Health Care Management Science

, Volume 18, Issue 4, pp 407–418 | Cite as

An examination of competition and efficiency for hospital industry in Turkey

  • Hacer Özgen Narcı
  • Yasar A. Ozcan
  • İsmet Şahin
  • Menderes Tarcan
  • Mustafa Narcı


The two particular reforms that have been undertaken under the Health Transformation Program in Turkey are enhancing efficiency and increasing competition. However, there is a lack of information about the relationship between competition and hospital efficiency. The purpose of this paper is to analyze the effect of competition on technical efficiency for the hospital industry in Turkey. The target population included all public and private general hospitals that were open in 2010 in Turkey (n = 1,224). From these, 1,103 hospitals met the selection criteria and were included in the study. Data were obtained from the Turkish Statistical Institute, the Ministry of Health, and through a field survey. Technical efficiency of hospitals was estimated using Data Envelopment Analysis with five outputs and five inputs. The intensity of competition among hospitals was measured by objective and subjective measures. Objective competition was measured using the Hirschman-Herfindahl Index, and subjective competition was measured based on the perceptions of top level hospital managers. Multivariate Tobit regression was used to investigate the relationship between competition and efficiency while controlling the effects of demand and supply characteristics of the market and the hospital traits. Efficiency results showed that 17 % of hospitals were technically efficient. Regression analyses portrayed that the degree of competition among general hospitals did not have a statistically significant relationship with hospitals’ technical efficiency. To conclude, hospital efficiency in Turkey does not seem to be affected by the intensity of competition among hospitals.


Hospital efficiency Hospital competition Perceived competition Turkey 

MSC code

90-XX Operations research mathematical programming 



This study was funded by the Scientific and Technological Research Council of Turkey with a project number of 110 K443. The authors retained control over the entire process during the production of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest in connection with this paper.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Hacer Özgen Narcı
    • 1
  • Yasar A. Ozcan
    • 2
  • İsmet Şahin
    • 3
  • Menderes Tarcan
    • 4
  • Mustafa Narcı
    • 5
  1. 1.Department of Health ManagementIstanbul Medipol UniversityIstanbulTurkey
  2. 2.Department of Health AdministrationVirginia Commonwealth UniversityRichmondUSA
  3. 3.Department of Healthcare ManagementHacettepe UniversityAnkaraTurkey
  4. 4.Department of Healthcare ManagementOsmangazi UniversityEskişehirTurkey
  5. 5.Bahceli Sok. Berat Apt. No: 15/18Sahrayıcedit-İstanbulTurkey

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