The impacts of health care reforms on the efficiency of the Turkish public hospitals: Provincial markets

Sulku, Seher Nur (2011): The impacts of health care reforms on the efficiency of the Turkish public hospitals: Provincial markets. Published in: The European Journal of Public Health No. http://eurpub.oxfordjournals.org/content/early/2011/11/09/eurpub.ckr163 (2011): pp. 1-5.

Abstract

Turkey has implemented major health care reforms to improve the efficiency of the health care system since 2003. The objective of this study is to investigate the impact of these reforms, especially the performance-based payment system (P4P), on the efficiency of public hospitals. We employ the Data Envelopment Approach and the Malmquist index to comparatively examine before and after the reform years, 2001 and 2006 respectively. Our analyses compare the performances of public hospitals served in provincial markets. Inputs of number of beds, number of primary care physician, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits, surgical operations are investigated. Indeed, as the quality indicators dead rate, hospital bed occupation rate and average length of stay are considered.

We found that the P4P was successful in boosting productivity due to advancements in technology and technical efficiency. It is seen that the average technical efficiency gains took place because of the significantly improved scale efficiencies, but the average pure technical efficiency did not improve. The lower pure technical efficiencies compared to scale efficiencies affirms the lack adaptation of the hospital management to the renewed system. Additionally, our analysis indicates that in the socio-economically disadvantaged provinces productivity gains have not been achieved. Lastly, it is seen that the hospital quality indicators have not improved in the short run.

In the international literature, P4P has been examined extensively for the developed countries. However there are a limited number of studies on developing countries. As it has been noted in the OECD health system review of Turkey: “Turkey is closing the performance gap with other OECD countries and, on a number of measures including overall costs, performs well relative to other comparable upper middle-income countries. Indeed, there may be much that other countries can learn from the recent health reforms in Turkey, especially in the use of performance-related pay to raise staff productivity”. Thus, our study would contribute to the existing literature with a comprehensive analysis of the health system efficiency in Turkey.

• Item Type: MPRA Paper
• Language: English
• Keywords: Turkey; Healthcare reform; Performance based supplementary payment system; Hospital efficiency
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; C - Mathematical and Quantitative Methods > C3 - Multiple or Simultaneous Equation Models ; Multiple Variables > C33 - Panel Data Models ; Spatio-temporal Models

References

1. Akdağ, R., Health transformation program in Turkey progress report. Ministry of Health Publication No: 749, Turkey: Ankara, 2009.

2. Aletras, V., Kontodimopoulos, N., Zagouldoudis, A., and Niakas, D., The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals. Health Policy. 83: 236–245, 2007.

3. Barnum, H., and Kutzin, J., Public hospitals in developing countries: Resource use, cost, financing. John Hopkins University Pres, Baltimore, 1993.

4. Carey, K. A., Panel data design for estimation of hospital cost functions. Review of Economics and Statistics. 79: 443-453, 1997.

5. Charnes, A., Cooper, W. W., and Rhodes, E., Measuring the efficiency of decision making units. European Journal of Operational Research. 2: 429-444, 1978.

6. Chen, S. N., Productivity changes in Taiwanese hospitals and the national health insurance. The Service Industries Journal. 26: 459-477, 2006.

7. Coelli, T. J., A guide to DEA version 2.1: A data envelopment analysis (computer) program. The University of New England, Department of Econometrics, Center for Efficiency and Productivity Analysis (CEPA) Working Paper No: 8/96, 1996.

8. Cooper, W.W., Seiford, L. M., and Tone, K., Data envelopment analysis: A comprehensive text with models, applications, references and DEA-solver software. Kluwer, Boston, 2000.

9. Ersoy, K., Kavuncubası, S., Ozcan, Y. A., and Harris, J. M., Technical efficiencies of Turkish hospitals: DEA approach. Journal of Medical Systems. 21: 67-74, 1997.

10. Erus, B., and Bilir, A., Obligatory service requirement and physician distribution in Turkey. Bogazici University Working Paper, Turkey: Istanbul, 2007.

