Dr. Adrian COSINSCHI, Manager of the Câmpulung Moldovenesc Municipal Hospital, at FERM 2025: “Small hospitals in mountainous areas must be treated as a distinct regional system, with equal rights to resources”

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REGIONAL ECONOMIC FORUM MOLDOVA 2025

19th Edition – Vatra Dornei, July 9–13, 2025

Thematic Panel:

Healthcare and Medical Services in the Moldova Region

Speaker:

Dr. Adrian Cosinschi – Manager, Câmpulung Moldovenesc Municipal Hospital

Presentation topic:
“Continuity of Medical Services in a Mountain Hospital”

Dr. Adrian Cosinschi, manager of the Câmpulung Moldovenesc Municipal Hospital, delivered a solid and analytical address on the need to recognize the specific characteristics of hospitals in mountainous areas and the lack of equity in the current healthcare organization and financing model. His speech clearly highlighted how the geographic and demographic realities of the mountain area impose different needs, often ignored by centralized health policies.

Mountain Area of Suceava: Large Area, Dispersed Population, Limited Access

“The mountain area of Suceava County is disadvantaged in terms of healthcare access,” emphasized Cosinschi.

The county is the second largest in Romania by area, and almost half of its territory is covered by hard-to-reach mountainous regions. In this area, there are three municipal hospitals: Vatra Dornei, Câmpulung Moldovenesc, and Gura Humorului, which together serve approximately 150,000 inhabitants – about a quarter of the county’s population.

“The mismatch between the large area we cover and the low population density creates serious inequities. The road network is sparse, and in winter, we are sometimes completely cut off from the County Hospital.”

Small Hospitals with Big Missions but Insufficient Means

The three mountain hospitals each operate with only two on-call lines – one medical and one surgical – due to a lack of specialized doctors and resources needed to support more lines.

“A single on-call line requires at least four specialist doctors. With just 90 beds, we struggle to maintain even one. We barely exceed the bed threshold, but we have no choice: we lack the personnel.”

The situation is even more severe in critical specialties like pediatrics, obstetrics-gynecology, ICU, or emergency medicine, where no on-call shifts exist at all.

“We have neither doctors nor financial resources to organize on-call shifts in these specialties. This means that the entire mountain region lacks 24/7 emergency care for mothers and children.”

Innovative Proposal: A Regional Health Entity for the Mountain Area

Dr. Cosinschi put forward a concrete and structured proposal: the creation of an autonomous regional healthcare entity for Suceava County’s mountain area. This entity could function as a regional hospital composed of the three smaller hospitals, together having over 500 beds, and could support rotational regional on-call shifts in the most deficient specialties.

“The mountain area deserves the same treatment as Rădăuți or Fălticeni, which have four on-call lines. We have human resources, just not enough within a single hospital. Together, we can meet the needs.”

To make this solution work, the following are needed:

• Legislative intervention and institutional recognition;

• Additional funding, as the served population goes beyond each hospital’s local jurisdiction;

• Financial incentives for doctors, including those covering on-call shifts at other hospitals than their own;

• Reimbursement of travel expenses and a clear model of regional coordination.

Lack of a Dedicated Policy for Small Hospitals

The manager of the Câmpulung Moldovenesc Hospital raised a long-standing gap: the absence of a national strategy for small and medium-sized hospitals. He advocated for the creation of a department within the Ministry of Health, similar to the SME-focused model in economics, that would understand and respond to the specific needs of these crucial healthcare units.

“We are municipal hospitals, but small. We cannot be measured by the same yardstick as large hospitals. The current legislation is too generic, and small hospitals are distorted by it, like in a Procrustean bed.”

Focus on Human Resources

Dr. Cosinschi concluded his plea with a clear message: human resources are essential, and attracting and retaining specialist doctors in mountain areas must become a priority. Without an active policy of motivation and support, “even the most modern buildings or equipment will be useless.”

Conclusion: A Call for Fairness and Adaptation

Dr. Adrian Cosinschi’s address at FERM 2025 was one of the most grounded pleas for territorial equity in healthcare. With clear data, coherent proposals, and a regional vision, the manager showed that small hospitals in mountainous areas are not mere appendages of the system – but foundational pillars for hundreds of thousands of people who cannot be left behind due to statistical inefficiency.

“Regional on-call systems are not a fantasy, but a necessity. And mountain hospitals have the right to an equal chance.”

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