Özel Hastanelerde Finansal Sürdürülebilirlik Performansının İçsel Belirleyicileri Üzerine Bir Çalışma

Year 2024, Volume: 27 Issue: 1, 321 - 331, 30.04.2024

Doğancan Çavmak

https://doi.org/10.29249/selcuksbmyd.1451872

Cited By: 1

Abstract

Finansal sürdürülebilirlik konusu, son dönemde tüm sektörler için önemli bir hedef haline gelmiştir. Türkiye sağlık sisteminde önemli bir yere sahip olan özel hastaneler de faaliyetlerini devam ettirebilmek için finansal sürdürülebilirliği bir hedef olarak benimsemek durumundadırlar. Literatürdeki çalışmalar, hastanecilik sektörünün yüksek düzeyde finansal sıkıntılar ile hizmet üretmeye devam ettiklerini göstermektedir. Bu çalışmanın amacı, özel hastanelerde finansal sürdürülebilirlik performansı ile ilişki içsel faktörleri irdeleyerek aralarındaki ilişkileri analiz etmek ve böylece öneriler geliştirmektir. Nicel ve kesitsel tipte olan araştırmada veri toplama aracı olarak anket formu kullanılmıştır. Araştırmanın katılımcıları, farklı şehirlerdeki özel hastanelerin idari ve mali fonksiyonları ile ilgili birimlerinde çalışan yetmiş kişiden oluşmuştur. Veriler yapısal eşitlik modellemesi aracılığıyla analiz edilmiştir. Araştırmada finansal sürdürülebilirlik performansı ile ilişkili olabilecek olan boyutlar arasında maliyet yönetimi, lojistik performans ve pazarlama uygulamaları değişkenleri yer almıştır. Korelasyon analizi sonuçları, ilgili değişkenler ve finansal sürdürülebilirlik performansı arasında anlamlı ve pozitif yönde ilişki olduğunu göstermiştir. Yol analizi sonuçları ise finansal sürdürülebilirlik performansı üzerinde en yüksek ve anlamlı etkiye sahip olan değişkenin pazarlama çabaları ve onu takiben maliyet yönetimi uygulamaları olduğunu göstermiştir. Lojistik yönetiminin modelde anlamlı bir etkiye sahip olmadığı tespit edilmiştir. Sağlık sektörünü finansal sürdürülebilirlik teması çerçevesinde muhtemel belirleyicileri ile inceleyen çalışma sayısı oldukça kısıtlıdır. Bu çalışma, özel hastanelerde bu olguyu işletme içi faktörlerle birlikte inceleyerek, pratik uygulamalar için anlamlı bulgular sağlamaktadır.

Keywords

Finansal Sürdürülebilirlik, Özel Hastaneler, Sağlık Hizmetleri

Ethical Statement

Çalışmanın modelinin ve veri toplama aracının etik yönden uygunluğu, Tarsus Üniversitesi Sosyal ve Beşerî Bilimler Etik Kurulu'nun, 18/01/2024 tarihli ve 2024/2 nolu toplantısındaki karar ile onaylanmıştır.

Supporting Institution

-

Project Number

-

Thanks

-

A Study on The Internal Determinants of Financial Sustainability Performance in Private Hospitals

Abstract

Financial sustainability has been a significant goal across all sectors recently. It is also imperative to set financial sustainability as an objective to sustain operations in private hospitals that are pivotal within Türkiye’s health system. Literature highlights that the hospitals deliver services amidst significant financial challenges. The purpose of this study is to explore the internal factors related to financial sustainability performance in private hospitals, analyze the relationships between them, and develop recommendations based on the analysis. A quantitative, cross-sectional approach was employed in the research, utilizing a questionnaire to collect data. Seventy participants working in the administrative and financial departments of private hospitals from different cities were included. The data were analyzed by structural equation modeling. The study identified cost management practices, logistic performance, and marketing efforts as variables potentially related to financial sustainability performance. Correlation analysis indicated a significant, positive relationship between the variables and financial sustainability performance. Path analysis revealed that marketing efforts had the most significant impact on financial sustainability performance followed by cost management. Logistic performance had no significant influence within the model. The number of studies on healthcare sector considering financial sustainability and its’ possible determinants is highly limited. This study provides practical implications by examining this phenomenon with its’ potential internal determinants.

