Evolution of the Romanian Pharmaceutical System in the Period 1990-Present

: In this study I present the evolution of the number of Pharmacies, Pharmacists, Pharmacy graduates, Pharmacy/Population ratio, Pharmacist/Population after 1990. If in 1990 there were 1948 pharmacies, in 2017 their number reached 7945. And the number of pharmacists increased in a fast pace, in 1990 were 6286 to a population of 23206720 inhabitants, in 2017 their number reached 17833 in a population of 19588146 inhabitants. In 2017 the Pharmacy/Population ratio is 2465 and the Pharmacist/Population ratio is 1098. This increase in the number of pharmacists was due to the establishment of new Pharmacy Faculties in different cities of the country after 1990. I also succinctly present the Legislation that has undergone a number of changes over time and has influenced the evolution of these indicators: Law No. 95 of 14 April 2006 on Health Reform, Order of the Minister of Health No. 2234 of 1994, Order of Health Minister No. 201 of 1999, Order of the Minister of Health and Family No. 626 of 2001, Order of Health Minister No. 1199 of 2004, Order of Health Minister No. 962/2009, Law No. 266 of 2008 of the Pharmacy, Law No. 266 of 2008 of the Pharmacy, Reprocessed, Law No. 46 of 21 January 2003 on Patients' Rights.


Introduction
When we speak of the Romanian pharmaceutical system, of course we all think about its efficiency, the costs of providing the medicine to the population, the quality of the pharmaceutical act and, last but not least, to the beneficiary for whom this system is organized: the patient.
The transition to the market economy also meant a permanent debate on the criteria and conditions for the establishment and functioning of the pharmacy [1].
Pharmacists are considered an integral part of the health services system, because from these patients can obtain accessible information in a relaxed environment without needing programming. Law No. 95 of 2006 on Health Reform, establishes the activities which the holder of the official title of pharmacist carries out, including the provision of information and advice on medicinal products, cooperation with the physician for the establishment and monitoring of patient therapy [2].

Objective
Evolution of human and materials resources from the Romanian Pharmaceutical System and Pharmaceutical Legislation after 1990.

Materials and Method
For the realization of this article I studied Statistical Yearbook, Literature, Legislation, I used the statistic method. The statistical method is based on the collection, processing and valorisation of data on the elements taken in the study. In order to achieve the proposed objective, we have studied the following elements: human and materials resources (pharmacists, pharmacist graduates, pharmacies).

Results and Discussions
In social aspect, Romania's population decreased due to the steady decline in birth and massive exodus abroad.
If the census of 1990 Romanian population counted 23206720 inhabitants, in 2017 their number reached 19588146.
The number of pharmacies has steadily increased, changing the existing property type. In Table 1 I regive the number of pharmacies in the period 1990-2017 [3]. In Table 2 we extracted from the Yearbook the number of pharmacists in the period 1990-2017:  1990  6286  2000  7189  2010  13624  1991  5080  2001  7298  2011  14575  1992  3817  2002  7328  2012  15435  1993  2790  2003  7793  2013  16301  1994  2814  2004  8763  2014  17099  1995  2646  2005  9283  2015  17135  1996  2578  2006  9.932  2016  17180  1997  5955  2007  11108  2017  17833  1998  6209  2008  11704  --1999  6610  2009  . This is also the consequence of the establishment of Pharmacy Faculties in different cities of the country after 1990. It is observed from the table a decrease in the number of pharmacists after 1992 due to pensioners in the system and also an increase in their number after 1996.
It is therefore compulsory to have a good correlation between the needs of the society on pharmaceutical knowledge, the aspirations of the profession in general, the possibilities of Pharmacy Facultaties and the number of pharmacists.

