Rafila: Underfunding in healthcare cannot be solved without structural reforms and better budget revenue collection

Alexandru Rafila says that the underfunding of the healthcare system cannot be analyzed separately from the fiscal and administrative causes that limit state revenues. The chair of the Health and Family Committee in the Chamber of Deputies says reform must include better budget revenue collection, digitalization, the use of AI and funding closer to the real costs of medical services.

Healthcare underfunding, linked to low budget revenue collection

Alexandru Rafila, chair of the Health and Family Committee in the Chamber of Deputies, said on Tuesday, June 9, that the discussion about the underfunding of the healthcare system must start from the causes that led to this situation, not only from the visible effects in hospitals, medical services and patients’ access to care.

The ideas were also presented during the Aspen Healthcare Summit 2026, held on June 8-9 in Bucharest, where Rafila took part in the panel dedicated to financing, efficiency and the role of artificial intelligence in healthcare systems.

According to him, Romania continues to have the lowest budget revenue collection rate in the European Union, while tax evasion seriously affects the state’s ability to finance essential public services.

“Healthcare underfunding is frequently discussed, but much less often the causes that led to this situation. If we do not address the underlying problems, any solution will have limited and temporary effects,” Alexandru Rafila said.

Uncollected VAT and lost resources for public services

Rafila identified tax collection as one of the major problems limiting healthcare financing. He said that, with almost 30% of VAT not being collected, the state loses significant resources every year that could support investments in healthcare, education and infrastructure.

“Tax evasion seriously affects the state’s ability to finance essential public services. With almost 30% of VAT not being collected, we lose important resources every year that could support investments in healthcare, education and infrastructure,” Rafila said.

The statements come at a time when the sustainability of healthcare financing is increasingly discussed in relation to the budget deficit, the pressure on the National Health Insurance Fund and rising medical costs.

Patients bear a higher financial burden than the European average

According to Rafila, one direct effect of the current financing model is the transfer of a significant share of costs to patients.

He noted that, while the European average for out-of-pocket payments for medical services is around 15%, in Romania the level is close to 30%.

“The consequences can also be seen in the financial burden borne by patients. While the European average for direct payments for medical services is around 15%, in Romania it is close to 30%. This is a clear signal that the current financing model needs adjustments and consistent reforms,” Rafila said.

High out-of-pocket payments are an important indicator of the financial pressure on patients and may affect access to medical services, especially for people with low incomes or patients with chronic diseases.

Risk of growing pressure on the National Health Insurance Fund

Rafila warned that, without structural decisions, the pressure on the National Health Insurance Fund could become increasingly difficult to manage in the coming years.

He criticized the fact that many measures adopted in healthcare have been fragmented and focused on short-term objectives, without a coherent and predictable strategy.

“For years, we have avoided addressing some structural problems in the healthcare system. Moreover, the measures adopted have often been fragmented and oriented toward short-term objectives. We need a coherent strategy, built with responsibility and consistency, that provides predictability and sustainability,” Alexandru Rafila said.

Digitalization and AI, part of the same reform vision

In Rafila’s view, the modernization of the healthcare system cannot be separated from digitalization, the use of artificial intelligence and the adjustment of funding to the real costs of medical services.

He said reform must include both technological tools and a change in the way services are financed.

“System modernization, digitalization, the use of artificial intelligence and funding closer to the real costs of medical services must be part of the same reform vision,” Rafila said.

The topic was also present in the Aspen Healthcare Summit 2026 program, where one of the main sessions focused on whether solidarity-based systems can still be sustained amid financial pressure, population ageing, rising costs and new technologies.

Healthcare reform, between financing, efficiency and solidarity

Alexandru Rafila’s statements bring back into discussion an essential issue for the healthcare system: healthcare financing does not depend only on annual budget allocations, but also on the state’s ability to collect revenue, control waste, pay realistically for medical services and reduce the burden transferred to patients.

“A strong healthcare system is not built through short-term measures, but by addressing the causes that limit its development,” Rafila concluded.