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Scientific rationale for the Mandatory Healthcare Insurance Development Strategy in the Republic of Moldova”

Author: Mihail Ciocanu
Degree:doctor habilitat of medicine
Speciality: 14.00.33 - Social Medicine and Management
Scientific consultant: Dumitru Tintiuc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 16 April, 2008
Approved by NCAA on the 19 June, 2008


Adobe PDF document3.03 Mb / in romanian


CZU 614.2:369.22

Adobe PDF document 13.52 Mb / in romanian
409 pages


mandatory healthcare insurance, solidarity and equity, health system stewardship, financing of healthcare facilities, provision of healthcare services


This paper is a complex research that describes the rationale of the mandatory healthcare insurance feasibility in the Republic of Moldova and future strategic development directions. An analysis of the public expenses dynamics in health sector, before the implementation of mandatory healthcare insurance, underlined that the quota from GDP reduced from 6,2% in 1996 to 3,1% in 2003. The substantial decrease in financing determined a great decrease in population accessibility to health services and in the health care quality. In such situation, the decisionmakers had to use the scarce public resources in the most strategic way and find sustainable methods to collect extrabudget finances in order to face all challenges.

The research carried out by the author served as an important source of information for decision-making regarding the implementation of mandatory healthcare insurance that afterwards proved to develop real pre-requisites for the improvement of financial situation of the healthcare facilities. The originality of this paper lays in the rationale of the new concept of health system financing based on transparent insurance contributions regardless the risk of developing a disease, by maintaining the whole tax-based financing structure. This offered a good method of collecting the financial resources in the health system. The scientific novelty of the achieved results lays in the first time research in the feasibility of the mandatory healthcare insurance in the Republic of Moldova. It described the scientific rationale for all peculiarities in management and financing the proposed system of mandatory healthcare insurance. Also, it offered rationale for the amount of services provided to the insured population and established their cost. A comparative analysis of the results of the activity of healthcare facilities, in extreme conditions and situations undisclosed to mandatory insurance, identified major problems and new organizational forms for providing healthcare services to population were formulated.

The results of the healthcare quality assessment within the mandatory health care insurance system contributed to the emphasis of the new regulations on the demand and consumption of services, a fact that made possible to forward concrete proposals for improving the legal and normative framework. It was stated that the new conditions created prerequisites for significant salary raise for health staff and a more efficient use of the resources allocated for maintaining the infrastructure. The practical value of the paper lays in the improvement of the normative framework for reimbursement of the serviced provided, remuneration of health staff, giving the financial autonomy to the public healthcare facilities providing health services to the insured, development of structures and institutional capacities for healthcare quality management and development of assessment and monitoring indicators. The results of the research are extremely important by its expertise in management of mandatory healthcare insurance in the Republic of Moldova and coordination with the stakeholders/partners involved in the policy development network in the context of the economic and political evolution of the country. The author proposes a new model for the management of financing resources in the health sector at territorial level that comprise both the identification of all financing resources and assessment of population needs, including of the uninsured. The rationale for the mandatory healthcare insurance strategic development directions that imply the constitutional ratification of the fund self-governance, increase the insurance coverage and spreading the autonomy of the service providers offer important prerequisites for equity and efficiency in the use of allocated resources.