1 National Anticorruption Directorate

Press release number 868/VIII/3. On Sept 1, 2017, the prosecutors of the Romanian National Anticorruption Directorate detained 14 people on charges of corruption, with the president of the National Health Insurance House (NHIH), the head of the NHIH's Antifraud Department, and the director of the Bucharest Health Insurance House among them.They are accused of having orchestrated reimbursement of home care services for fictional patients to the detriment of real patients on waiting lists, who had been denied services. Initial estimates indicate damage of at least €3 million to the NHIH budget between January, 2016, and August, 2017.

2 Ionescu C Corruption targeted in Romania's health reforms. 3 Romanian Health Observatory

41 cases of high-level corruption in the Romanian healthcare system between 2015 and 2017. Widespread corruption is no longer news for the Romanian health-care system,which has the lowest health expenditure (per capita and relative to gross domestic product) in the European Union. Since 2015, 41 high-ranking health officials and hospital managers have been brought to trial or sentenced on corruption charges.Among them are a secretary of state of the Ministry of Health, four presidents and one vice-president of the NHIH, four presidents of the County Health Insurance Houses, and 15 managers of public hospitals.

Despite the European Commission's recommendations to curb informal health-care payments, they remain frequent. The Ministry of Health received 600 reports of such payments within the first 3 months of the launch of a newly designed patient satisfaction survey.

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et al. Aligning public financial management and health financing, health financing working paper number 4. Against the backdrop of tight budgets and corruption, the Romanian political discourse abounds with calls for increased health spending, with the essential role of good governance in health spending efficiency and the need to align health financing with public financial management systems overlooked.

Despite some progress, accountability and oversight mechanisms remain weak in Romania. The 2016–20 National Anticorruption Strategy contains a chapter on the health sector, but its transformative potential is dim without consistent high-level leadership and committed investments in the strengthening of institutions and the development of big data analytic tools to prevent health-care fraud. In the meantime, formal rationing mechanisms, such as waiting lists, remain vulnerable to manipulation—ultimately disfavouring those whom they should serve.

5 Hartikainen S Romania's mass protests, corruption controversy highlight growing risks to foreign investors. Forbes (New York). However, there is hope. Romania's fight against corruption has successfully brought to justice (and to the public spotlight) countless politicians, high-ranking officials, and business people. An attempt by the Romanian Government to soften anticorruption regulations led to street protests, 600 000 people strong, in support of anticorruption legislation.If anything is to be achieved, continued efforts to improve governance in the Romanian health-care system need to be firmly embedded in the broad anticorruption fight.

We declare no competing interests.