Performance-based Payment System Research Articles

Remuneration: Performance-Based Payment System in Higher Education Institutions

This study aims to solve payroll problems at Universitas Binamika Tangerang (UBT) by identifying factors that are considered to play a role in the preparation and determining the stages of the payroll system on the remuneration basis. Data collection and processing were carried out by means of focused group discussions using fishbone diagrams to obtain data related to the old payroll system and the new payroll system with the remuneration model. Discussions involving fifteen personnel as informants, documentation studies and observations were also carried out to complete data acquisition. The results of the study identified eight elements that are key to the successful preparation and implementation of a remuneration payroll system, namely type of employment, staffing level, payroll information system, layer determination, payroll element, performance indicator, system models, and implementation stage.

MP39-13 THE ASSOCIATION OF PRIVATE EQUITY ACQUISITION OF UROLOGY PRACTICES AND MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) PERFORMANCE

You have accessJournal of UrologyCME1 Apr 2023MP39-13 THE ASSOCIATION OF PRIVATE EQUITY ACQUISITION OF UROLOGY PRACTICES AND MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) PERFORMANCE Kassem Faraj, Rodney Dunn, Lindsey Herrel, Avinash Maganty, Vahakn Shahinian, and Brent Hollenbeck Kassem FarajKassem Faraj More articles by this author , Rodney DunnRodney Dunn More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , Avinash MagantyAvinash Maganty More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been an increase in private equity (PE) involvement in mergers and acquisitions of urology practice in recent years. Little is known about the impact of these acquisitions on quality of care in the years after acquisition. The merit-based incentive payment system (MIPS) is a performance-based payment system implemented by the Centers for Medicare and Medicaid Services (CMS) in 2017 to improve quality and reduce healthcare costs. Its metrics can be leveraged to assess clinical performance in practices acquired by PE. This study investigates the implications of PE mergers and acquisition on MIPS performance. METHODS: We conducted a retrospective study of urologist performance in the MIPS database. We focused on years where data would be available before and after a PE acquisition, which were 2018 and 2019. We compared MIPS performance and the probability of receiving a bonus payment between acquired practices to a control group that was oversampled to match the acquired practices’ source of reporting, which is an important predictor of performance. The probability of receiving a bonus payment was calculated based on thresholds reported by CMS. Multivariable regression analysis was performed to assess adjusted MIPS scores and the probability of receiving a bonus payment. RESULTS: In total, there were 6603 urologists who reported to MIPS in 2017. There were 33 total mergers and acquisitions from 2016-2022 (Figure). Compared to nonacquired controls, physicians in acquired practices experienced a decreased adjusted overall MIPS score the year after acquisition (5.2 point difference, p=0.01). The only individual MIPS component score that differed between groups pertained to cost, with slightly higher performance in the nonacquired group (73.2 vs 69.7, p=0.0295). On adjusted analysis, the probability of a bonus payment (Figure) was significantly lower in practices that were acquired vs those that were not acquired in the year after acquisition (50% vs. 73.7% p<0.001). CONCLUSIONS: Private equity acquisition is associated with reduced overall MIPS performance, compared to nonacquired controls. This was associated with significantly reduced probability of a physician receiving a bonus payment. Source of Funding: This study is supported by funding from National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the National Cancer Institute RO1 CA269367 (Hollenbeck, Shahinian). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e540 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Rodney Dunn More articles by this author Lindsey Herrel More articles by this author Avinash Maganty More articles by this author Vahakn Shahinian More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement PDF downloadLoading ...

