Kamu Hastane Birliklerine Geçiş Öncesi ve Sonrası İkinci Basamak Tedavi Hizmetleri Sunan Kamu Hastanelerinin Etkinliğinin Değerlendirilmesi: Şanlıurfa Örneği
Özet
As of November of 2012, within the frame of the Health Transformation Program, public hospitals are linked to the Associations of Public Hospitals, which are the provincial organizations of the Turkish Public Hospitals Institution, and managements of them are gathered under one roof in Turkey. In this study, efficiencies of public hospitals linked to the Şanlıurfa Association of Public Hospitals and which provide secondary care services, were assessed before and after the transition to Associations of Public Hospitals. Input Oriented Constant Return to Scale and Variable Return to Scale Data Envelopment Analysis methods were used to analyze hospital efficiency. Nine models were used, which were consisted of the combinations of different input and output variables according to the type of the services hospitals provide, the provider clinics and the variables, and general, technical and scale efficiencies were calculated. Hospitals, which didn’t have useable input and/or output variables, weren’t included in some models. Totally 11 hospitals were analyzed 88 times in 9 models, and they were found technically efficient 51 times both before and after the transition (Technical Efficiency Ratio for all models is 0.58). Post-transition Financial Technical Efficiency levels were found higher than the pre-transition levels. In the other models, technical efficiency levels were found similar before and after the transition. Hospitals relatively large-scale sized and located in districts with a higher urban population, were found less efficient in the technical efficiency analysis. In this study assessing the first year of the transition to Associations of Public Hospitals, the expected increase in hospital efficiency was not observed in Şanlıurfa province. The study data covered 9-month period in the Financial Efficiency Model and 12-month period in the other models, before and after the transition. The reforms in health care management may give different results in short, medium and long term. Therefore, in the future, it is recommended that similar studies should be conducted with the data, including more time in duration before and after transition periods and more other provinces and/or regions, and further researches should be planned to evaluate the internal and the external factors that may affect the efficiency of inefficient hospitals.
