Key points
- Romania runs the Bismarck model: compulsory social health insurance overseen by the National Health Insurance House (NHIH), under the Ministry of Health, with provision decentralised to 41 districts and Bucharest.
- Coverage is universal on paper but the thinnest in the EU: an estimated 89% of the population was covered by social health insurance in 2024, the lowest proportion among EU countries, and about 11% were uninsured.
- Austerity reforms in September 2025 further reduced the contribution exemptions that had applied to 19 population groups, and the contributor base is expected to expand by around one third.
- Households paid 23.0% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database), up from 19% in 2019.
- Life expectancy at birth was 76.2 years in 2023, and health spending was 5.7% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: Romania runs the Bismarck model: compulsory social health insurance overseen by the National Health Insurance House (NHIH), under the Ministry of Health, with provision decentralised to 41 districts and the capital city, Bucharest. Coverage is universal on paper but the thinnest in the EU: an estimated 89% of the population was covered by social health insurance in 2024, the lowest proportion among EU countries, and about 11% were uninsured. Austerity reforms in September 2025 further reduced the contribution exemptions that had applied to 19 population groups. Households paid 23.0% of health spending out of pocket in 2023. Life expectancy at birth was 76.2 years in 2023 — and healthy life expectancy 66.0 years — and health spending was 5.7% of GDP in 2023 (WHO Global Health Estimates, October 2026; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — compulsory social health insurance (NHIH) |
| Who pays | Compulsory contributions to the NHIH, with the state funding contributions for exempt groups; in 2023, government and compulsory schemes financed 77% of health expenditure |
| Who delivers | Provision decentralised to 41 districts and Bucharest; GPs as the first point of contact, with hospital care in publicly owned facilities |
| What is free at the point of use | The broad benefits package for insured people, and a state-funded minimum package for the uninsured covering emergency care, treatment for infectious and epidemic-prone diseases, maternal care, family planning and community health |
| Life expectancy at birth | 76.2 years (2023, WHO Global Health Estimates) |
| Health spending | 5.7% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | State of Health in the EU — Romania: Country Health Profile 2025 |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Social health insurance is compulsory in Romania. The National Health Insurance House (NHIH), under the Ministry of Health, oversees the system, and the provision of most health services is decentralised to 41 districts and the capital city, Bucharest. The benefits package is broad — inpatient, outpatient, specialist and preventive care, pharmaceuticals and medical devices — and it also covers people fleeing the war in Ukraine.
Coverage is universal on paper but the thinnest in the EU. In 2024, an estimated 89% of the population was covered by social health insurance, the lowest proportion among EU countries, and an estimated 11% of the population were uninsured. That group includes citizens living abroad, informal workers, unregistered unemployed people and people without identity documents, including Roma communities. Until 2025, 19 population groups were exempt from contributions, including children, students, pensioners, people with chronic conditions, people with disabilities, unemployed people and those with incomes below the minimum wage. Austerity reforms in September 2025 further reduced these exemptions, and the new measures are expected to expand the contributor base by around one third over the coming years.
Uninsured individuals can access a state-funded minimum benefits package covering emergency care, treatment for infectious and epidemic-prone diseases, maternal care, family planning and community health. In 2023, this package was expanded to include primary care services as well as selected laboratory tests and specialist consultations for certain chronic conditions, including hepatitis B and C and cancer. However, uninsured patients still pay out of pocket for outpatient medicines and other laboratory and imaging services.
Who pays, and what people pay
Compulsory contributions to the NHIH pay for most of it: in 2023, government and compulsory schemes financed 77% of health expenditure, lower than the EU average of 80%, while private funding accounted for the remaining 23%, almost all of it through out-of-pocket payments. Health expenditure was EUR 1,800 per capita in 2023 (adjusted for differences in purchasing power) — Romania has the lowest per capita health spending among EU countries, less than half the EU average — and 5.8% of GDP in the Country Health Profile, against 5.7% in the World Bank series used for the template figure. Out-of-pocket payments were 23% of total health spending in 2023, up from 19% in 2019 and above the EU average of 16%. Nearly 60% of out-of-pocket spending was on pharmaceuticals (more than twice the EU average), 18% on dental care and 9% on outpatient care. Informal payments also contribute: 9% of Romanians reported making an extra payment or giving a gift, three times the EU average.
What is free, and what is not
Free at the point of use: the broad benefits package for insured people, and the state-funded minimum package for the uninsured. Public financing covers most hospital and outpatient care but is limited for medicines and dental care: the NHIH reimburses 50% of the reference price for medicines on the positive list, and around 70% of outpatient medicines on the positive list were exempt from co-payments in 2020. Pensioners benefit from a 90% reimbursement scheme for medicines, with the income threshold raised to EUR 321 per month in 2023. What is not free is the margin: outpatient medicines, dental care — where public coverage is about five times lower than the EU average — and the informal payments that 9% of Romanians report making.
How it compares
Romania spends 5.7% of GDP on health (2023), below the OECD average of 9.3% (2024), and its life expectancy of 76.2 years is 4.9 years below the OECD average of 81.1 years (2023). Romania is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is how little the system spends and how thin the cover is: the lowest per capita health spending among EU countries, the lowest share of the population covered by social health insurance in the EU, and only 10% of health spending going to primary care — while hospital beds ran at 7.3 per 1,000 people in 2023, the third-highest rate in the EU, and only 20% of health spending went to outpatient care, the second-lowest share in the EU. Life expectancy reached a new all-time high of 76.6 years in 2024, still 5.1 years below the EU average, and cardiovascular disease remained the leading cause of mortality, accounting for 56% of all deaths in 2022. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is healthcare free in Romania?
The benefits package is broad, and uninsured people can access a state-funded minimum package — but households paid 23.0% of health spending out of pocket in 2023, mostly for medicines, and 9% of Romanians reported making an informal payment.
What does the NHIH cover?
The National Health Insurance House oversees compulsory social health insurance: inpatient, outpatient, specialist and preventive care, pharmaceuticals and medical devices — with public financing covering almost all inpatient care but only half of pharmaceutical spending.
Who is uninsured in Romania?
About 11% of the population in 2024 — citizens living abroad, informal workers, unregistered unemployed people and people without identity documents, including Roma communities — though the uninsured can access a state-funded minimum package.