Keep Us Strong WikiLeaks logo

Currently released so far... 97115 / 251,287

Articles

Browse latest releases

Browse by creation date

Browse by origin

A B C D F G H I J K L M N O P Q R S T U V W Y Z

Browse by tag

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
ETRD EAGR ETTC EAID ECON EFIN ECIN EINV ELAB EAIR ENRG EPET EWWT ECPS EIND EMIN ELTN EC ETMIN EUC EZ ET ELECTIONS ENVR EU EUN EG EINT ER ECONOMICS ES EMS ENIV EEB EN ECE ECOSOC EK ENVIRONMENT EFIS EI EWT ENGRD ECPSN EXIM EIAD ERIN ECPC EDEV ENGY ECTRD EPA ESTH ECCT EINVECON ENGR ERTD EUR EAP EWWC ELTD EL EXIMOPIC EXTERNAL ETRDEC ESCAP ECO EGAD ELNT ECONOMIC ENV ETRN EIAR EUMEM ENRGPARMOTRASENVKGHGPGOVECONTSPLEAID EREL ECOM ECONETRDEAGRJA ETCC ETRG ECONOMY EMED ETR ENERG EITC EFINOECD EURM EENG ERA EXPORT ENRD ECONEINVETRDEFINELABETRDKTDBPGOVOPIC EGEN EBRD EVIN ETRAD ECOWAS EFTA ECONETRDBESPAR EGOVSY EPIN EID ECONENRG EDRC ESENV ETT EB ENER ELTNSNAR ECHEVARRIA ETRC EPIT EDUC ESA EFI ENRGY ESCI EE EAIDXMXAXBXFFR EETC ECIP EIAID EIVN EBEXP ESTN EING EGOV ETRA EPETEIND ELAN ETRDGK EAIDRW ETRDEINVECINPGOVCS EPEC ENVI ELN EAG EPCS EPRT EPTED ETRB EUM EAIDS EFIC EFINECONEAIDUNGAGM EAIDAR ESF EIDN ELAM EDU EV EAIDAF ECN EDA EXBS EINTECPS ENRGTRGYETRDBEXPBTIOSZ EPREL EAC EINVEFIN ETA EAGER EINDIR ECA ECLAC ELAP EITI EUCOM ECONEFINETRDPGOVEAGRPTERKTFNKCRMEAID EARG ELDIN EINVKSCA ENNP EFINECONCS EFINTS ECCP ETC EAIRASECCASCID EINN ETRP EAIDNI EFQ ECOQKPKO EGPHUM EBUD ECONEINVEFINPGOVIZ ENERGY ELB EINDETRD EMI ECONEFIN EIB EURN ETRDEINVTINTCS EIN EFIM ETIO ELAINE EMN EATO EWTR EIPR EINVETC ETTD ETDR EIQ ECONCS EPPD ENRGIZ EISL ESPINOSA ELEC EAIG ESLCO EUREM ENTG ERD EINVECONSENVCSJA EEPET EUNCH ECINECONCS ETRO ETRDECONWTOCS ECUN EFND EPECO EAIRECONRP ERGR ETRDPGOV ECPN ENRGMO EPWR EET EAIS EAGRE EDUARDO EAGRRP EAIDPHUMPRELUG EICN ECONQH EVN EGHG ELBR EINF EAIDHO EENV ETEX ERNG ED
KMDR KPAO KPKO KJUS KCRM KGHG KFRD KWMN KDEM KTFN KHIV KGIC KIDE KSCA KNNP KHUM KIPR KSUM KISL KIRF KCOR KRCM KPAL KWBG KN KS KOMC KSEP KFLU KPWR KTIA KSEO KMPI KHLS KICC KSTH KMCA KVPR KPRM KE KU KZ KFLO KSAF KTIP KTEX KBCT KOCI KOLY KOR KAWC KACT KUNR KTDB KSTC KLIG KSKN KNN KCFE KCIP KGHA KHDP KPOW KUNC KDRL KV KPREL KCRS KPOL KRVC KRIM KGIT KWIR KT KIRC KOMO KRFD KUWAIT KG KFIN KSCI KTFIN KFTN KGOV KPRV KSAC KGIV KCRIM KPIR KSOC KBIO KW KGLB KMWN KPO KFSC KSEAO KSTCPL KSI KPRP KREC KFPC KUNH KCSA KMRS KNDP KR KICCPUR KPPAO KCSY KTBT KCIS KNEP KFRDCVISCMGTCASCKOCIASECPHUMSMIGEG KNNB KGCC KINR KPOP KMFO KENV KNAR KVIR KDRG KDMR KFCE KNAO KDEN KGCN KICA KIMMITT KMCC KLFU KMSG