Poverty and health care in the context of Romanian postcommunism

The market transition in postcommunist Romania brought transformations in the distribution and quality of health care. These changes have improved the quality of health care for many people. However, increasing socioeconomic disparities have severely affected access to adequate healthcare for at least half of Romania's estimated 2.5 million Roma, most of whom remain mired in poverty. Some scholars argue that the Roma constitute a marginalized "underclass" whose social and cultural characteristics exclude them from full participation in Romanian society. Other scholars assert that although Roma poverty has intensified, the Roma actively participate in the capitalist economy, and some Roma are developing strategies to compete in it. My research examined these concerns by exploring the effects of free market policies and health care reforms on the Roma of Cluj County, Romania.;The information presented throughout this dissertation is based primarily on formal and informal interviews, participant observation, and literature review. Roma informants were the most critical group to this project because they are the most directly affected by the negative consequences of exclusion from the health care system. I interviewed health care workers, NGO project directors, and city and county officials because their actions have direct and indirect impacts on Roma health care.;Roma informants involved in this study differed in terms of eligibility for health insurance, social assistance, pension, and employment, all of which directly affect access to health care. Community location, proximity to services and resources, and the local environment also affect access to health care and quality of health. Both the changes to the health care system since communism and legislation regarding residency and eligibility are probably the biggest factors in obtaining health insurance. Informants commonly asserted that they preferred most aspects of their lives during communism, including health care. This indicates a disparity in benefits that have developed from the social system during the market transition. The results of this project show that Roma, on average, have poor access to health care. This is significant because it suggests that the legislation that determines health care access and quality of life is unfair and indirectly leads to inequality.