11. Evans, R. G., and Walker, H. D., Information theory and the analysis of hospital cost structure. Canadian Journal of Economics. 5: 398–418, 1972.

12. Färe, R., Grosskopf, S., Norris, M., and Zhang, Z., Productivity growth, technical progress and efficiency changes in industrialized countries. American Economic Review. 84: 66-83, 1994.

13. Färe, R.S., Grosskopf, S., and Lovell, C. A. K., Production frontiers. Cambridge University Press, Cambridge, 1994.

14. Farell, M.J., The measurement of productive efficiency. Journal of the Royal Statistical Society. 120: 252–281, 1957.

15. Grosskopf, S., & Valdmanis, V., Evaluating hospital performance with case-mix-adjusted outputs. Medical Care. 31: 525–532, 1993.

16. Hollingsworth, B., The measurement of efficiency and productivity of health care delivery. Health Economics, 17: 1107–1128, 2008.

17. Jensen, G.A., and Morrisey, M. A., Medical staff specialty mix and hospital production. Journal of Health Economics, 5: 253–276, 1986.

18. Lagarde M., Timothy, P. J. and Blaauw, D., Managing incentives for health providers and patients in the move towards universal coverage. Background paper for the global symposium on health systems research: 16-19 November 2010, Montreux, Switzerland, 2010.

19. Linna, M., Health care financing reform and the productivity change in Finnish hospitals. Journal of Health Care Finance, 26:83-100, 2000.

20. Ministry of Health, The statistical year book of inpatient health care organizations of Turkey. Ministry of Health, Directorate General of Curative Services, Ankara, Turkey, 2001.

21. Ministry of Health, The statistical year book of inpatient health care organizations of Turkey. Ministry of Health, Directorate General of Curative Services, Ankara, Turkey, 2006.

22. Ministry of Health, Health at a glance: Turkey. Ministry of Health, Refik Saydam Hygiene Center, School of Public Health, Ankara, Turkey, 2007.

23. Ministry of Health, The progress so far health transformation program in Turkey. Ministry of Health, Ankara, Turkey, 2007.

24. Ministry of Health, Performance management in health, performance based supplementary payment system, transformation in health series 8. Ministry of Health, Performance Management and Quality Management Department, Ankara, Turkey, 2008.

25. OECD, OECD Health Data Base, 2008.

26. OECD, Reviews of Health Systems Turkey. OECD and the International Bank for Reconstruction and Development/The World Bank, 2009.

27. Roemer, M. I., Moustafa, A. T., and Hopkins, C. E. A proposed hospital quality index: hospital death rates adjusted for case severity. Health Services Research. 3: 96–118, 1968.

28. Sahin, I., and Ozcan, Y. A., Public sector hospital efficiency for provincial markets in Turkey. Journal of Medical Systems. 24:307-320, 2000.

29. Sahin, I., Ozcan, Y. A., and Ozgen, H., Assessment of hospital efficiency under health transformation program in Turkey. Central European Journal of Operations Research. http://www.springerlink.com/content/mq87542401733n7m/, 2009.

30. Seiford, L. M., and Thrall, R. M., Recent developments in DEA: the mathematical programming approach to frontier analysis. Journal of Econometrics. 46: 7–38, 1990.

31. Sommersguter-Reichmann, M., The impact of the Austrian hospital financing reform on hospital productivity: Empirical evidence on efficiency and technology changes using a nonparametric input-based Malmquist approach. Health Care Management Science. 3:309–321, 2000. 32. State Planning Organization, Research of the socio-economic development of provinces. State Planning Organization Press, Ankara, Turkey, 1996.

33. Sulku, S. N., and Caner, A., Health care expenditure and gross domestic product: the Turkish case. European Journal of Health Economics. 12, 29–38, 2011.

34.WHO, European Region Health Data Base. data.euro.who.int/hfadb, 2009.

35. Vujicic, M., Sparkes, S., and Mollahaliloglu, S., Health workforce policy in Turkey: Recent reforms and issues for the future. The International Bank for Reconstruction and Development / The World Bank, USA: Washington DC, 2009.