The Influence of Intrinsic and Extrinsic Motivation in Workers’ Productivity: Empirical Evidence from the Construction Industry

The human resource remains the most critical productive asset of any organization as it is the human element that gives direction and dynamism to the organization. This study investigated the effect intrinsic motivations and extrinsic motivations have on employee productivity of four selected construction companies in Delta State. To achieve its objectives, the study adopted a quantitative research approach with a survey research design. From a population figure of 242 low-level permanent employees of the four selected construction companies in Delta State, 151 constituted the sample as data were collected through a structured questionnaire using the cross-sectional approach. Descriptive statistics and simple regression analysis were used to analyze the data gathered and test the study hypotheses. Findings revealed that intrinsic motivation has a significant positive effect on employee productivity and extrinsic motivation also exerts a significant positive effect on employee productivity. Also, the most effective tools of extrinsic motivation are competitive salaries, extra work bonuses, and opportunities for promotion. Based on these findings, it was concluded amongst others, that the desire to gain mastery and contributes to societal development through construction-related activities gives low-level construction workers some level of satisfaction and financial-related incentives have an immediate and powerful effect on their performance. The key recommendation of the study is that to make a foster high level of productivity from the employee, top management should adopt a performance-based payment system and sell the benefits of contributing to societal development to the construction workers, acknowledging their contribution through noble initiatives like recognition from an authority, opportunity for mentoring, participation in decision making.

Stimulativni sistem zarada iz ugla procesnih teorija motivacije - studija slučaja

This case study analyzes the existing characteristics of the performance measurement system and incentive payment in an international manufacturing company in Serbia, from furniture industry. The main aim of the paper is to understand the cause-andeffect relationship that the performance-based payment system has on employees and the organization, that is, to assess the real motivational power of rewarding employees with financial incentives. The aim of the paper is to analyze the advantages and disadvantages of incentive pay systems from the point of view of process motivational theories that deal with the cause-and-effect relationship of motivation for work, performance and job satisfaction in people. A case study method was used. The existing practice was evaluated with a purpose-built instrument, based on assumptions derived from process theories of motivation. The results indicate that regardless of the high salaries of employees (up to 30% higher than other employee salaries in the market), there is still high employee turnover and absenteeism, reduced motivation, dissatisfaction and unethical behavior. The causes are inadequate and unrealistic goals, non-transparent performance measurement, frequent changes in teams, lack of work resources and technical training, as well as numerous operational problems in the company. After the identification and analysis of the current method of performance management, practical recommendations were given on how to overcome the observed shortcomings and increase the satisfaction and motivation of employees.

Opinions of Physicians and Nurses on Performance-Based Supplementary Payment System: A Qualitative Study

Opinions of Physicians and Nurses on Performance-Based Supplementary Payment System: A Qualitative Study

Explaining the Factors Affecting the Relative Value of Services and Their Role in the Performance-Based Payment System in Teaching-Therapeutic Centers in the Six national-Wide region of the Country

BackgroundPay for performance (P4P) is one of the most important issues in the health systems that promotes clinical quality, productivity, and patient satisfaction.ObjectivesThe current study aimed to identify and explain factors affecting the relative value of services and applying them in P4P in Iranian teaching-therapeutic centers.MethodsThe current study was performed following a thematic analysis framework with an interview technique. The study population consisted of P4P experts in the six national-wide region of the country. Participants were selected using the purposeful and gradual sampling technique. Sampling was stopped upon reaching data saturation (i.e. 11 participants). Lincoln and Gubachr('39')s evaluation method was used to determine reliability and validity. Qualitative data were analyzed using Nvivo version 12.Results In total 13 basic themes and two organizer themes (i.e. technical and professional components) were identified regarding the factors affecting the relative value of health care services. Seven important elements in determining the professional component of the relative value of services included required time to perform the service, stress, knowledge, skill, experience, risk, as well as difficulty and complexity of the service.ConclusionThe model developed in the present study can be used to determine the total relative value of each service and setting tariff of medical services provided by health staff, including nurses.

Barriers in the performance-based payment in Iran health system: Challenges and solutions.