Keywords

Financial Sustainability, Private Hospitals, Healthcare Services

Project Number

-

References

• Adelino, M., Lewellen, K., & McCartney, W. B. (2022). Hospital financial health and clinical choices: evidence from the financial crisis. Management Science, 68(3), 2098-2119. https://doi.org/10.1287/mnsc.2020.3944
• Akinleye, D. D., McNutt, L. A., Lazariu, V., & McLaughlin, C. C. (2019). Correlation between hospital finances and quality and safety of patient care. PLoS One, 14(8), e0219124. https://doi.org/10.1371/journal.pone.0219124
• Al Rahhaleh, N., Al-Khyal, T. A., Daghran Alahmari, A., & Al-Hanawi, M. K. (2023). The financial performance of private hospitals in Saudi Arabia: An investigation into the role of internal control and financial accountability. Plos one, 18(5), e0285813. https://doi.org/10.1371/journal.pone.0285813
• Al-Qarni, A. A., Alsharqi, O. Z., Qalai, D. A., & Kadi, N. (2013). The impact of marketing mix strategy on hospitals performance measured by patient satisfaction: an empirical investigation on Jeddah private sector hospital senior managers perspective. International Journal of Marketing Studies, 5(6), 210.
• Al-Qatawneh, L., Abdallah, A. A., & Zalloum, S. S. (2019). Six sigma application in healthcare logistics: a framework and a case study. Journal of Healthcare Engineering, 2019, ID 9691568. https://doi.org/10.1155/2019/9691568
• Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I., & Akdağ, R. (2013). Universal health coverage in Turkey: enhancement of equity. The Lancet, 382(9886), 65-99. https://doi.org/10.1016/S0140-6736(13)61051-X
• Augurzky, B., Engel, D., Schmidt, C.M., &Schwierz, C. (2012). Ownership and financial sustainability of German acute care hospitals. Health Economics, 21(7), 811-824.
• Başaran, G., & Özdemir, M. (2022). Türkiye’de hastane hizmetleri sektöründeki firmaların finansal performanslarının covid-19 dönemiyle birlikte oran analizi ve Waspas yöntemi ile belirlenmesi. Socıal Mentalıty And Researcher Thınkers Journal (SMART Journal), 8(59), 887-901. https://doi.org/10.29228/smryj.62360
• Bowersox, D., Closs, D.J., & Cooper, M.B. (2002). Supply chain logistics management. McGraw-Hill Higher Education
• Christopher, M. (2011). Logistics and supply chain management. Pearson Prentice Hall
• Cochrane, B. S., Hagins Jr, M., King, J. A., Picciano, G., McCafferty, M. M., & Nelson, B. (2015). Back to the future: patient experience and the link to quality, safety, and financial performance. Healthcare Management Forum, 28(6), 47-58. https://doi.org/10.1177/0840470415598405
• Dražić Lutilsky, I., Žmuk, B., & Dragija, M. (2016). Cost accounting as a possible solution for financial sustainability of Croatian public hospitals. Croatian Economic Survey, 18(2), 5-38. https://doi.org/10.15179/ces.18.2.1
• Dubas-Jakóbczyk, K., & Kozieł, A. (2020). Towards Financial Sustainability of the Hospital Sector in Poland—A Post Hoc Evaluation of Policy Approaches. Sustainability, 12(12), 4801. https://doi.org/10.3390/su12124801
• Dubas-Jakóbczyk, K., Kocot, E., & Kozieł, A. (2020). Financial performance of public hospitals: a cross-sectional study among Polish providers. International Journal of Environmental Research and Public Health, 17(7), 2188. https://doi.org/10.3390/ijerph17072188
• Enumah, S. J., & Chang, D. C. (2021). Predictors of Financial Distress Among Private US Hospitals. Journal of Surgical Research, 267, 251-259. https://doi.org/10.1016/j.jss.2021.05.025
• Essila, J. C. (2022). Strategies for reducing healthcare supply chain inventory costs. Benchmarking: An International Journal, 30(8), 2655-2669. https://doi.org/10.1108/BIJ-11-2021-0680
• Field, A. (2018). Discovering statistics using IBM SPSS statistics. Sage.
• Gapenski LC, & Reiter KL (2016). healthcare finance: an İntroduction to accounting and financial management (6 ed.). Chicago: Health Administration Press.
• Gider, Ö. (2011). Ekonomik kriz dönemlerinin özel hastanelere etkileri: bir özel hastanenin oran analizleri yöntemiyle finansal performansına bakış. Öneri Dergisi, 9(36), 87-103. https://dergipark.org.tr/en/download/articlefile/165771
