Misalignment Between Public Reimbursement and Private Dental Service Provision in Romania: A Cross-Sectional Analysis...

Background/Objectives: Romania's National Health Insurance House (CNAS) reimbursement basket is the principal public financial-protection mechanism, yet whether it reflects the therapeutic services patients actually seek has not been tested against private-market offerings. This study compared the public basket with the private dental service portfolio, using the latter as an indirect, supply-side signal of expressed need rather than a direct measure of demand. Methods: In this cross-sectional study (November 2024-February 2025), the publicly listed portfolios of 420 private dental practices in Bucharest (n = 256), Cluj-Napoca (n = 104), and Iași (n = 60) were analyzed, stratified by size (0-3 vs. >3 employees). Practices were identified from CAEN 8623 records on listafirme.ro; portfolios were extracted from official websites displaying prices. Services were classified as functional or aesthetic by two independent raters (Cohen's κ = 0.91), with disagreements resolved by consensus. Results: Across all municipalities and strata, approximately 53-68% of private services fell outside the CNAS basket. Critically, about 95-96% of private services were functional rather than aesthetic (4-5%), indicating that the gap reflects functional treatments patients seek and providers offer yet that remain unfunded-not elective demand. No statistically significant geographic differences emerged. Geographic location was not associated with portfolio breadth, whereas in multivariable models larger practices (>3 employees) independently offered approximately 33% more services. Conclusions: Because the analysis reflects advertised portfolio breadth rather than utilization, and a documented Romanian orientation toward reactive over preventive care, these hypothesis-generating findings make private supply a pragmatic, supply-side reference point for evidence-based revision of the CNAS basket, pointing to two directions directly supported by the data-aligning coverage with observed demand and administrative simplification of contracting. To our knowledge, this is the first benchmarking of the CNAS basket against private supply, relevant to other predominantly private European dental systems.