KSEC KUM KCUL KMNP KSMT KCOM KOMCSG KSPR KPMI KRAD KIND KCRP KAUST KWAWC KTER KCHG KRDP KPAS KITA KTSC KPAOPREL KWGB KIRP KJUST KMIG KLAB KTFR KSEI KSTT KAPO KSTS KLSO KWNN KPOA KHSA KNPP KPAONZ KBTS KWWW KY KJRE KPAOKMDRKE KCRCM KSCS KWMNCI KESO KWUN KPLS KIIP KEDEM KPAOY KRIF KGICKS KREF KTRD KFRDSOCIRO KTAO KJU KWMNPHUMPRELKPAOZW KEN KO KNEI KEMR KKIV KEAI KWAC KRCIM KWCI KFIU KWIC KCORR KOMS KNNO KPAI KBWG KTTB KTBD KTIALG KILS KFEM KTDM KESS KNUC KPA KOMCCO KCEM KRCS KWBGSY KNPPIS KNNPMNUC KWN KERG KLTN KALM KCCP KSUMPHUM KREL KGH KLIP KTLA KAWK KWMM KVRP KVRC KAID KSLG KDEMK KX KIF KNPR KCFC KFTFN KTFM KPDD KCERS KMOC KDEMAF KMEPI KEMS KDRM KEPREL KBTR KEDU KNP KIRL KNNR KMPT KISLPINR KTPN KA KJUSTH KPIN KDEV KTDD KAKA KFRP KWNM KTSD KINL KJUSKUNR KWWMN KECF KWBC KPRO KVBL KOM KFRDKIRFCVISCMGTKOCIASECPHUMSMIGEG KEDM KFLD KLPM KRGY KNNF KICR KIFR KM KWMNCS KAWS KLAP KPAK KDDG KCGC KID KNSD KMPF KPFO KDP KCMR KRMS KNPT KNNNP KTIAPARM KDTB KNUP KPGOV KNAP KNNC KUK KSRE KREISLER KIVP KQ KTIAEUN KPALAOIS KRM KISLAO KWM KFLOA
PHUM PINR PTER PGOV PREL PREF PL PM PHSA PE PARM PINS PK PUNE PO PALESTINIAN PU PBTS PROP PTBS POL POLI PA PGOVZI POLMIL POLITICAL PARTIES POLM PD POLITICS POLICY PAS PMIL PINT PNAT PV PKO PPOL PERSONS PING PBIO PH PETR PARMS PRES PCON PETERS PRELBR PT PLAB PP PAK PDEM PKPA PSOCI PF PLO PTERM PJUS PSOE PELOSI PROPERTY PGOVPREL PARP PRL PNIR PHUMKPAL PG PREZ PGIC PBOV PAO PKK PROV PHSAK PHUMPREL PROTECTION PGOVBL PSI PRELPK PGOVENRG PUM PRELKPKO PATTY PSOC PRIVATIZATION PRELSP PGOVEAIDUKNOSWGMHUCANLLHFRSPITNZ PMIG PREC PAIGH PROG PSHA PARK PETER POG PHUS PPREL PS PTERPREL PRELPGOV POV PKPO PGOVECON POUS PGOVPRELPHUMPREFSMIGELABEAIDKCRMKWMN PWBG PMAR PREM PAR PNR PRELPGOVEAIDECONEINVBEXPSCULOIIPBTIO PARMIR PGOVGM PHUH PARTM PN PRE PTE PY POLUN PPEL PDOV PGOVSOCI PIRF PGOVPM PBST PRELEVU PGOR PBTSRU PRM PRELKPAOIZ PGVO PERL PGOC PAGR PMIN PHUMR PVIP PPD PGV PRAM PINL PKPAL PTERE PGOF PINO PHAS PODC PRHUM PHUMA PREO PPA PEPFAR PGO PRGOV PAC PRESL PORG PKFK PEPR PRELP PREFA PNG PGOVPHUMKPAO PRELECON PINOCHET PFOR PGOVLO PHUMBA PRELC PREK PHUME PHJM POLINT PGOVPZ PGOVKCRM PGOVE PHALANAGE PARTY PECON PEACE PROCESS PLN PRELSW PAHO PEDRO PRELA PASS PPAO PGPV PNUM PCUL PGGV PSA PGOVSMIGKCRMKWMNPHUMCVISKFRDCA PGIV PRFE POGOV PEL PBT PAMQ PINF PSEPC POSTS PHUMPGOV PVOV PHSAPREL PROLIFERATION PENA PRELTBIOBA PIN PRELL PGOVPTER PHAM PHYTRP PTEL PTERPGOV PHARM PROTESTS PRELAF PKBL PRELKPAO PKNP PARMP PHUML PFOV PERM PUOS PRELGOV PHUMPTER PARAGRAPH PERURENA PBTSEWWT PCI PETROL PINSO PINSCE PQL PEREZ PBS

