Vladimir Odnostalko, Gabriela Kuneva, Emil Cheban
These are the general parameters of the draft law on the MHIF submitted to the Parliament. During the debates on the draft, PAS deputy Ana Oglinda characterized the parameters of the budget as follows: “Maintaining financial balance through the prism of fairness, transparency and institutional control”.
The largest sum from the basic fund of the MHIF is allocated to inpatient medical care – 8.98 billion lei, which is 4.3 per cent more than in 2025. More than 3.9 billion lei (+14%) is envisaged for primary health care. More than 2 billion lei are planned for ambulance and pre-hospital care services – almost 476 million lei more than this year. A total of 1.74 billion lei is envisaged for specialized outpatient care. It is planned to expand the access to compensated medicines and medical preparations, for which 1.4 billion lei will be allocated. 70 million lei is planned for the preventive measures fund, which is 15 million lei more than in 2025. High-complexity services will amount to about 428 million lei (+5 million lei).
According to Gabriela Cuneva, an MP of the Alternative bloc and member of the specialized parliamentary commission, the growth of investments does not necessarily mean the growth of their efficiency.
“There are disproportions: on the one hand, a multiple increase of investments in expensive equipment is planned, on the other hand, the expenses for services of high complexity are practically unchanged and, taking into account inflation, they are reduced by 6%. It is necessary to pay more attention to the quality, transparency and control of procurement,” believes Cuneva.
Prevention is cheaper than cure
The deputies emphasize the need to develop the primary medical care more efficiently – this would save billions of lei on in-patient treatment in hospitals. The Moldovan population uses inpatient medical care twice as intensively as in the EU countries, and underfinancing of primary medical care directly leads to excessive use of expensive inpatient services. This should be taken into account when allocating MHIF funds with a focus on primary care and prevention.
Vladimir Odnostalco, PSRM deputy, vice chairman of the commission:
“Why did I pay attention to primary medicine and to what is happening in the districts now? The biggest problems come from there. For example, 55% of villages do not have a permanent pediatrician, which means that a child cannot receive timely consultation or medical assistance. As a result, we come to the fact that in Germany the infant mortality rate is 3 children per 1,000 newborns, while in our country it is about 11.8 per 1,000, mortality under 5 years of age is 12.8. This is a serious problem and evidence that management, to put it mildly, is not management. There is an impression that the approach is hospital-centered rather than patient-centered. This needs to be dealt with.
At the same time, 70 million lei is earmarked for prevention in next year’s health budget. Although this is more than this year, the amount is still less than the amount envisaged by law – 2% of the budget, or almost 400 million lei.
“I understand that there is no such money. But when the whole society screams about drug addiction, beer alcoholism among teenagers, tobacco smoking, when teenage girls smoke more than boys, we need money and, most importantly, tools. The ones that are being used now do not work,” Odnostalco said.
The new Minister of Health, for whom the presentation of the MHIF budget was the first serious public test in this post, tried to “stand up” for primary medicine.
“The system of family medicine and primary care in our country is one of the best in the world, there are few such systems. However, over the years it has been overloaded with hundreds of orders. The family medicine doctor has been entrusted with too much: pregnant women, tuberculosis, immunization and many other functions,” said Emil Cheban.
Personnel risks
At the same time, indexation of salaries for them is not provided for in the budget. According to the Minister, medical workers financed from the system of Mandatory Health Insurance Funds, which is about 45 thousand people, will receive salary indexation, maybe in the second half of the year: “When the budget is adjusted. At the moment, unfortunately, it is not planned”.
Vladimir Odnostalco called it “a bad signal”.
“The doctor will compensate it in some way, Mr. Minister, and you know it. Compensation will be at the expense of the patient – and you know that very well too. They will say: “There, they sit in ministries and get 50 percent bonuses for European integration, and what have they done? And what do you say to them?”, – asked the rhetorical question of the deputy.
Gabriela Kuneva also asked to pay attention to the solution of personnel problems. Already now every fifth doctor is over retirement age, and the shortage of primary care specialists is especially acute in the regions. Salaries of middle and junior medical personnel are below the average for the economy. Only one out of three medical school graduates continues to work in the system.
Gabriela Cuneva:
“Staff shortage is one of the critical risks that can negate the effect of planned capital investments.”
Interest income of 3 million lei
At the same time, about 2 billion lei remain annually in the accounts of the National Medical Insurance Company (NMIC). Ion Kicu, a deputy from the Alternative bloc and former prime minister, asked to clarify the interest rate at which the company deposits them: “So that we can compare it with the interest rate at which the Ministry of Finance borrows funds on the domestic market, which is about 8-9%”.
NMSC General Director Ion Dodon explained:
“These funds are used primarily to cover temporary cash gaps, especially at the beginning of the year. We have a schedule of transfers from the state budget with the Ministry of Finance. As you know, we have been working with medical institutions – the absolute majority since the establishment of the health insurance system – on the principle of advance payments: 80% of the planned volume of services is paid in advance, and then the final payment is made. The Ministry of Finance through the State Treasury places temporarily free resources in interest-bearing accounts, and the income received is transferred back to the Mandatory Health Insurance Funds – if there is such a possibility. The interest income amounts to about 3 million lei per year”.
According to him, in general, the financial management has improved in recent years. If earlier about 50,000 people were insured in a fixed amount, now there are almost three times as many. This was the result of the implementation of a new information system and active informing of citizens.
Nevertheless, citizens still have questions, especially in terms of diaspora insurance. Once again, CNAM explains: “Persons permanently residing on the territory of the Republic of Moldova – as employed citizens – are obliged to be insured, either at a fixed amount or at the expense of the state. Persons staying outside the country for more than 183 days a year are not obliged to be insured. However, they have the right – guaranteed by the state – to be insured in Moldova. The preservation of this right has led to certain manipulations”.
The Moldovan MHI system will be 22 years old on January 1. Every year it faces the same criticisms about underfunding. However, no one has yet proposed anything better. Given the deplorable state of the economy and the catastrophic lack of resources in the country, this budget is probably the only realistic one. Perhaps that is why no one dared to vote against it.
Priorities – in favor of the center
The 2026 budget of the Mandatory Health Insurance Funds approves 240 million lei for the modernization of hospitals, but it is earmarked for only five large institutions. The buildings of the Emergency Institute, the Institute of Cardiology, the Institute of Cardiology, the Institute of Mother and Child, the Republican Clinical Hospital and the Onco-Institute are scheduled for overhaul. The question arises: is this decision not related to the fact that the district hospitals have allegedly had time to “grow a belly”? Should they start to worry or not yet? Adrian Bely, chairman of the Commission for Social Protection, Health and Family, pointed out in Parliament the “causal link” and promised to return to the issue of district hospitals later: “After Mr. Minister takes office, after the vote on the budgets, we will discuss in detail all the steps to be taken and implemented together”.
The Ministry of Health promised Logos Press a comment on the subject. Until then, we are forced to refer to the words of Minister Emil Cheban from the rostrum of the Parliament.
Emil Ceban, Minister of Health:
“Funding priority has been given to the five largest hospitals. About 300 million lei is envisaged for the regions – 200 million lei from the state budget and 100 million lei from the National Health Insurance Company. We will work there as well, but the priority will be determined based on the needs of specific hospitals. At the same time, the development of the hospital system will be continued”.
