Türkiye’de Sağlık Hizmeti Sunum Verimliliğinin Değerlendirilmesi

Abstract

Unpredictability of demand, especially after global or country-level events such as war, disaster, epidemics, and political developments, is a unique feature of healthcare services. This uncertainty underlies significant vulnerabilities in health systems. Türkiye also witnessed important developments in the health sector both at the global and country levels in the 2012-2020 period. In this study, it is aimed to reveal how the efficiency of hospitals serving throughout Turkey varies according to their ownership and according to provinces between the periods of 2012-2020. The population of the research consists of 81 provinces for public, 62 for private, 37 for university, and 81 for Turkey in general. Basic service data (bed, examination, surgery, patient, staff, etc.) for the 2012-2020 period of the provinces included in the study were taken from the Basic Health Statistics Module (TSIM) with the permission of the Ministry of Health and analyzed with the Malmquist Index (ME). In order to evaluate whether there was a significant difference in efficiency levels in the examined periods, a one-way analysis of variance in repeated measurements and Data Envelopment Analysis (DEA) for the 2020 period were conducted to determine the sources of inefficiency. According to the research findings, there is no significant difference between the technical efficiency (TE) and scale efficiency (SE) levels of the provinces evaluated for the public sector, but the change in total factor productivity (TFP) is significant (F=89.77; p<0.001); For the private sector, the change in TE (F=3.14; p=0.008), SE (F=3.69; p=0.002) and TFP was statistically significant (F=6.18; p <0.001); For the university sector, the differences in TE changes (F=3.1; p=0.015) and TFP changes (F=5.22; p=0.006) were statistically significant, but the differences in the average changes in TFP were not significant; It is understood that the differences in the average changes in the TE and SE levels of the provinces for Turkey in general are not statistically significant, but the differences in the average changes in TFP are significant (F=103.8; p<0.001). The opposite changes in TFV and TE change indicate that technological change directs TFP. According to the results of the research, healthcare efficiency in Türkiye in general shows a decreasing trend. This research provides clues about factors that may cause inefficiency for each sector. Finally, it is recommended that the resources of all stakeholders be evaluated together and service delivery plans specific to each hospital be made on a regional-province-hospital basis.