Browse by classification

Community resources

courage is contagious

Viewing cable 08BUCHAREST604, ROMANIAN HEALTHCARE PART 2: PHARMACEUTICAL DEMAND RISING,

If you are new to these pages, please read an introduction on the structure of a cable as well as how to discuss them with others. See also the FAQs

Understanding cables
Every cable message consists of three parts:
  • The top box shows each cables unique reference number, when and by whom it originally was sent, and what its initial classification was.
  • The middle box contains the header information that is associated with the cable. It includes information about the receiver(s) as well as a general subject.
  • The bottom box presents the body of the cable. The opening can contain a more specific subject, references to other cables (browse by origin to find them) or additional comment. This is followed by the main contents of the cable: a summary, a collection of specific topics and a comment section.
To understand the justification used for the classification of each cable, please use this WikiSource article as reference.

Discussing cables
If you find meaningful or important information in a cable, please link directly to its unique reference number. Linking to a specific paragraph in the body of a cable is also possible by copying the appropriate link (to be found at theparagraph symbol). Please mark messages for social networking services like Twitter with the hash tags #cablegate and a hash containing the reference ID e.g. #08BUCHAREST604.
Reference ID Created Released Classification Origin
08BUCHAREST604 2008-07-30 14:10 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Bucharest
VZCZCXRO9479
PP RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHBM #0604/01 2121410
ZNR UUUUU ZZH
P 301410Z JUL 08
FM AMEMBASSY BUCHAREST
TO RUEHC/SECSTATE WASHDC PRIORITY 8540
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
UNCLAS SECTION 01 OF 02 BUCHAREST 000604 
 
SIPDIS 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: ECON ELAB EINV PGOV SOCI AMED RO
SUBJECT: ROMANIAN HEALTHCARE PART 2: PHARMACEUTICAL DEMAND RISING, 
BUT ACCESS AND QUALITY REMAIN CONCERNS 
 
REF: A) Bucharest 601 
 
Sensitive but Unclassified; not for Internet distribution. 
 
SUMMARY 
 
1.  (SBU) As incomes rise in Romania, pharmaceutical consumption is 
also increasing.  Better awareness of useful medications has put 
pressure on the Government of Romania (GOR) to expand the national 
drug list and to include more cutting-edge medications.  While any 
pharmaceutical which has been on the EU market for at least one year 
may be legally sold, even if it is not on the national list, these 
medications are not covered under the national insurance system. 
This keeps them out of reach for average Romanians.  Breakdowns in 
the system sometimes leave patients without access to the 
prescriptions they need at the right time. 
 
2.  (U) This is the second of a three-part series on healthcare in 
Romania.  Part 1 focused on the public healthcare system, while part 
3 will look at the emerging private healthcare market.  End 
Summary. 
 
THE MARKET FOR PHARMACEUTICALS 
 
2.  (SBU) Romanian pharmaceutical consumption is well below the EU 
per capita average, which indicates that the market has significant 
room to grow.  However, the cost of prescriptions already accounts 
for nearly 20% of government health expenditures, leaving little 
room for expansion absent radical restructuring of the healthcare 
delivery system.  Because healthcare is publicly financed, payment 
arrears to drug makers on the part of hospitals are not uncommon. 
Hospitals which do not receive timely reimbursements from the 
National Insurance House cannot pay distributors, causing 
distributors to halt shipments.  Likewise, when distributors cannot 
pay pharmaceutical companies, the companies sometimes halt shipments 
to distributors.  This cycle of missed payments creates intermittent 
drug shortages for key medications. 
 
