Abstract

AbstractMedicalization of childbirth services and regional differences are the major obstacles in the improvement of women and child health in Turkey. The present study analyzes the geographic distribution of the efficiency of childbirth services in Turkish provinces. Data was collected from the official statistical records of the 2017 Public Hospitals Statistical Yearbook. Charnes, Cooper, and Rhodes’ (Eur J Oper Res 2(6):429–444, 1978) input-oriented data envelopment analysis (DEA) was applied to determine provincial efficiency scores, using childbirth-specific input and output indicators. Jackknife analysis was used for a robustness check of the DEA scores. Four different DEA models were constructed, and the final model’s efficiency scores were recorded. Finally, a decision-tree procedure was integrated into the DEA results, and predictors of efficient and inefficient provinces were examined. A total of 81 provinces in Turkey, representing seven geographic regions, were included in the analysis. The results showed that 18% of the provinces were efficient in terms of childbirth services. Average efficiency scores were high (0.71) for provinces located in the Southeast Anatolia Region. The most important predictor of efficiency for childbirth services is the number of beds in neonatal intensive care units (Neo_int_n_b). A geographic distribution of the provincial efficiency scores of childbirth services shows that eastern Turkey has the highest score. Neo_int_n_b is the most important determinant of efficiency scores. Ensuring public-health managers’ awareness about and continuous monitoring of childbirth services, while focusing more on regional differences, is essential to improve the status of children’s health in Turkey.KeywordsChildbirthMaternal healthcare servicesEfficiencyData envelopment analysisRandom forests

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