The unexpected outcomes of the closure of 67 inpatient care facilities in 2011 in Romania.

One of the main objectives of the National Strategy for Hospitals Rationalization approved by the Romanian Government in 2011 was to resize the hospital sector in order to improve efficiency. To this end, the government decided the closure of 67 inpatient care facilities with low efficiency scores, giving them the opportunity to become nursing homes for elderly under a national programme financed by the Ministry of Labour, Family and Social Protection. The measure faced a tremendous public opposition that put pressure on politicians to re-open some hospitals, while other hospitals were re-opened by the governments that followed in order to consolidate their power. Since only 20 closed institutions have been reorganized as nursing homes for elderly and almost 40 are currently performing medical activities, this decision was generally perceived as a policy failure. Nevertheless, a thorough analysis, shows that the medical facilities that are still functioning - either merged with other hospitals, or re-organized as state or private medical institutions have improved efficiency by reshaping services provided to the population needs, mobilizing communities and local authorities investments and initiating public-private partnerships. Besides revealing the unexpected benefits resulted from the implementation of this policy, the Romanian experience provides some useful insights for other countries that are also facing the challenge of reducing the oversized hospital sector.