BACKGROUND:One of the main goals of hospital management is to attract, maintain, and increase the number of qualified and efficient human resources, and one of the key and most important factors in achieving this goal is to design and implement a fair and efficient payment system. The purpose of this project is to determine the challenges of the performance-based payment system and provide solutions to overcome its obstacles in the city of Tehran.MATERIALS AND METHODS:This qualitative research sought to perform content analysis so as to explore the experiences and perceptions of a purposeful group of specialists and managers of Tehran's educational and medical centers (n = 10). Data were collected using in-depth semi-structured interviews and were ongoing until the point of saturation.RESULTS:On analysis of data by Specialists and managers of Tehran's educational and medical centers, three main themes including behavior, organization, rules and regulation were defined alongside seven subthemes includes scheduling, platform, education, quantity-oriented, motivation, implementation, and payment system.CONCLUSION:In general, it can be concluded that for the successful implementation of any project, the necessary infrastructure must be provided for implementation. In this plan, despite the challenges in the field of behavior, organization, and rules and regulations, the need for necessary training before implementing the plan, special attention to quality instead of quantity, motivating employees to cooperate in implementing the plan as successfully as possible, creating a platform Appropriate before the implementation of the plan and most importantly, the pilot implementation of the plan before its widespread implementation seems necessary.

Performansa dayalı ödeme sisteminde hekimlerin örgütsel adalet algısı (Hekimlerin ödemelere yönelik adalet algısı)

Amaç: Bu araştırma, Performansa Dayalı Ödeme Sisteminin hekimlerin örgütsel adalet algısını nasıl etkilediğini ölçmek ve sağlık standartlarının geleceğine yönelik öneriler geliştirmek amacıyla yapılmıştır. Yöntem: Kesitsel tipteki bu araştırma, hem Sağlık Bakanlığı hem de Üniversite Hastanesini temsil eden, uzman hekim ve üzeri statüye sahip 312 geçerli katılımcı ile yürütülmüştür. Araştırmanın verisi, yüz yüze anket tekniği kullanılarak toplanmıştır. Nicel veri analizinde Mann Whitney U-testi ve Kruskall Wallis H-testi, nitel veri analizinde ise Betimsel Analiz ve Sistematik Analiz uygulanmıştır. Bulgular: Katılımcıların % 68.3’ü Sağlık Bakanlığı Hastanesi hekimi, % 65.7’si erkek, % 76.3’ü kırk yaşın üzerinde, % 46.1’i profesör ve doçent statüsünde, % 45.5’i dahili tıp branşında ve % 88.5’i günlük sekiz saatten fazla çalışanlardır. Hekimlerin Performansa Dayalı Ödeme Sistemine yönelik genel adalet algısı X̄= 2.00 ± 0.50’dir. En şiddetli adaletsizlik, kişilerarası adalet alt boyutunda izlenmiştir (X̄= 1.51). Performans ödemelerinin adilliği açısından en dezavantajlı grup, temel tıp branşlarıdır. Katılımcılar, performans ödemelerinin sağlık ekonomisini sürdürülebilirliği olmayan bir alana sürüklediğini ve mesleki saygınlığı kaybettirdiğini düşünmektedir. Sonuçlar: Hekimlerin, daha adil bir ödeme sistemine acilen ihtiyacı vardır. Yeni sistem, kolektif bir bakış açısına sahip olmalı, hekimler ve politikacılardan oluşan Üst Kurul tarafından tasarımlanmalıdır. Etik çerçevenin ideal forma taşınabilmesi için hekimlerin sabit ücretleri reel piyasa koşullarına hizalamalı ve ödemeler finansal olmayan motivasyon araçları ile desteklenmelidir.

Knowledge, attitude and self-efficacy of elderly caregivers in Chinese nursing homes: a cross-sectional study in Liaoning Province

ObjectiveThis study aimed to investigate the perceptions of elderly caregivers in Chinese nursing homes (NHs) and associated factors with regard to knowledge, attitude about elderly and self-efficacy.SettingA cross-sectional questionnaire survey...

