Report: Temporary health. Analysis of CAS and DSP appointments over the last 10 years

The report analyzes the hiring procedures for the public health directorates (DSP) and the county health insurance departments (CASJ). The purpose of the analysis is to highlight the potential for politicization of the process. The analysis is based on data provided by FOIA requests by the National Health Insurance House (CNAS), the Ministry of Health (MS) and the National Agency of Public Servants (ANFP). Data from the portal developed by EFOR , declarations of wealth and interests published on the ANI portal and from the mass media were also used.

The main conclusions

  • For both CASs and DSPs, a large proportion of appointments were made by delegation/temporary duty, which is the replacement solution for appointment of a director in case the candidates do not pass the exam or there is no other available person. These phenomena reflect an instability of the function and is prone to politicization. Excluding very long mandates, in the case of DSPs the average mandate in the period 2012-2022 is close to six months, i.e. the maximum period for delegations.
  • The competition for official contests is relatively low, and in some cases even directors who had held the same position cannot pass the contest, which may indicate – without being an exhaustive reason – a lack of capacity in human resources or a possible lack of interest in the occupation these functions
  • The competition in CAS is different by county: in some counties there are more than two or three candidates, but the rule is that the number of candidates is small, with an average of 1-2 candidates
  • In the case of both institutions, there are cases of counties where only one director held this position during the analyzed period, and in some counties the list of directors can reach 6-7 names. Counties with heavy rotation are not necessarily the same for DSP and CAS
  • The performance of the directors cannot be evaluated by third parties, as the management contracts are not public and have not been provided. Moreover, the CVs that would reflect the experience are not found on the institutions’ websites
  • Most of the temporary appointments to DSPs were made in 2020, especially in January, before the pandemic really started.
  • There are strong hints of politicization in both cases. At CASs almost 20% of directors have political connections in various forms, including candidates, holding an public position at local or central level or holding a leading position in a party. In the case of DSPs, the percentage approaches 16%. However, the statistics only reflect political relationships that can be documented from declarations of wealth or interests, from donations or candidacies, but cannot include power relationships at the local level that may favor these appointments.
    Politicization appears to be a phenomenon that spans the entire period studied and is cross-party.

Other specific conclusions


  • Data related to the most recent CNAS competitions reflect the fact that a relatively small number of candidates managed to pass the competition
  • In the last 10 years, 13 competition sessions were organized for the position of president general manager/general manager, at the national level, in 2013, 2014, 2015, 2016, 2017 and 2021. No contests were organized between 2017 and 2021.

  • The competition is low in such contests, and the most candidates (average) were in Dâmbovița, i.e. 3.3. In Buzău, the average dropped to 2.3, and in Botoșani, Covasna and Bucharest to 2 candidates. In seven counties – Caraș Severin, Cluj, Dolj, Harghita, Mehedinți, Olt, Sibiu – the competition stagnated at one candidate each.
  • The most appointments took place in 2020, i.e. 141 contracts, when no contest was organized. In 2020, between 2 and 4 appointments were made for each of the insurance companies, and the most contracts were concluded in Buzău, i.e. six.
  • Although there are insurance companies that have very little delegation, the rule is rather that management positions are filled in this manner.
  • As a result of the verification of more than 1200 declarations of wealth and interests available on the portal, it follows that 32 people held leadership positions in political parties at the local or central level, were candidates or held public positions. The platform illustrates that a number of 32 names appear registered with political contributions, donations, loans or contributions for electoral campaigns. In 19 cases, the mentioned party is PD/PDL/PNL/USL, in two cases UDMR, and for the rest PSD. The data show us that there is a cross-party practice of promoting people with a political profile for leadership positions in the CASs. Furthermore, it seems that the trend covers the entire analysed period.


  • The data from the National Agency for Civil Servants and those from the Ministry of Health contain certain differences regarding the periods/start dates of the contracts in which the respective public positions were held, but the names coincide
  • According to ANFP, it appears that a number of 105 people were appointed between 2016 and 2022. In 13 counties there was only one director, appointed by final decision
  • We estimate that approximately 80% of these appointments were made by delegation/temporary execution of the function. To be noted that the information refers to the data available from ANFP, which are partial. In the last six years, according to the data available to EFOR, only temporary appointments were made in counties such as Suceava, Neamț, Brașov, Arad, Timiș, Olt or Călărași.
  • According to data from the Ministry of Health, most appointments took place in 2020 . Although we do not have a complete picture of the type of appointment, we believe that most of them were temporary. A fifth of the appointments were made in January, before the pandemic began, but several of the appointed directors were already in the position.
  • Data from the Ministry of Health show us that there is an increased percentage of short mandates. At the same time, if we analyse at the total number of days for mandates, the results show that there are some directors who have accumulated more than 9-10 years of mandate.

  • If we exclude very long or very short mandates, the average per mandate seems to be close to half a year, which is the maximum period for delegation. It is difficult to calculate an average that faithfully reflects the period of mandates, as there are differences in reporting. However, this fact shows us that delegations seem to be the rule.


Project funded by the US Department of State, Bureau of Democracy, Human Rights and Labor (DRL) and coordinated by the CEELI Institute.

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