Improving primary health care: output-based contracting in Romania

In 1994 the Romanian government introduced a pilot scheme of output-based contracts for the provision of primary health services. The contracts were aimed at supporting efforts to develop the independent provision of primary services, to increase the share of health spending going to preventive care, and to improve access to health services, especially in rural areas. To help achieve these objectives, the scheme relied on output- based financial incentives and competition between doctors for patients. The pilot resulted in higher patient satisfaction, more primary care services for patients, and higher incomes for doctors. But the weak regulatory and monitoring capability of the purchasing authorities diluted the benefits. Now, with modifications based on lessons from the pilot, the scheme has been extended across the entire country.