University team works to reform Romanian health care system

Edward Lawlor, Dean of the School of Social Service Administration, leads a team of researchers from the University in their goal to improve the Romanian Health care system.

On one of their first days in Romania, Edward Lawlor, Laurence Lynn Jr. and Henry Webber “saw the extraordinary beauty of the Romanian countryside, enjoyed outstanding Romanian hospitality––and actually made significant progress in the work of our [health care] partnership,” according to a log entry made during a 1996 visit to Romania to help reform its health care system.

Lawlor, Dean of the School of Social Service Administration and director of the American side of the U.S. Romania Partnership in Health Care Management; Lynn, the Sydney Stein Jr. Professor in Public Management at the Harris School and SSA; and Webber, Senior Lecturer in SSA and Vice President for Community Affairs––along with others ––have been working since 1995 to help revamp the health care system of Romania as part of the U.S. Romania Health Management Partnership.

“That day in September 1996, we were going to a district in the center of the country to see reform in action. We saw the impressive commitment to health reform, but we also saw the grinding poverty in the country––and we met up with the frustration of trying to instill the ideal of privatization when there are local hospitals and local doctors who have been doing business the same way for 50 years.”

Members of the American International Health Alliance in Romania approached Lawlor and others in the Graduate Program in Health Administration and Policy in 1995 to be half of a partnership dedicated to reinventing Romania’s health care system. After its initial site visit, the University team decided to focus on broadening and deepening Romanian training in health management. To achieve this, the team would work to improve management teaching and methods, extend Romanian expertise and in-depth knowledge of health management and policy, and increase the exchange of health management and policy experience through collaborative research.

As a vital part of the information exchange, some Romanian hospital staff members have taken classes at the University, and one has become a doctoral candidate here.

Working with their Romanian partners––the Institute of Hygiene, Public Health, Health Services and Management, and the Department of Health Services and Management at the University of Medicine and Pharmacy––gave the American team an appreciation for Romania’s struggle to reformulate not only its entire health care system, but also its society.

“This country has jumped from political and economic isolation under a dictatorship to a market economy, private industry and a new democracy in just a few years,” said Lawlor. “We’re giving folks there the tools to repair their health care system during this time of tremendous upheaval.

“It’s certainly given us a window into the changes of Eastern Europe,” Lawlor added. “Significant change occurs trip to trip to trip.”

Romania was a dictatorship until 1989, when Nicolai Ceaucescu was shot in the street. At that time, the country’s health care system was run Soviet-style, overseen by a Ministry of Health that made all the decisions. “There were just no incentives for modern management to occur, no incentives for innovation or change,” Lawlor said. “There were few records, no meaningful data. Each hospital received the same amount of money no matter how productive they were or how many patients they had.”

When members of the American team visited Romania in 1996, one of Bucharest’s major hospitals lacked management and management staff. The director of the hospital practiced medicine and taught, and there were no graduate programs in health administration, no private health facilities and no health insurance. There was new medical machinery donated by western foundations and countries, but most of it was sitting unused in a small room. “They are still using equipment built in the 1940s because it’s easier to repair and maintain,” Lawlor said.

Lawlor gave an example of how the lack of an open economy had affected the medical system there. “One doctor I talked with was trying to set up a new physicians’ organization for doctors in private practice. His question to me was, ‘How do we set a price for an office visit?’ He said he had gone to a grocery store and picked out a bundle of groceries he thought should be equivalent to an office visit and then figured out how much that costs,” Lawlor said. “It’s a useful illustration because we take a market system for granted––but Romanian health providers have never needed to set prices before.”

Previously, Romanian teaching occurred in a very authoritarian classroom, Lawlor said. “People would lecture, and students would take notes. But Larry Lynn developed case studies similar to those used in business schools, based on actual situations occurring in Romania. He then taught Romanian professors how to use those case studies for a more interactive, engaging classroom––stimulating decision-making and discussion among future policymakers.”

However, Lawlor emphasized that the poor state of health care in Romania was not what was most startling to the Americans. “The thing that amazed many of us was how well the system works with the scarce resources it has to work with because the economy is so poor,” Lawlor said.

The University team is hoping to continue the partnership by going to Romania again in late spring, where it will be led by Thomas D’Aunnuo, Associate Professor in the SSA, and Kristiana Raube, Acting Director of the Center for Health Administration Studies. “In the next phase, we’d like to help develop two new master’s degree programs in health and social service management and develop and evaluate a program to improve the health status and quality of life of elderly residents in Bucharest,” Lawlor said. “There’s a lot to be done.”

The Dean's Team

Edward Lawlor, Laurence Lynn Jr. and Henry Webber are using their expertise in the U.S. Romania Partnership in Health Care Management.

Also offering their expertise to the American team are Thomas D’Aunnuo; Kristiana Raube; Richard Sewell, Director of the SSA-affiliated Chicago Health Policy Council; George Bateman, Adjunct Professor in the Graduate School of Business; Richard Bacon, Manager of Financial Planning & Analysis for the University Hospitals; Marshall Chin, Assistant Professor in Medicine; and Katie Merill, Senior Analyst for the Center for Health Administration Studies.