Job Satisfaction and Related Factors in Physicians and Nurses Who Work in Hospitals in Edirne City of Turkey

One of the most important conditions for individuals to be happy and productive in workplaces is job satisfaction. In this study, it was aimed to determine the levels of job satisfaction in physicans and nurses who worked in hospitals in Edirne and to evaluate the effects of potential influencing factors on job satisfaction. The population of the study was composed of a total of 1376 individuals. The sample group was composed of a total of 385 healthcare staffs including 192 physicians and 193 nurses (28% of the population). The data were collected using a questionnaire form and Minnesota Job Satisfaction Scale and evaluated by SPSS (Statistical Package for Social Sciences) 20.0 package program. Job satisfaction levels were found better in the healthcare staffs who worked in private hospital. When assessed by profession, the highest level of job satisfaction was found in academic member. This study was found that 82% of the health staffs reported that they did not feel safe while working, 75% were exposed to verbal or physical abuse. When the satisfaction of the participants related to the institution where they worked and the occupation they had was examined, it was observed that approximately 37% reported that they thought to leave the institution where they worked and 25% even reported that they thought quitting their jobs. The general job satisfaction was better in individuals who were experts in their areas, who worked in private hospital, who loved their profession, whose working hours were regular, who felt themselves safe in their institutions and who worked free from violence. The worst level of job satisfaction was found in general practitioners. The job satisfaction of healthcare staffs who thought that the performance-based payment system applied in Turkey was unfair was low.

Optimal combination of wage cuts and layoffs\u2014the unexpected side effect of a performance-based payment system

This study analyzes the trade-off relationship between layoffs and wage cuts. If the introduction of a performance-based payment system stimulates workers’ pecuniary-motivated minds, their morale can be damaged more severely by wage cuts than prior to the introduction thereof. Utilizing this idea, we demonstrate theoretically that the more heavily wages are based on performance, the more firms, fearing that workers’ morale will be damaged by wage cuts, try to avoid wage cuts and instead prefer layoffs. Next, we show empirically the trend whereby firms with performance-based payment systems are unlikely to implement wage cuts. Given this first-stage regression, the status of a performance-based payment system, based on the firm’s past decision and assured to be exogenous, is employed as an instrumental variable (IV) for wage cuts in a layoff regression model to overcome simultaneous bias. In the second-stage regression, the IV estimates for the impact of wage cuts on layoffs are significantly negative: if a firm implements wage cuts, it will reduce the probability of layoffs by 0.172. This supports the theoretical implication that implementing wage cuts can be a potential device for reducing layoffs. These results may imply an unexpected side effect of the increasing use of performance-based payment systems: as such systems become more widespread, layoffs will increase because firms will become less likely to impose wage cuts, thus potentially resulting in high unemployment.

Effects of provider incentives in integrated healthcare delivery system reform: a quasi-experiment on patients with chronic diseases in rural China

