Estimating technical efficiency of Turkish hospitals: implications for hospital reform initiatives

Abstract

BackgroundThe Government of Turkey has initiated a series of major health reforms in 2003 with an objective of increasing access to health care services and improving efficiency of public and private hospitals. This study attempts to understand the technical efficiency of public and private hospitals in Turkey to better guide hospital reform.MethodsWe use data from 1079 public and private hospitals and translog stochastic production frontier was adopted to estimate technical inefficiency of hospitals.ResultsResults indicate that there is no statistically significant difference in the degree of inefficiency of hospitals by geographic location or its level of economic development. Efficiency scores vary significantly across hospital types with Ministry of Health (MoH) General Hospitals being the most efficient followed by MoH teaching hospitals. Better performance of MoH hospitals may be due to successful implementation of 2003 health reforms in Turkey, which intended to improve resource utilization within and across MoH hospitals. Among MoH hospital types, integrated county hospitals were the least efficient. Since the hospital outcome measure did not include the value of medical training, efficiency scores of university hospitals became relatively low. Wide variability of efficiency scores of private general hospitals implies the existence of both highly efficient and inefficient hospitals in the private sector.ConclusionsEfficiency differences of various hospital types can be leveraged to guide future reforms by emphasizing the strengths of general hospitals and improving the referral system from county hospitals to general hospitals. Encouraging resource sharing across hospitals, as being done by the 2011 reforms, should further improve hospital efficiency. Promoting private hospitals may not necessarily be efficiency enhancing due to high variability of private hospitals in terms of efficiency scores. Similarly, implementation of common productivity standards and quality control measures are likely to improve hospital technical efficiency scores further.

Levels, Trends and Determinants of Technical Efficiency of General Hospitals in Uganda: Data Envelopment Analysis and Tobit Regression Analysis

“…Regarding teaching status, the study finding is in tandem with several other studies which show that hospitals which act as teaching hospitals are more inefficient than their peers that only deliver health services (53). Teaching hospitals provide more intense services, use higher volumes of resources, and adopt newer and more expensive technologies -characteristics explaining why they have higher proportion of complicated cases (54,5). In Uganda's context where only 68% of general hospital staff positions are filled, dividing staff time for service delivery and teaching in addition to engaging students in service delivery is likely to increase inefficiency.…”

Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three‐stage data envelopment analysis of the Shanxi province

“…The OB/GYN units' size and capital can be measured by the “Number of Beds” . For output variables, the “Number of Discharged Patients” and “Average Length of Stay” were used by many studies that examined hospital and OB/GYN unit efficiency; these two indicators were consistent with the inclusion principles.…”

Determinants of Hospital Efficiency: insights from the literature

“…In the presence of congestion inefficiency, the increase of inputs over a given level results in a decrease of outputs. The teaching status of a hospital often requires conducting additional clinical tests and diagnostics for the benefit of the residents this imply that teaching hospitals are likely to use higher level of resources than nonteaching hospitals for producing the same level of output [40]. An empirical study of the determinants of hospital efficiency in Italy using four-randomcomponent stochastic frontier model did not find statistically significant effect of teaching hospitals on transient (short-term) and permanent (long-term) inefficiency [15].…”

“…As such, hospitals in rural and remote areas are not as busy as those in urban areas. This results in the presence of unused capacity including underutilized inputs such as doctors and other healthcare professionals leading to lower efficiency scores [40]. However, hospital efficiency scores may change when hospitals are evaluated in their own groups [50].…”