Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization.

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.

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.