Indication: The number of pharmacy graduates appears in the yearbook until the Yearbook of 2014, after this year appears cumulated-Health and social assistance
In the table we can see that the number of graduates of Pharmacy Faculties from 1990 to 2012 increased 13 times, after which followed a decrease in the number of pharmacy graduates in 2013 and 2014.
And Legislation in the pharmaceutical field has undergone several modifications.
In summary: If from 1990 to 1998 pharmacy owner was the pharmacist, from 1998 to today pharmacy owner can be anyone, hiring a chief pharmacist; on the demographic criterion, from 1991 to 1999, a pharmacy could be established at 7000 inhabitants, from 1999 to 2004 a pharmacy to 5000 inhabitants, from 2004 to 2009 a pharmacy to 3000 inhabitants in Bucharest, a pharmacy to 3500 inhabitants in the cities of county residence, a pharmacy at 4000 inhabitants in other cities. The rural environment being disadvantaged, local distribution oficins could be established where there are no pharmacies, including in the villages of cities; if by 1994 the geographical criterion was not specified in the rules, from 1994 to 1999 a pharmacy could be established at 500 m from another pharmacy, and from 1999 to 2001 a pharmacy at 250 m from another pharmacy. From 2001 the geographical criterion is eliminated [5][6][7][8][9].
It should be said that in most European countries pharmacies operate according to the ethical model.
The health policy in Romania is reflected in the Law No. 95 of 2006 on Health Reform, as amended. By its magnitude, the law is a real public health code where pharmaceutical assistance is naturally addressed. The law harmonises many aspects of the health system with existing European legislation and is in a continuous update, interventions and amendments to the content over the years being countless.
Pharmacy Law No. 266 of 2008, in its original form, contained contradictory and inapplicable provisions. It was found that the institutions and professional associations involved in the process of authorisation, endorsement, inspection, control and sanctioning of pharmaceutical units belonged to different administrative areas and lacked competence and capacity administrative burden to carry out the activities assigned to them by the law of pharmacy or are in conflict of interest [10].
Law No. 236 of 2009 is the Legislative Act amending and supplementing Law No. 266 of 2008 known as the Law 266 republish [11].
Law No. 46 of 2003 on the rights of the patient comprising the component elements of the realization of this projection, the foundation necessary for the elaboration of health legislation. The law states that "patients are entitled to the highest quality medical care that the company has, in accordance with human, financial and material resources" (article 2) [12]. For the pharmaceutical sector this means a high training of specialist staff, adequate patient counselling, flawless services in an appropriate ambient environment [13][14][15].
In Figure 1 I present the evolution of the Pharmacy/Population ratio and Pharmacist/Population ratio in the period 1990-2017: In accordance with the legislation in continuous change (not necessarily for the better!), we observe from the graphic an increase in the Pharmacy/Population ratio after 1999 immediately, after which a steep decrease in 1993, then this indicator continues to decline.
And the Pharmacist/Population ratio has undergone changes over time, initially there was an increase after 1990, then a decrease in 1997 (due to the establishment of Pharmacy Faculties after 1990, migration of the population), then follows its allure as in the case of the Pharmacy/ Population ratio.
In Figure 2 I present the evolution of the number of Pharmacy Graduates, as observed in the two figures the increase in the number of Pharmacy Graduates after 1997 resulted in the decrease of the Pharmacist/Population ratio while decreasing the population [3].

Conclusions
With regard to the main synthetic pharmaceutical indicators we see profound changes, even if they have occurred amid a decrease in the number of inhabitants: if in 1990 a pharmacy returned to 11913 inhabitants, in 2017 it reaches 2465 inhabitants. The Pharmacist/Population report dropped from from 3692 to 1990 to 1098 in 2017.
Pharmaceutical regulations during the period analysed were numerous. There were many Orders of the Minister who changed the conditions of organization and functioning of pharmaceutical units, and a Law of Pharmacy was adopted only in 2008 with numerous amendments from the occurrence to date.
We have noticed over the years the increase in the number of Phamacies, Pharmacists, Pharmacy Graduates and we ask ourselves whether this growth has also led to increased pharmaceutical act over time.