals has dropped significantly. Trade unions have estimated that the net loss can reach up to 1,200 RON per month for employees who previously received the maximum allowance. This reduction affects tens of thousands of employees nationwide, a large portion of whom are doctors, nurses, and auxiliary staff in public hospitals. In addition to the financial cut, a non-monetary benefit was also reduced: the supplementary paid leave for harmful work conditions was lowered from up to 10 working days per year to a maximum of 5. In other words, healthcare workers exposed to stress and difficult environments are losing not just income, but also valuable time for physical and mental recovery.

For family doctors in rural and urban outpatient practices, the direct impact of this ordinance may be more limited, as they did not typically receive the hazard allowance (which was more commonly associated with hospital and laboratory work). However, they too feel the effects of the overall restrictive budget climate: practices are facing funding caps, rising operational costs, and difficulties in hiring support staff (such as community nurses) due to the public sector hiring freeze. Moreover, primary care depends on a functional referral and diagnostic system in hospitals – and when hospitals are under financial and staffing pressure, family doctors’ activity is affected as well.

Back in the hospital setting, reactions were swift. Health sector trade unions (SANITAS and Solidaritatea Sanitară) strongly criticized the ordinance, claiming it violates acquired salary rights and demotivates staff. At the meeting of the Economic and Social Council (CES) on June 30, 2025, union representatives issued a negative opinion on the ordinance, citing potential unconstitutionality in cutting wage rights via emergency decree. In their arguments, union leaders emphasized that reducing the allowance for dangerous and harmful conditions directly affects the living standards of publicly funded workers, their motivation on the job, and the quality of public services (including healthcare) delivered to citizens. In other words, there is concern that medical staff, feeling undervalued and treated unfairly, may become disengaged and consider either seeking better-paid jobs (in the private sector or abroad) or protesting and refusing overtime, which would further strain hospital operations.

It is important to note that not all salary supplements for healthcare workers have been eliminated. Following negotiations with the Government at the end of 2024, some rights were maintained, such as the allowance for work performed on Saturdays, Sundays, and public holidays – a vital compensation for staff working shifts and on-call duty.

Therefore, nurses and doctors performing on-call shifts still receive extra pay for working weekends and holidays, which partly mitigates the austerity impact on their earnings. However, the hazard allowance was widely applied across the healthcare system (in many hospitals, nearly all staff received it, given the variety of risk factors – from exposure to infectious agents to psychological strain). The loss of this monthly bonus flattens salaries downward and causes frustration, especially among lower-paid categories such as auxiliary staff and nurses, for whom the ~300 RON cut weighs heavily on personal budgets.

Another possible consequence of these changes is the shift in professional behavior and career choices. Some specialists may avoid taking posts in high-risk departments (ICU, ER, Infectious Diseases, etc.), knowing that the compensatory bonus is now small and fixed, regardless of actual danger or base salary. Additionally, with the enforcement of the restriction on employing retired doctors (as previously discussed), hospitals risk losing overnight coverage for certain on-call shifts, increasing the workload for the remaining staff. Burnout among doctors and nurses – already flagged by recent studies (the Romanian College of Physicians reported a burnout rate of ~36% among doctors in 2023) – may be exacerbated by the reduction in extra leave days and rising job strain. Furthermore, data collected from over 700 doctors nationwide show that on-call shifts typically last 18–24 hours but can stretch up to 30 hours of continuous work when preceded or followed by regular working hours. Overall, these measures send a signal of instability and uncertainty to medical staff, potentially undermining their trust in the public employer and making them more open to opportunities outside the Romanian public healthcare system.

Implications for the Quality of Medical Services

The quality of healthcare services is closely tied to the motivation and availability of medical staff, as well as to the system’s resources and infrastructure. Therefore, austerity measures that impact staff can have indirect consequences on patients as well. Trade unions warn that reductions in staff income and morale may lead to a decline in the quality of care and even pose risks to patient safety. A demotivated, overworked doctor or nurse who feels their efforts are not adequately rewarded may be less attentive or empathetic in their interactions with patients, potentially affecting the care experience. Additionally, an aggravated personnel shortage (due to the forced retirement of experienced specialists and hiring freezes) means increased workload for those who remain: understaffed hospital departments may see longer waiting lists, extended ER wait times, and unfavorable patient-to-staff ratios. All of this can result in less attention for each patient and a higher risk of errors or complications due to limited time and resources.