3.  (SBU) In a July 23 meeting with EconOff, Romania Country Manager 
for Merck Sharp and Dohme (MSD), Agata Jakoncic, stated that while 
the issue of payment arrears has improved this year, this is only 
because the Government wants to appear responsive to patients in an 
election year.  She expects payment problems to be a continuing 
issue after the parliamentary elections this fall.  The difficulties 
inherent in working through the state-run system have led some 
pharmaceutical companies to focus their energies on direct sales to 
the small private sector and on marketing non-prescription drugs. 
Still, the pharmaceutical sector is growing despite these 
challenges.  Sales are expected to increase 5-10% in 2008, on top of 
an 11.2% increase in 2007.  Imported drugs make up 80% of the 
available number of medications but account for only 44% of sales, 
meaning that most consumers continue to rely on inexpensive, 
locally-produced generic medications. 
 
4.  (SBU) Maintained by the Ministry of Health, the national drug 
list currently contains 2,106 medications which are covered under 
the state health insurance program.  These drugs are reimbursed on a 
sliding scale of 100, 90, or 50 percent.  Drugs reimbursed at 100 
percent include select medicines used to treat serious illnesses 
such as hepatitis-B and cardiovascular disease.  Generics are 
reimbursed at 90 percent, and most brand name drugs are reimbursed 
at 50 percent.  This structure favors generics over brand names, 
making it difficult for the branded medications to compete.  This 
helps to explain the high usage of generics in the Romanian market, 
since they are not only cheaper but are also reimbursed at a 
significantly higher rate.  For drugs not on the list, 
pharmaceutical companies are forced to offer their own discount 
deals to consumers if they hope to sell the drugs at all. 
 
5.  (SBU) While in theory all of the drugs on the national list are 
provided at no or reduced cost to any insured consumer, in practice 
not all patients receive their medications at subsidized prices. 
Under the existing public health insurance scheme, fixed amounts of 
insured medications are delivered to each pharmacy, with the 
pharmacy permitted to seek other additional supplies directly from 
distributors.  Medication is only free or at reduced cost so long as 
the "insured amount" remains in stock at the pharmacy.  When the 
allotted amount of medication runs out, patients must choose either 
to pay the market price for the prescription or they may wait until 
the next official shipment. 
 
6.  (SBU) According to Jakoncic, the infrequency with which the 
national drug list is updated is a significant source of frustration 
for pharmaceutical companies.  Although Romanian law states that the 
list may be updated as often as once per year, in practice the GOR 
does so at very irregular intervals.  The most recent revision came 
in July 2008 after having remained static since 2005.  Companies are 
reluctant to sell non-listed drugs because the market for them is 
much smaller.  In addition, Romanian law does not allow a drug to 
enter the local market unless it has already been on the EU market 
 
BUCHAREST 00000604  002 OF 002 
 
 
for one year.  These barriers to entry mean that, depending on when 
the list was last updated, some new, life-saving drugs may not be 
available in Romania, despite being widely used elsewhere in the EU. 
 
 
7.  (SBU) Control over the quality and the appropriate dispensing of 
drugs remains an issue.  The sometimes cozy relationships that 
hospital directors have with drug suppliers and distributors allows 
for kickbacks and the occasional distribution of second-rate 
medications.  The limited regulation on pharmacies has allowed for 
an environment where clerical staff will often dispense medication 
without first consulting a pharmacist.  It is not uncommon for 
pharmacies to have insufficient reference materials to check drug 
interactions or dosages.  The overall lax enforcement of 
prescription requirements has meant that most prescription 
medications are relatively easy to acquire from a pharmacy for any 
paying customer. 
 
COMMENT 
 
8. (SBU) Comment:  The pharmaceutical distribution system 
illustrates some of the worst aspects of Romania's "universal care" 
medical system.  Transparency and predictability are lacking. The 
infrequently updated national drug list serves as a central 
gatekeeper, making it difficult for new drugs to enter the market in 
a timely fashion.  In theory, there are no barriers to obtaining any 
needed medication approved on the list.  In practice, the 
availability at the insured price is unreliable.  While the ability 
to pay cash improves the odds of access to medication, it does not 
guarantee it.  This access remains a very real concern for many 
Romanians, including those whose lives are seriously endangered if 
they must miss doses due to temporary supply disruptions.  Reforming 
the public healthcare system to ensure consistent access to 
medication will be a challenge for Romanian policymakers and 
provides an opening for private health insurance.  End Comment. 
 
TAUBMAN