Background/Objectives: Our study investigates the primary characteristics of managerial decision-making processes in the public hospital units in Romania, particularly in the Northeast region. This research aims to delineate the decision-making model applied by managers in these units, considering the multitude of legislative, economic, technical, ethical, and organizational changes prompted by the pandemic. Methods: A mixed-method research approach was utilized, combining semi-structured interviews and autoethnography, to capture experiences, attitudes, perceptions, motivations, and ethical considerations of decision-makers within the healthcare system. Results: The findings revealed that managerial decisions in public hospitals were influenced by unique elements such as the vulnerability and support needs of patients, the absence of a clear hierarchy, the personalized nature of healthcare services, the complexity of care processes, and the use of advanced technology. External factors, notably political and economic influences, alongside internal ethical dilemmas, significantly impacted decision making. Conclusions: This study identifies the reliance on evidence-based decision making and a consultative managerial style as key to addressing these challenges. This research contributes theoretically by comparing decision-making models and practically by identifying a decision-making model that includes forms, techniques, and tools that could guide managers in decision making in Romanian public hospitals.

Background/Objectives: Municipal hospitals in transitional health systems operate under structural resource constraints that complicate managerial decision-making and shape patient perceptions. This study examines how patients interpret resource allocation and evaluate the ethical and legitimacy consequences of alternative strategic priorities. Methods: A qualitative research design was employed using semi-structured patient interviews. Participants were recruited using purposive sampling based on predefined inclusion criteria: age over 18, hospitalization for digestive symptoms, undergoing diagnostic investigations, and provision of informed consent. Thematic analysis identified key expectation domains related to technological modernization, workforce capacity, infrastructure, and relational communication. These themes were translated into core governance variables and integrated into a conceptual simulation model comparing three allocation scenarios: technological investment, human resource expansion, and status quo preservation. Results: Findings show that patient evaluations extend beyond satisfaction to include distributive fairness, symbolic modernization, and institutional legitimacy. Simulation findings suggest that technological investment strengthens symbolic legitimacy and perceived equity but may increase workload and fiscal exposure; workforce expansion enhances relational justice and operational stability yet leaves modernization gaps; and status quo preservation maintains short-term fiscal balance while risking gradual legitimacy erosion. Conclusions: The study demonstrates that satisfaction metrics alone are insufficient for governance evaluation. Integrating ethical analysis, organizational legitimacy theory, participatory input, and systems thinking provides a structured framework for assessing resource allocation trade-offs in resource-constrained municipal hospitals.

Ethical decision-making is essential in healthcare management, particularly in addressing challenges such as resource constraints, stakeholder conflicts, and legislative ambiguities. The aim of this study is to explore the ethical decision-making process in public hospital management, including its challenges and models. The research objectives are to identify the ethical decision-making models employed by public hospital managers in Romania, to investigate how the ethical dilemmas influence the decision-making process in Romanian public hospital management and to determine the role of ethical values in the decision-making process undertaken by Romanian public hospital managers. To this end, quantitative survey data were collected from hospital managers to assess how ethical considerations shape managerial choices. The main research results reveal that ethical dilemmas, especially in areas like resource allocation and strategic planning, delay decision-making and increase its complexity. Ethical values such as fairness, transparency, and trust are central to guiding decisions, yet the lack of formal ethics training among many managers limits their ability to address these dilemmas effectively. Structured frameworks like the PLUS and IDEA models, while valuable, are underutilized, further hindering consistent ethical decision-making. This study highlights the need for mandatory ethics training, institutionalized decision-making models, and strengthened organizational policies to improve.

Background/Objectives: Cardiovascular diseases continue to be the foremost global cause of morbidity and mortality, representing about 40% of all causes of death. Atherosclerotic cardiovascular disease is the most common and clinically important type of these, occurring when cholesterol accumulates over time in the artery intima, which induces an inflammatory process that leads to the production of atherosclerotic plaques. Nowadays, lipid profile alterations and high/very high cardiovascular risk can be observed in more and more patients. Combination therapy, which includes high-intensity statins, ezetimibe, bempedoic acid, and PCSK9-targeted medicines, can lower LDL-C by more than 80%, which is far more than the 50% that statin monotherapy usually achieves. Thus, novel lipid-lowering therapies are needed, as current agents—though effective in reducing cardiovascular events—leave considerable residual risk in many patients. Methods: The aim of our study was to evaluate the cost-effectiveness of Inclisiran and its association with standard of care for the prevention of cardiovascular events across multiple international settings, in articles that reported quality-adjusted life years gained and cost-effectiveness metrics. Results: Our findings suggest that the cost-effectiveness of Inclisiran is highly context-dependent, shaped by local pricing, population risk, and system-level capacity. While Inclisiran demonstrates potential economic value in high-income settings or among high-risk patients, its widespread adoption for primary prevention appears unjustified under current conditions. Conclusions: Policymakers should consider risk-based targeting, price renegotiation, and performance-based reimbursement models to improve the value proposition of such interventions.

Background/Objectives: Long-acting lipid-lowering injectable therapies, including PCSK9 monoclonal antibodies, inclisiran, and selected glucagon-like peptide-1 receptor agonists, represent a structural innovation in chronic disease management. By reducing dosing frequency and embedding pharmacologic persistence within healthcare delivery systems, these therapies address persistent challenges of long-term statin non-adherence. However, from a health economics perspective, such innovations may also alter incentive structures related to preventive behaviors. This study examines whether outcome measurement in the long-acting injectable literature reflects shifts in the balance between pharmacologic adherence and lifestyle-related prevention. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Eligible studies included adult populations receiving PCSK9 monoclonal antibodies, inclisiran, or GLP-1 receptor agonists that reported pharmacologic adherence or persistence and/or lifestyle-related measures. Studies were categorized by therapy class and design. The prevalence of adherence and lifestyle outcome measurement was calculated, and a descriptive Measurement Asymmetry Index was defined as the difference between adherence measurement prevalence and lifestyle measurement prevalence. Results: Four studies met the inclusion criteria, comprising randomized controlled trials. Pharmacologic adherence or persistence was measured in all included studies (100%), whereas lifestyle-related outcomes were assessed in only one study (25%), limited to a GLP-1 receptor agonist trial. No study explicitly evaluated behavioral substitution, risk compensation, or changes in patient responsibility. The Measurement Asymmetry Index was 75 percentage points, indicating a pronounced imbalance between pharmacologic and behavioral outcome domains. Conclusions: The findings do not provide evidence of behavioral moral hazard at the individual level but reveal a structural asymmetry in how prevention is assessed within the injectable therapy evidence base. This pattern may reflect an emphasis on drug-attributable and measurable outcomes, with comparatively limited attention to lifestyle engagement. As long-acting therapies become more integrated into chronic disease management, incorporating standardized lifestyle metrics into cardiovascular research may be necessary to support a more balanced framework of preventive responsibility.