The medical staff shortage could worsen: fiscal restrictions have forced the retirement of experienced doctors, leaving some departments without adequate coverage. A telling example is the difficulty in covering on-call shifts in small or rural hospitals after the ban on employing retired doctors. Some medical facilities may be unable to staff on-call lines for specific specialties, jeopardizing continuity of care. In such cases, patients may have to be transferred to larger, more distant hospitals, increasing the time to medical intervention. Moreover, the loss of experienced personnel also impacts the mentorship and training of young residents – if senior doctors exit the system abruptly, younger generations lose access to their guidance, which may affect professional development and, in the long term, the quality of medical care.

However, in assessing the overall impact on care quality, we must also consider compensatory factors or positive developments that may partially offset the effects of austerity. The large-scale investments announced through the PNRR and other government programs aim to improve healthcare quality. Building new hospitals, upgrading neonatal intensive care units, equipping facilities with modern technology, and implementing measures to reduce hospital-acquired infections will help create a safer and more efficient environment for patients. A modern MRI machine or a well-equipped laboratory can enhance diagnosis and treatment, reducing both staff workload and patient risks. Additionally, system digitization (such as the electronic patient record, telemedicine, and hospital IT management systems) – also part of ongoing reforms – could improve efficiency, allowing healthcare providers to spend more time with patients and less on bureaucratic tasks.

Another factor worth considering is the temporary nature of the current ordinance (in effect until the end of 2026). If the economy recovers and public finances return to a sustainable path, there is hope that some restrictions will be relaxed. If healthcare professionals and patients perceive this period as a transitional effort rather than a permanent state, the psychological toll could be lessened. For instance, if by 2027 hazard bonuses are restored to their previous formula or incorporated into a fairer salary framework, the sense of injustice may be retroactively mitigated. In the short term, however (2025–2026), the main challenge will be to maintain the quality of care under existing constraints. This will require additional effort in human resource management (task redistribution, work schedule optimization, avoiding staff overload), as well as continuous dialogue between authorities and healthcare professionals to quickly resolve emerging dysfunctions.

Outlook and Likely Developments in 2025–2026

Taking into account all the elements discussed so far, a complex picture emerges regarding the evolution of Romania’s healthcare system over the next two years. The period 2025–2026 will be marked by the challenge of balancing fiscal prudence with the pressing needs of the health sector. Below are some possible directions and forecasts:

In summary, the 2025–2026 outlook for Romania’s healthcare system will be defined by efforts to adapt to a harsh fiscal reality, while also seizing opportunities for modernization through targeted investments. Healthcare professionals will need to navigate these challenges by maintaining care quality as much as possible and continuing to engage with authorities to ensure their voices are heard in the policymaking process.

The emergency ordinance adopted on June 30, 2025, marks a turning point for Romania’s healthcare system, imposing a difficult compromise between fiscal discipline and the motivation of medical staff. In the short term, the direct consequences include reduced income for some healthcare employees and the loss of certain work-related benefits, understandably generating dissatisfaction among those affected.

Family doctors, specialists, nurses, and other professionals are experiencing uncertainty and increased pressure brought on by these changes. There is a risk that morale and staff availability will decline, with potential consequences for how services are delivered to patients. Alarm bells have already been sounded by unions and professional organizations, signaling that the system is in a fragile balance – austerity measures must be carefully managed so as not to jeopardize the functioning of hospitals and clinics.

Nevertheless, when looking at the broader picture, there remains a visible commitment to improving the healthcare system. The cap on bonuses and similar measures are being presented as temporary and necessary for economic stabilization, while structural reforms and investments (such as those funded through the PNRR) are continuing in parallel. Authorities have stated that healthcare remains a national priority, even amid austerity, and that the intent is not to cut costs at the expense of patients or vulnerable populations.

Whether these promises will translate into reality remains to be seen – social dialogue mechanisms and the ability of healthcare professionals to present their views with evidence and clarity will play a key role. The experience of recent years has shown that the collective voice of doctors and nurses (through unions and associations) can influence decisions – such as preserving weekend and on-call bonuses, or the partial unfreezing of hiring in 2025 after negotiations.

Looking ahead, the system’s evolution through the end of 2026 will depend on the balance between constraints and solutions. If management and infrastructure reforms meet their targets, and the economy allows a gradual easing of austerity, there is a real chance the healthcare system could emerge stronger from this period of trial. Professionals can support this path by maintaining care standards, adapting to new realities (for example, optimizing activity with fewer resources), and actively contributing to policy development (through proposals and expertise).

Protecting the quality of healthcare services must remain the central objective – this is the key message for both decision-makers and those who deliver care every day.

Despite the immediate challenges brought on by austerity policies, Romania’s healthcare system has the opportunity to move forward through long-term vision and close cooperation between authorities and the medical community. By 2027, this could lead to the creation of a renewed social contract in healthcare: one that is financially sustainable, attractive to professionals, and beneficial to patients.