IMPRIME, SOCIEDAD ANONIMA 2,450.00

GIRBAN Marilena Gela

Ph.D. student, Doctoral School/Department Management , "Valahia" University, Targoviste, Romania, [email protected]

PARGARU Ion

Professor, Faculty of Entreprenorship Engineering and Business Administration/ Department of Economic Engineering, University Politehnica of Bucuresti, Bucharest, Romania, [email protected]

Abstract: Recently, many health systems in the world in their heart patient's needs. The Romanian system is no exception to this trend. Quality health care is no doubt an evaluating of patient satisfaction. The purpose of this article is to analyze how the perception of quality medical services according to perceived needs of patients when you can call the doctor. Research methods used were: documentation, technical survey and comparative analysis with other countries, and expected results are the level of satisfaction of patients, correlated with a medical provider and available resources.

Key words: satisfaction questionnaire, quality assessment, patients, health systems, performance management

JEL classification: I 10 – health general

1. Introduction

Quality medical services that benefit patients in Romania is a topic extensively dissected. Theme topic is not based on lack of resources, which is often correlated with service quality evaluation and

satisfaction of patients, but efficient and effective use of those available.

European health systems and beyond, have changed focus from general to particular, from institutions to the patient to better identify needs and to tailor treatments ingirijire the sick and not a disease.

An important component of evaluating the quality and efficiency of care and patient satisfaction is. As an indication of defense and felt needs for care of patients, patient satisfaction, although it contains a high degree of subjective factor and often not directly related to the medical act itself, but rather with administrative services, hotels, attitude and behavior of personnel entering patient contact. The present study concerns a comparative analysis of the level of satisfaction expressed by patients in the current funding of service providers. The case study concerns a chronic disease hospital in Buzau County, located in a village, 20 km from the county town, the only hospital of its kind in the area. A questionnaire method was used, for the year 2011 and first quarter of 2012. Events and events were conducted in the foreground with the patient and the results are shown below.

For an overview of overall patient satisfaction is the degree of response to their expectations. These expectations, the waiting time at the emergency room until the room air temperature, the appearance of food and bedding to cyclical change and general hygiene, not least respect infomarea hours of treatment or on medication, listing only a few indicators of satisfaction, reflects what the patient wants

to achieve and the impression is what has been, rather than disease stage and treatment response.

2. The conceptual framework

As a structure, defined by the Health Act, the Romanian system is composed of several actors: - health care providers - primary care (GPs), secondary care (ambulatory and medical practices speciaity), tertiary (hospitals) and the Quaternary (rehabilitation).

- insurer - currently represented by the National Health Insurance and the county - third party payer - patient - care recipient.

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Service providers

Primary care is provided by family doctors. The most common type of organization is their individual

medical office, but there is a growing number of civil society than medical.

General practitioners provide primary care medical services to patients insured by health insurance system, their lists (without pay) or other medical lists of family and uninsured patients (fee). General practitioners have the owner / legal representative, a family doctor. They provide preventive care, curative and emergency recovery.

This differs significantly from medical services before 1998, when primary care was provided by

a large number of dispensaries of various types: local, school and business. They were given territorial area hospital. Patients were repatizati, having no choice option advice.

With the reorganization in the CMI, or other forms of organizational, patients were given the right to choose their doctor, they were paid per capita (for each patient enrolled in the list), which was introduced competition between service providers primary care. An attempt was also an increased role in filtering GP patients to other medical services.

Family doctors are independent suppliers are no longer employees. Manages its own budget and enter into contract with the Health Insurance.

Secondary care include specialized care: ambulatory, ambulatory integrated hospitals, clinics, diagnostic and treatment centers, medical specialty civil society, etc.

Ambulatory care units are particularly suited for outpatient health care. They are either legal entities or the structure of a hospital (outpatient integrated). Those providing medical treatment for medical specialty for which they were intended.Generally, they have one specialty, but there are cases which are grouped several related medical specialties. Services provided are preventive, curative and emergency recovery. In these types of units can take place and educational activities. Hospitals or clinics are unincorporated, which provides specialized care in many specialties, outpatient. They work in the public system (paid and unpaid) or the private system, providing preventive care, curative and emergency.

Diagnostic and treatment centers are hospitals providing the care specialty beds featuring day. These were mainly the task of diagnosis, treatment and outpatient treatment recommendations. Tertiary care - provided by hospitals, sanatoriums, preventoria, social medical units - mostly belongs to the public sector.

Hospitals are hospitals (public, private public and private sections) with beds, public utility, with legal personality, which provides medical services to persons hospitalized or attending outpatient health insurance population. Under health reform law, which provides preventive care, curative and palliative recovery. The organizational structure comprises of a hospital if necessary: wards, laboratories, diagnostic and treatment services, departments, services or technical offices, economic or administrative, pre- hospital care services and emergency transport, emergency receiving structures. Hospitals may have the structure of specialized outpatient services, day hospital services, home care and outpatient laboratory services. Hospitals are required to operate and research medical education for physicians, nurses and other medical and non medical staff.

Nursing is bedded hospitals providing medical care using natural healing factors, associated with other methods, techniques and therapeutic means.There are units with legal personality and is organized as tuberculosis sanatoriums, sanatoriums sanatoriums of neurosis or spa for various specialties (impaired motor, cardiovascular, digestive, renal, etc.).

Preventoria are hospitals with beds, with legal personality, which provides prevention and combating of tuberculosis in children and young people, and in patients with clinically stable and non- contagious tuberculosis.

Health centers are hospitals with beds that provide health care specialist at least two specialties, the population of several adjacent locations.

Social medical units specialized beds are public institutions with legal personality, subordinated to local authorities, which provide people with medical needs social care services, medical services and social services.

Romania has chosen to reform the public health system, Beveridge model the transition from one based on health insurance. Changes in health care last year but did not solve the problems of services, the system currently one hybrid, innovative in this regard.

Reforming health services continued in 2010 producing significant changes in health system infrastructure and personnel structure involved in providing health services, both public sector and in private.

Network health units recorded in 2010 significant changes. Thus, the number increased by 29 hospitals, 5 outpatient at the hospital's integrated with that of the 353 dental offices and pharmacies with 340 numbers, points of pharmacies and drug stores work. The network of medical units in 2010 were separated institutes and institutions without beds, the total land is 108 such units.

Previous year, in 2010, distribution prinipalelor health units in Table 1 is as follows:

Table 1: Number of health units in the main categories of units

Health units 2009 2010 In 2010 compared to 2009 Differences (+/-) Hospitals 474 503 29 Polyclinics 268 311 43 Dispensaries 211 204 -7 TB sanatoria 5 4 -1 Preventoria 4 4 - Spa sanatoriums 7 7 - Medico-social units 68 68 - Specialty ambulatory 69 75 6

Integrated outpatient hospital 392 397 5

Family medical 1390 1170 -220

GP surgeries 1055 1000 -55

Dentist 1683 1236 353

Medical specialty 998 8870 -1128

Civilian medical societies 108 110 2

Civil society dental care 165 159 -6

Civil society specialist medical 251 218 -33

Pharmacies, pharmacy outlets and drugstores 7586 7926 340 Source: INS – activities of medical units in 2010