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Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis

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Abstract

This study aimed to reflect the efficiency of hospitals under the Ministry of Health (MoH) before and after the implementation of Public Hospital Associations (PHAs). This study covered 3 years before (2010–2012) and 3 years after (2013–2015) the implementation. The population of the study included 865 hospitals under the MoH providing health care services in 81 provinces. No sample was selected; all hospitals were included under the scope of study. The provinces were chosen as the decision-making unit. Changes in the efficiency values of hospitals were analyzed with the Malmquist Total Factor Efficiency Index. The results showed that, for the pre-PHAs period, 24 provinces in 2010, 27 provinces from 2010 to 2011, and 32 provinces from 2011 to 2012 were assessed as efficient. From 2012, the year of implementation, to 2013, the number of efficient provinces dropped to 16. However, 20 provinces were subsequently found to be efficient from 2013 to 2014, and 26 from 2014 to 2015. The efficiency scores average of all provinces were found to be 0.89, 0.92, 0.92, 0.82, 0.88, and 0.90, respectively. Further, the efficiency score average of the 3 years before PHAs (0.91 ± 0.09) was significantly higher than the score obtained 3 years after PHAs (0.86 ± 0.11; p < 0.05). In consideration of such finding, the PHAs established at the provinces were identified as hampering increased efficiency.

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Authors and Affiliations

  1. Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, 06800, Ankara, Turkey

    Bayram Şahin & Gülnur İlgün

Authors
  1. Bayram Şahin
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  2. Gülnur İlgün
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Correspondence to Bayram Şahin.

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Key Messages

• With this study, the efficiency of Public Hospital Associations implementation at the provincial level in Turkey was examined according to the BCC method and Malmquist Total Factor Efficiency Index.

• According to the results of the study, the Public Hospital Associations established at the provinces level was identified as not increasing the efficiency.

• During the 6 years of study, only 5 provinces (Adana, Bayburt, İstanbul, Kilis and Şanlıurfa) out of 81 maintained their efficiency.

• This study is considered to be an important contribution to the literature as it is the first study to examine the efficiency of Public Hospital Associations implementation in Turkey.

• Both the provinces’ efficiency scores and the input and output variables used in efficiency analysis demonstrated statistically significant difference for the periods before and after PHAs implementation.

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Şahin, B., İlgün, G. Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis. Health Care Manag Sci 22, 437–446 (2019). https://doi.org/10.1007/s10729-018-9463-5

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  • DOI: https://doi.org/10.1007/s10729-018-9463-5

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