As an American it completely breaks my expectations that district heating not only works can be more efficient that decentralized heating. The amount of heat lost just moving water from the water heater on one side of the house to the shower on the other is ridiculously high in houses here. The idea that you can insulate well enough to efficiently move heat across a city is amazing to me.
Badly maintained infrastructure (as an American you're probably familiar with the idea). Keeps breaking down. Not enough money invested to bring it to modern standards. Pipes are not well insulated, they break down constantly, huge leakages and losses.
Cost of heating is so high that about 20% or more of the entire Bucharest city budget (I've just checked, budget: ~$1.8 billion, subsidies: ~$450 million; Bucharest has about 2.2 million people) is spent on subsidizing heat for poor families. Heating/hot water sometimes go down for hours or even days in random districts.
In many districts district heating is mandatory because everyone who can pull out does so and that makes the system even more inefficient, which would cause the collapse of the entire system, hurting poor families even more.