Background: Provider incentive was a key strategy in facilitating the integrated healthcare delivery reform, however information about the appropriate form and evidence was insufficient in low- and middle-income countries (LMICs). From July 2012 to December 2014, we implemented a multi-faceted intervention in Qianjiang County in Chongqing Municipality of Southwestern China, to realize and prove the effectiveness of an integrated care model among patients with chronic diseases, and to compare the effects with/without provider incentives. Methods: A quasi-experiment was performed with 2 treatment groups and one control group. One treatment group was intervened with multi-disciplinary team (MDT) together with other strategies to improve the continuity of care (COC) between primary-secondary-tertiary care, and the physicians in the other treatment group was additionally provided with financial incentives besides the integrated delivery intervention, in the form of performance-based prospective payment system. The control group conducted usual care without any inter-professional collaboration and implemented traditional “fee-for-service” system. In total, 6 towns were randomized into these 3 groups and 1641 patients with hypertension and 332 with Type 2 Diabetes were enrolled under stratified sampling strategy. Data including health outcomes, medical expenses and provider behaviors were collected at the baseline study and followed up for 30 months based on the official health records, questionnaires and claims data. Results：Compared to the control group, the blood pressure (BP) was decreased by 6.7% in double treated group and 5.9 % in single treated group; the health related quality of life (HRQoL) was increased by 15.5% and 8.2% in double and single treated group, respectively. The COC was increased by 10.4% in both groups after intervention, and another 26.9% increase in double treated group compared to single treated. Doctors’ willingness to cooperate was increased by 13.1% and the likelihood of using an upper level hospitalization service was reduced by 0.16% compared to single treated group. Reimbursed inpatient spending was reduced by 12.43%. All P Discussion: The integrated healthcare delivery model improved both the health outcomes of patients with chronic diseases and professional collaborative behaviors from multi-institutions, while reducing the potential medical expenses by lowering the likelihood of using upper level services – which was much more expensive. And the provider incentives had been proved with marginal effects in the above areas. Conclusions: Policy makers in LMICs are suggested to implement proper provider incentives system when conducting integrated healthcare delivery system reform. Lessons learned: The doctors were the most difficult stakeholders to be influenced by the policy, which reminded us the necessity of fully negotiation (usually several rounds) with the policy executors before a reform was completely initiated. Limitations: The trial implementation was not perfect and the results were contaminated to some extent. By process evaluation of trial exposure , enrollment, reach and following up, we had found out that the effective implementation to be 60% upmost, which might suggest that the actual effect might be underestimated. Suggestions for future research: The trial driven cost may hinder many potential reforms in LMICs. Therefore economic evidence such as cost-effectiveness analysis may be needed before generalization.

The Medicare Access And CHIP Reauthorization Act: Effects On Medicare Payment Policy And Spending.

In 2015, Congress repealed the Sustainable Growth Rate formula for Medicare physician payment, eliminating mandatory payment cuts when spending exceeded what was budgeted. In its place, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which established a two-track performance-based payment system that encourages physicians to participate in alternative payment models. MACRA could have huge effects on health care delivery, but the nature of those effects is highly uncertain. Using the RAND Corporation's Health Care Payment and Delivery Simulation Model, we estimated the effects of MACRA on Medicare spending and utilization and examined how effects would differ under various scenarios. We estimate that MACRA will decrease Medicare spending on physician services by -$35 to -$106billion (-2.3percent to -7.1percent) and change spending on hospital services by $32 to -$250billion (0.7percent to -5.1percent) in 2015-30. The spending effects are critically dependent on the strength of incentives in the alternative payment models, particularly the incentives for physicians to reduce hospital spending and physician responses to MACRA payment rates.

An Ethical Analysis of Performance-Based Supplementary Payment in Turkey’s Healthcare System

In 2003 Turkey introduced the Health Transition Program to develop easily accessible, high-quality, and effective healthcare services for the population. This program, like other health reforms, has three primary goals: to improve health status, to enhance financial protection, and to ensure patients' satisfaction. Although there is considerable literature on the anticipated positive results of such health reforms, little evidence exists on their current effectiveness. One of the main initiatives of this health reform is a performance-based supplementary payment system, an additional payment healthcare professionals receive each month in addition to their regular salaries. This system may cause some ethical problems. Physicians have an ethical duty to provide high-quality care to each patient; however, pay-for-performance and other programs that create strong incentives for high-quality care set up a potential conflict between this duty and the competing interest of complying with a performance measure.

The Cost Efficiency of Turkish Hospitals: A Stochastic Frontier Analysis

The purpose of this study is to estimate cost efficiencies of public hospitals in Turkey using data for the period 2007 to 2009. Hospital cost efficiencies are estimated using the Stochastic Frontier Analysis method with a translog cost function. The results indicate that performance-based supplementary payment system does not increase the cost efficiency of hospitals. According to the inefficiency effects model, occupancy rates are positively correlated with the efficiency scores. On the other hand, hospitals efficiency is inversely associated with the population and development levels of regions. In addition, there is a positive correlation between the hospital capacity and efficiency.