• Gleißner, W., Günther, T., & Walkshäusl, C. (2022). Financial sustainability: measurement and empirical evidence. Journal of Business Economics, 92, 467-516. https://doi.org/10.1007/s11573-022-01081-0
• Günther, T., Gleißner, W., & Walkshäusl, C. (2020). What happened to financially sustainable firms in the corona crisis. Sustainability Management Forum, 28, 83-90. https://doi.org/10.1007/s00550-020-00503-3
• Hair, J.F., Jr Hult, G.T.M., Ringle, C.M., & Sarstedt M.A. (2021). Primer on partial least squares structural equation modeling (PLS-SEM). Sage Publications
• Ho, F. N., & Huang, C. W. (2020). The interdependencies of marketing capabilities and operations efficiency in hospitals. Journal of Business Research, 113, 337-347. https://doi.org/10.1016/j.jbusres.2019.09.037
• Inbasagaran, N., & Chandrasekaran, R. (2017). Impact of marketing mix strategy on coimbatore private hospitals performance measured by patient satisfaction: an empirical study. International Journal of Business Management & Research, 7(5), 15-24.
• Işikçelik, F., Turgut, M., & Ağirbaş, İ. (2022) Hastanelerde finansal performansın farklı analiz yöntemleri ile değerlendirilmesi. Süleyman Demirel Üniversitesi Vizyoner Dergisi, 13(34), 505-519. https://doi.org/10.21076/vizyoner.948785
• Jawab, F., Frichi, Y., & Boutahari, S. (2018). Hospital logistics activities. In Proceedings of the International Conference on Industrial Engineering and Operations Management , 3228-3237.
• Jena, B. N. (2017). Effective marketing tool for the marketing professionals in healthcare organization: the 4 ‘S’model. International Journal of Healthcare Management, 13(3), 201-206. https://doi.org/10.1080/20479700.2017.1402423
• Khullar, D., Bond, A. M., & Schpero, W. L. (2020). COVID-19 and the financial health of US hospitals. Jama, 323(21), 2127-2128. https://doi.org/10.1001/jama.2020.6269
• Kludacz-Alessandri, M. (2020). The relationship between cost system functionality, management accounting practices, and hospital performance. Foundations of Management, 12(1), 223-236. https://doi.org/10.2478/fman-2020-0017
• Koçyiğit, S., Ekinci, N., & Özşahin, F. (2022). Özel bir zincir hastane grubunun finansal performansının dupont analizi tekniğiyle incelenmesi. International Review of Economics and Management, 10(1), 1-17.
• Kolomoyets, A. V., Hbur, Z. V., Koshova, S. P., Mykhalchuk, V. M., & Savychuk, N. O. (2021). Financial and economic effect for the healthcare institution from the introduction of logistics management methods. Wiadomości Lekarskie, 74(6), 1499-1504. https://doi.org/10.36740/WLek202106139
• Kourtis, M., Curtis, P., Hanias, M., & Kourtis, E. (2021). A strategic financial management evaluation of private hospitals' effectiveness and efficiency for sustainable financing: a research study. European Research Studies, 24(1), 1025-1054.
• Kritchanchai, D., Hoeur, S., & Engelseth, P. (2018). Develop a strategy for improving healthcare logistics performance. Supply Chain Forum: An International Journal, 19(1), 55-69. https://doi.org/10.1080/16258312.2017.1416876
• Langabeer, J. R., Lalani, K. H., Champagne-Langabeer, T., & Helton, J. R. (2018). Predicting financial distress in acute care hospitals. Hospital Topics, 96(3), 75-79.
• Lee, D., Yu, S., & Yoon, S. N. (2019). Analysis of hospital management based on the characteristics of hospitals: focusing on financial indicators. Global Business & Finance Review, 24(3), 1-13. https://doi.org/10.17549/gbfr.2019.24.3.1
• Lee, H., Han, A., & Lee, K. H. (2023). Financial sustainability of hospitals and equity in healthcare access: Using the social resource-based view. Public Performance & Management Review, 46(6), 1442-1468. https://doi.org/10.1080/15309576.2023.2227160
• Lei, M., & Lomax, R. G. (2005). The effect of varying degrees of nonnormality in structural equation modeling. Structural Equation Modeling, 12(1), 1-27. https://doi.org/10.1207/s15328007sem1201_1
• Liaropoulos, L., & Goranitis, I. (2015). Health care financing and the sustainability of health systems. International Journal for Equity in Health, 14(1), 1-4. https://doi.org/10.1186/s12939-015-0208-5
