The ESCO Mechanism in the Romanian Public Healthcare System Structural Advantages

Abstract

The Romanian public healthcare system is subject to acute financial strain,
directly amplified by disproportionate operational expenditures across a clinical
building stock marked by profound physical and functional obsolescence. Within
this precarious administrative landscape, deploying Energy Performance
Contracting (EPC) through energy service companies (the ESCO mechanism)
emerges as a strategic alternative for rehabilitating healthcare infrastructure,
bypassing the requirement for immediate public capital mobilization. This study
provides a critical evaluation of the feasibility, techno-economic yields, and
specific barriers hindering the assimilation of this model within the domestic
hospital network. The investigative approach relies on a qualitative methodology,
utilizing a PESTEL matrix to map external environmental impacts in Romania,
paired with a comparative framework using a Most Similar Systems
Design (MSSD) model benchmarked against the consolidated systems of the
Czech Republic and the United Kingdom (NHS). Primary focus is directed toward
institutional support architectures, the transfer of technical performance risk, and
the accounting treatment of public debt. The findings indicate that while ESCO
structures guarantee utility expenditure rationalization and clinical microclimate
optimization, their operationalization is obstructed by severe systemic constraints:
high hospital management turnover, methodological complexities in defining
energy baselines within dynamic clinical environments, and a lack of regulatory
harmonization regarding multi-year budgetary credit commitments. Overcoming
this administrative stalemate demands coherent public policy interventions, with
the authors proposing the adoption of a healthcare-specific model EPC contract,
the clarification of off-balance sheet accounting rules in full compliance with
Eurostat directives, and the establishment of a Central Technical Assistance Unit.