Dynamic Consequences of Performance‐Based Payment Systems in Public Hospitals

The goal of performance‐based payment system (PBPS) is to increase the efficiency of healthcare resources by paying physicians and hospitals for increased performance. PBPS in Turkey has been implemented since 2004. After 10 years, assessments about the effectiveness of this system have been mixed. The purpose of this study is to model and analyze the dynamic impacts of PBPS on the behaviors of public hospitals and their physicians. The model includes physicians' interactions with patients, revenue pressures on physicians and the resulting impacts on health outputs. In order to increase productivity, PBPS encourages physicians to perform more medical activity. Thus, a physician who experiences revenue pressure may increase his or her medical activity and attach less importance to quality. Resulting inadequate treatments and wrongly diagnosed patients would have negative effects on health quality. On the other hand, physicians who have no revenue concerns may attach the quality of healthcare absolute priority, undermining higher productivity. This attitude may result in hospital crowding, hence crowding pressures on physicians. Such conflicting feedback forces are included in the model to investigate the impacts of PBPS on health outputs. Simulation results obtained agree with some of the dynamic behaviors recently observed and discussed in Turkish healthcare. Copyright © 2015 John Wiley &amp; Sons, Ltd.

The development of rural primary health care in China’s health system reform

China started its national health system reform in 2009, with the focus on primary health care (PHC). This study aimed to investigate the progress of PHC in rural China during the health system reform, with a special focus on human resources for health (HRH). It used data from health statistical yearbooks as well as a questionnaire survey and qualitative interviews in three provinces. The study found that central and local governments increased their financial subsidies to township health centres. Medical education and training activities were organized to improve HRH development. Health professionals’ monthly income increased as a result of the implementation of a performance-based payment system. The number and quality of health professionals at township health centres had a steady increase, but health managers reported serious HRH crises in terms of attraction and retention of qualified health professionals. The amount of medical and public health services provided by township health centres had a significant increase. The study recommended the control of uncoordinated expansion of public hospitals, strengthening of medical education, and improving health professionals’ income in order to promote HRH development and quality of rural PHC services.

A Qualitative Evaluation of the Performance-based Supplementary Payment System in Turkey

The Ministry of Health of Turkey introduced performance-based supplementary payment (PBSP) system in 2004. The importance of feedbacks from healthcare providers regarding the implementation of alternative health policies has been recognized in the literature. This study reports the perceptions of physicians about the PBSP system in Turkey. A qualitative analysis has been conducted in two hospitals in the Western province of Turkey, Balıkesir. Analysis results suggest that physicians have limited awareness about the pay for performance system. They agree that the PBSP system has not achieved the objectives of enhancing productivity, efficiency and quality of care. The major contributing factors to the limited success of the system have been identified as increased workload, stress and competition among the physicians. Thus revisions have been suggested for the proper implementation of the programme, which include the determination of a maximum number of medical examinations.

An empirical assessment of driver motivation and emotional states in perceived safety margins under varied driving conditions

Motivation models in driving behaviour postulate that driver motives and emotional states dictate risk tolerance under various traffic conditions. The present study used time and driver performance-based payment systems to manipulate motivation and risk-taking behaviour. Ten participants drove to a predefined location in a simulated driving environment. Traffic patterns (density and velocity) were manipulated to cause driver behaviour adjustments due to the need to conform with the social norms of the roadway. The driving environment complexity was investigated as a mediating factor in risk tolerance. Results revealed the performance-based payment system to closely relate to risk-taking behaviour as compared with the time-based payment system. Drivers conformed with social norms associated with specific traffic patterns. Higher roadway complexity led to a more conservative safety margins and speeds. This research contributes to the further development of motivational models of driver behaviour. Practitioner Summary: This study provides empirical justification for two motivation factors in driver risk-taking decisions, including compliance with social norm and emotions triggered by incentives. Environment complexity was identified as a mediating factor in motivational behaviour model. This study also recommended safety margin measures sensitive to changes in driver risk tolerance.

Effects of the New Health Care System on the Financial Conditions of the Ministry of Health Hospitals

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.