• Marques Clemente, L. M., Pereira Salgado Junior, A., Falsarella Júnior, E., Alves de Souza Junior, M. A., Chiaretti Novi, J., & de Castro Moura Duarte, A. (2018). Management towards financial sustainability for private health companies. Management Research Review, 41(3), 379-394. https://doi.org/10.1108/MRR-11-2016-0257
• Nikzamir, M., Baradaran, V., &; Panahi, Y. (2020). Designing a logistic network for hospital waste management: a benders decomposition algorithm. Environmental Engineering and Management Journal (EEMJ), 19(11), 1937-1956.
• O’Hanlon, C. E., Kranz, A. M., DeYoreo, M., Mahmud, A., Damberg, C. L., & Timbie, J. (2019). Access, quality, and financial performance of rural hospitals following health system affiliation. Health Affairs, 38(12), 2095-2104. https://doi.org/10.1377/hlthaff.2019.00918
• Öker, F., & Özyapici, H. (2013). A new costing model in hospital management: time-driven activity-based costing system. The Health Care Manager, 32(1), 23-36. https://doi.org/10.1097/HCM.0b013e31827ed898
• Özgülbaş, N. (2018). Sağlık sektöründe hizmet ve hastalık maliyet analizi. Siyasal Kitabevi.
• Pallant, J. (2020). SPSS survival manual: A step by step guide to data analysis using IBM SPSS. Routledge;
• Papalexi, M., Bamford, D., & Dehe, B. (2016). A case study of kanban implementation within the pharmaceutical supply chain. International Journal of Logistics Research and Applications, 19(4), 239-255. https://doi.org/10.1080/13675567.2015.1075478
• Park, Y. J., & Matkin, D.S. (2021). The demise of the overhead myth: Administrative capacity and financial sustainability in nonprofit nursing homes. Public Administration Review, 81(3), 543-557. https://doi.org/10.1111/puar.13269
• Pencheon, D. (2013). Developing a sustainable health and care system: lessons for research and policy. Journal of Health Services Research & Policy, 18(4), 193-194. https://doi.org/10.1177/1355819613503633
• Porter, M. (1998). Competitive advantage: creating and sustaining superior performance. The Free Press.
• Poulin, É. (2003). Benchmarking the hospital logistics process, CMA Management, 77(1), 20-26.
• Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: insights from the United States data. Frontiers in public health, 8, 156. https://doi.org/10.3389/fpubh.2020.00156
• Raju, P. S., & Lonial, S. C. (2002). The impact of service quality and marketing on financial performance in the hospital industry: an empirical examination. Journal of Retailing and Consumer Services, 9(6), 335-348.
• Ramamonjiarivelo, Z., Weech-Maldonado, R., Hearld, L., Menachemi, N., Epané, J. P., & O’Connor, S. (2015). Public hospitals in financial distress. Health Care Management Review, 40(4), 337-347. https://doi.org/10.1097/HMR.0000000000000032
• Rauliajtys-Grzybek, M., Baran, W., & Macuda, M. (2017). Cost accounting in public hospitals in Poland: Usefulness for internal and external purposes. Journal of Health Management, 19(2), 275-291. https://doi.org/10.1177/0972063417699690
• Tanç, Ş. G., & Eravcu, T. E. (2021). Özel hastanelerde finansal performans analizi: kayseri ilinde faaliyet gösteren özel hastaneler üzerine bir araştırma. İşletme Akademisi Dergisi, 2(4), 381-397. https://doi.org/10.26677/TR1010.2021.914
• Tatar, M., Mollahaliloğlu, S., Şahin, B., Aydın, S., Maresso, A., Hernández-Quevedo, C., & World Health Organization. (2011). Turkey: Health system review. https://iris.who.int/bitstream/handle/10665/330325/HiT-13-6-2011-eng.pdf
• Tiu, T. S., & Montemayor, C. T. (2019). Determinants of sustainable private hospitals. International Journal of Modern Trends in Business Research, 2(10), 1-12. http://www.ijmtbr.com/PDF/IJMTBR-2019-10-12-02.pdf
• Volland, J., Fügener, A., Schoenfelder, J., & Brunner, J. O. (2017). Material logistics in hospitals: a literature review. Omega, 69, 82-101. https://doi.org/10.1016/j.omega.2016.08.004
• Yener, E., & Öksüz, S. (2017). Özel hastanelerin karşılaştığı finansal sorunların tespiti ve çözüm önerileri. Ömer Halisdemir Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 10(2), 203-227. https://dergipark.org.tr/en/download/article-file/299135
• Yücel, E., & Önal, Y. B. (2015). Özel hastanelerde finansal sıkıntı ve yeniden yapılandırma: Adana ilinde bir uygulama. SGD-Sosyal Güvenlik Dergisi, 5(2), 88-123. https://dergipark.org.tr/en/download/article-file/297444