Hospital autonomy without results: Lack of access and overloaded services

The reform that aimed to give public hospitals more autonomy, efficiency and accountability, four years after its launch, has not yet translated into measurable improvement in the quality of service to patients.

A monitoring by the organization Together for Life (TFL) has found that the gap between the reform's objectives and its implementation remains considerable.

Hospital autonomy was presented as one of the most important reforms in the governance of the public health system in Albania. The logic was that public hospitals, by gaining more space in financial and administrative management, would be able to better organize resources, improve the quality of services, and reduce dependence on central decision-making.

But according to the published monitoring report, this transition remains incomplete. The analysis, based on monitoring of QSUNT, Fier Memorial Hospital and the regional hospitals of Durrës, Vlorë, Shkodra and Lezha, concludes that the establishment of new structures has not yet been accompanied by measurable results in the functioning of the system or in the patient experience.

Essentially, the report raises a question that goes beyond the administrative organization of hospitals: how is the success of a health reform measured? If the objective is to improve care, then the criteria are not the number of structures established or legal acts adopted, but waiting times, access to services, quality of treatment, more efficient use of public funds and the patient experience.

From this perspective, monitoring suggests that the reform has advanced more quickly in building the institutional architecture than in producing concrete results.

One of the main objectives of autonomy was to strengthen regional hospitals, so that they could provide more services closer to patients' homes and reduce dependence on the Mother Teresa University Hospital Center. Four years later, this objective remains unmet.

QSUNT continues to handle the bulk of specialized services, while regional hospitals have failed to increase capacity to the extent that was anticipated. As a result, pressure on the university hospital remains high, with consequences ranging from staffing levels to the organization of services and waiting times for patients.

In this sense, autonomy is not assessed by the powers transferred to institutions, but by their ability to use them to improve access to services. According to the report, this change has not yet become apparent.

Another key component of the reform was financial autonomy. The idea was that hospitals would be more able to generate revenue and reinvest it in improving services. However, the report finds that the main instrument in this regard—dual practice—still falls short of expectations.

Fier Memorial Hospital appears to be the most advanced institution in implementing this mechanism and monitoring patient satisfaction. However, even there, there is still no evidence of a measurable impact on revenue growth or organizational performance of the hospital. In other institutions, the practice is implemented to a limited extent, due to non-competitive fees, low demand and lack of economic incentives.

One of the most significant findings of the report is related precisely to the lack of evidence.

The Executive Director of Together for Life, Eglantina Bardhi, stated during the presentation of the report that "Monitoring shows that to date there is a lack of sufficient evidence to demonstrate a direct and measurable impact of the reform on the patient experience, the quality of care and health outcomes."

Even the Ministry of Health admits that some elements of the reform are still under development.

The Director of Hospital Policies, Flutura Beqo, described dual practice as a mechanism still in its "infantile stage", while saying that work is being done to cost services and create instruments that will support the financial and managerial autonomy of hospitals.

This stance implies that the responsible institutions themselves consider the reform still incomplete.

However, four years after its launch, the expectation is no longer related to the establishment of new structures or the drafting of new procedures. At this stage, the reform is expected to produce measurable results.

The report thus raises a broader issue about how public reforms in Albania are assessed. Institutional changes are often measured through legal acts, established structures or new organizational models.

In healthcare, however, success is determined by other indicators: whether patients receive service faster, whether hospitals function better, and whether public funds are used more efficiently. Without clear indicators and measurable outcomes, it becomes difficult to assess whether autonomy has actually changed the way the system works.

Four years after the launch of the reform, hospital autonomy remains a project in transition. The institutional framework has been built and objectives have been defined, but according to Together for Life's monitoring, the results that would justify the reform are not yet visible.

The challenge for responsible institutions is no longer to argue the need for autonomy, but to demonstrate, through data and performance, that it is improving the functioning of hospitals and the quality of care that patients receive./ acqj.al