PUBLIC HOSPITAL REFORM THROUGH FINANCIAL AUTONOMY: EVIDENCE FROM FIER HOSPITAL IN ALBANIA
PUBLIC HOSPITAL REFORM THROUGH FINANCIAL AUTONOMY: EVIDENCE FROM FIER HOSPITAL IN ALBANIA

Summary/Abstract: Across several transition economies in Southeast Europe, public hospital reforms increasingly prioritize decentralization and enhanced managerial and financial autonomy to address inefficiencies and unequal access to complex hospital services. In Albania, this reform agenda gained momentum following the COVID-19 pandemic and was institutionalized with the adoption of Law No. 55/2022, which established supra-regional hospitals as financially autonomous public entities intended to alleviate the concentration of specialized care in the capital city. This study examines the initial organizational and performance effects of this reform through an in-depth case study of the Memorial Regional Hospital in Fier, Albania’s first supra-regional public hospital. The analysis combines quantitative indicators of hospital activity with qualitative evidence on organizational structures and care coordination mechanisms, focusing on service provision, referral dynamics, and regional service attractiveness. The results reveal notable growth in hospital activity, improved coordination of emergency and inpatient care across the regional hospital network, and a significant decline in referrals to university hospitals, without compromising quality standards. These findings indicate that financial autonomy, when embedded within a supra-regional hospital model, can strengthen the effectiveness and efficiency of public hospital systems. The experience of Memorial Regional Hospital in Fier provides a practical framework for scaling up supra-regional hospitals nationally and offers policy-relevant insights for countries pursuing similar public hospital reforms. This study explores public hospital reform through the introduction of financial autonomy, using Fier Hospital in Albania as a case study. The research aims to assess how increased financial autonomy has influenced hospital governance, resource allocation, service delivery, and the hospital’s role within the national healthcare system. This study examines the organizational and performance effects through financial autonomy in Memorial Regional Hospital in Fier, the country’s first regional public hospital. The aim is to assess how financial and managerial autonomy influences service delivery, regional integration, and operational efficiency. This study employs a mixed-methods approach, combining quantitative hospital data analysis with case study examination and expert consultations.

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