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.
Highlights
The 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
The maximum likelihood estimates (MLE) of the logarithmic modified translog stochastic production frontier and inefficiency effects are presented in Tables 6 and 8, respectively
The second order coefficient for Intensive Care Unit (ICU) beds was statistically significant and combined with statistically significant and positive first order ICU beds coefficient, implies that hospitals investing in additional ICU beds will be able to generate output at an increasing rate
Summary
The 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. Better understanding of health facility efficiency is important for ensuring effective use of health resources, especially in countries where public involvement in health care provision is high. Life expectancy at birth has increased from about 65 years in 1990 to 78 years in 2013–15 [5] These accomplishments have not been distributed geographically [6] and, despite the rapid improvements, Turkey still lags behind most of the Organization for Economic Cooperation and Development (OECD) countries in terms of health outcomes and health care resource availability (Tables 1 and 2)
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