Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey

Abstract

The aim of the current study is to examine the impact of regional decentralization model on the performance of public healthcare services in Turkey. The efficiency of public hospitals has been determined by the type of healthcare services, "general healthcare" and "oral-dental healthcare", with Data Envelopment Analysis at the level of 81 provinces (NUTS-3) for 2014 and 2017. By continuing the transition to decentralization in public health services, the possible effects on the regional health level were analyzed. Notably, this study employed conducted a two-dimensional analysis. First, public hospital performance at province level was determined. Second, it was investigated whether the decentralization of health services had a significant effect on the efficiency of bordering (contiguity) provinces, a measure taht captures spillover effects between performance scores. The results indicate that the efficiency scores of 81 province hospitals differ significantly according to the provision of service patterns. Moreover, the relative efficiency score in 2017 is found to be higher when compared 2014, which is the year that signifies the beginning of the decentralization shift in healthcare services in Turkey. Furthermore, there is a positive spatial spillover between public hospitals based on two types of hospital services. This means that the hospital efficiency in the contiguous province has an effect of increasing the efficiency score of the region. This suggests that the decentralization model in public health services may have the potential to create a positive impact on the general health level in the future if supported by progressive economic and health policies for developing countries such as Turkey.

Evaluating the decentralization of public hospitals in Turkey in terms of technical efficiency: data envelopment analysis and Malmquist index

“…663. These results (Manavgat and Demirci, 2020). However, its findings are not in line with those of the current study because it is based on aggregated data at the provincial level.…”

“…Several studies have produced similar results as this study; others found different results. A research investigating the technical efficiency of governmental healthcare services in Turkey on a provincial basis found that decentralization increased technical efficiency (Manavgat and Demirci, 2020). However, its findings are not in line with those of the current study because it is based on aggregated data at the provincial level.…”

Türki̇ye’deki̇ Ulaştirma Ve Depolama Faali̇yetleri̇ni̇n Etki̇nli̇ği̇ Üzeri̇ne Bi̇r Anali̇z

“…Aynı şekilde BCC modeli de Banker, Charnes, Cooper'ın çalışmaları ile ortaya konularak geliştirilen, ölçeğe göre değişken getiri varsayımı altında benzer ölçekteki karar verme birimlerini (KVB) birbirleri arasında karşılaştırarak teknik etkinliği ölçmekte yararlanılan bir modeldir (Banker vd., 1984). CCR modelinden farklı olarak BCC modeli, çoklu girdi çoklu çıktı durumunda KVB'nin ölçeğe göre değişken getiri varsayımı altında araştırmaya olanak tanımaktadır (Manavgat ve Demirci, 2020). VZA ile etkinlik değerlendirmesinde; öncelikle çoklu girdi ve çoklu çıktı değerleri ağırlıklandırılmakta ve doğrusal olarak bir araya getirilmektedir.…”

The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review

“…The EFIC.EVAL2 hypothesis was not corroborated by the literature, as no study measured the impact of the existence of efficiency evaluation mechanisms. Three studies highlighted that the existence of these mechanisms assisted local governments in understanding the effects of implemented reforms and could guide considerations for future interventions [70,82]. However, despite some countries having monitoring systems for the execution of decentralized tasks, it remains unclear whether their existence contributes to improving efficiency.…”