Abstract
Turkey has implemented major health care reforms since 2003 with the initiation of the “Health Transformation Programme (HTP)”. The SSK hospitals have been transferred to the Ministry of Health (MoH), thereby separating the purchaser and the provider of health services and performance-based supplementary payment system (P4P) has been initiated. The MoH has provided more independence and flexibility to the management of hospitals over the hospital budget. The objective of this study is to investigate whether these reforms improve the financial conditions of public hospitals. For this aim, we examine the financial performances of 469 MoH hospitals in years 2001 and 2007 (pre and post reform years, respectively). As a financial indicator we employ hospital profit ratios. According to our results, the average profit ratio of hospitals after the reforms has risen to 14.5% from 5.7% pre-reforms average. After the reforms, 70% of the hospitals improved their profit ratios. We also compare the performances of the MoH hospitals considering the geographical locations. We observe the highest improvement in the South East Anatolia Region, the average profit ratio of the hospitals located in this region has increased to 20.6% after reforms while their average was negative before reforms, and it is observed that 74% of all hospitals in the region have better profit ratios. However, the financial performance of the hospitals located in the East Anatolia and the Black Sea Regions remained behind the others, as there was no significant increase in the average profit ratios of hospitals in these regions. Changes in the profit ratios of the MoH hospitals are also investigated by their sizes and statistically significant increase is seen in the profit ratios after the HTP reforms. The highest increase is observed for the hospitals with the 100-400 beds while their average profit ratios, was 2.1% before the HTP reforms, increased to 14% after reforms.
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