TECHNICAL EFFICIENCY AND ITS DETERMINANTS IN SECONDARY PUBLIC HOSPITALS IN TÜRKİYE: A DEA-TOBIT APPROACH

Year 2022, , 611 - 624, 26.10.2022

Melek Bilge Pınarbaşı , Fatma Mansur

https://doi.org/10.51551/verimlilik.1015158

Abstract

Purpose: In this study, the technical efficiency levels of the secondary public hospitals in Türkiye are revealed.

Methodology: In the study Data Envelopment Analysis (DEA) was employed. After the DEA, the effects of being located in a metropolitan, having 200 or more beds, bed turnover rate, bed occupancy ratio, the number of beds per specialist physician and the number of assistant health personnel on the DEA scores were examined by a Tobit regression model.

Findings: According to the Tobit regression results, while being located in a metropolitan and bed turnover rate had a statistically significant and positive effect on the technical efficiency levels, the number of assistant health personnel has a statistically significant and negative effect (p<0.05). The effects of other variables (having 200 or more beds, bed occupancy ratio, the number of beds per specialist physician) on the technical efficiency were positive, but not statistically significant (p>0.05).

Originality: For the first time with this study, the technical efficiency levels of the secondary public hospitals in Türkiye and the factors affecting them are discussed with a DEA-Tobit Approach.

Keywords

Technical Efficiency in Hospitals, Data Envelopment Analysis, Tobit Regression

TÜRKİYE’DEKİ İKİNCİ BASAMAK KAMU HASTANELERİNDE TEKNİK ETKİNLİK VE BELİRLEYİCİLERİ: BİR VZA-TOBİT ÇALIŞMASI

Abstract

Amaç: Bu çalışmada Türkiye’de faaliyet gösteren ikinci basamak kamu hastanelerinin teknik etkinliği ortaya konmuştur.

Yöntem: Çalışmada Veri Zarflama Analizi (VZA) kullanılmıştır. VZA’dan sonra kurulan Tobit regresyon modeli ile hastanelerin bulunduğu ilin büyükşehir olma durumu, yatak sayısının 200 ve üzerinde olma durumu, yatak devir hızı, yatak doluluk oranı, uzman hekim başına düşen yatak sayısı ve yardımcı sağlık personeli sayısı değişkenlerinin VZA skorlarına etkisi incelenmiştir.

Bulgular: Tobit regresyon sonuçlarına göre, hastanelerin bulunduğu ilin büyükşehir olma durumu ve yatak devir hızı teknik etkinliğe istatistiksel olarak anlamlı şekilde olumlu etki ederken, yardımcı sağlık personeli sayısı teknik etkinliğe istatistiksel olarak anlamlı şekilde olumsuz etki etmektedir (p<0,05). Diğer değişkenlerin (yatak sayısının 200 ve üzerinde olma durumu, yatak doluluk oranı, uzman hekim başına düşen yatak sayısı) teknik etkinlik üzerindeki etkileri olumlu olmakla birlikte istatistiksel olarak anlamlı değildir (p>0,05).

Özgünlük: Bu çalışma ile ilk defa Türkiye’de faaliyet gösteren ikinci basamak kamu hastanelerinin teknik etkinlik düzeyleri ve buna etki eden faktörler VZA-Tobit Yaklaşımı ile ele alınmıştır.

Keywords

Hastanelerde Teknik Etkinlik, Veri Zarflama Analizi, Tobit Regresyon

References

• Abou El-Seoud, M.S. (2013). “Measuring Efficiency of Reformed Public Hospitals in Saudi Arabia: An Application of Data Envelopment Analysis”, International Journal of Economics and Management Sciences, 2(9), 44-53.
• Ahangar, A., Ahmadi, A.M., Mozayani, A.H., Dizaji, S.F. ve Safarani, S. (2019). “Transition of Health Financing, Cost Risk-Sharing and Risk-Pooling Models in the Health Sector: A Systematic Review (1990 - 2019)”, Iranian Red Crescent Medical Journal, 21(12), e63215.
• Alatawi, A.D., Niessen, L.W. ve Khan, J.A. (2020). “Efficiency Evaluation of Public Hospitals in Saudi Arabia: An Application of Data Envelopment Analysis”, BMJ Open, 10(1), e031924.
• Ali, M., Debela, M. ve Bamud, T. (2017). “Technical Efficiency of Selected Hospitals in Eastern Ethiopia”, Health Economics Review, 7(1), 1-13.
• Bağci, H. ve Konca, M. (2021). “Evaluating the Technical Efficiency of Hospitals Providing Tertiary Health Care in Turkey: An Application Based on Data Envelopment Analysis”, Hospital Topics, 99(2), 49-63.
• Banker, R.D., Charnes, A. ve Cooper, W.W. (1984). “Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis”, Management Science, 30(9), 1078-1092.
• Bardakçı, S. ve Filiz, M. (2020). Veri Zarflama Analizi İle Kamu Hastaneleri Için Etkinlik Ölçümü: Artvin İlinde Örnek Bir Uygulama”, İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 8(2), 445-460.
• Bates, L.J., Mukherjee, K. ve Santerre, R. (2006). Market Structure and Technical Efficiency in the Hospital Services Industry: A DEA Approach”, Medical Care Research and Review 63(4), 499-524.
• Büchner, V.A., Hinz, V. ve Schreyögg, J. (2016). “Health Systems: Changes in Hospital Efficiency and Profitability”, Health care management science, 19(2), 130-143.
• Campanella, P., Azzolini, E., Izzi, A., Pelone, F., De Meo, C., La Milia, D., Specchia, M.L. ve Ricciardi, W. (2017). “Hospital Efficiency: How to Spend Less Maintaining Quality?”, Annali dell'Istituto superiore di sanita, 53(1), 46-53.
• Charnes, A., Cooper, W.W. ve Rhodes, E. (1978). “Measuring the Efficiency of Decision Making Units”, European Journal of Operational Research, 2, 429-444.
• Charnes, A., Cooper, W. ve Rhodes, E. (1981). “Evaluating Program and Managerial Efficiency: An Application of Data Envelopment Analysis to Program Follow Through”, Management Science, 27(6), 668-697.
• Chilingerian, J.A. (1995). “Evaluating Physician Efficiency in Hospitals: A Multivariate Analysis of Best Practices”, European Journal of Operational Research, 80, 548-574.
• Cooper, W.W., Seiford, L. ve Zhu, J. (2011). Handbook on Data Envelopment Analysis. Second Edition, Springer, New York. Farrell, M.J. (1957). “The Measurement of Productive Efficiency”, Journal of the Royal Statistical Society, 120(3), 253-290.
• Ferreira, D.C. ve Marques, R.C. (2019). “Do Quality and Access to Hospital Services Impact on Their Technical Efficiency?”, Omega, 86, 218-236.
• Fragkiadakis, G., Doumpos, M., Zopounidis, C. ve Germain, C. (2016). “Operational and Economic Efficiency Analysis of Public Hospitals in Greece”, Annals of Operations Research, 247(2), 787-806. Frontier Economics (2012). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/303160/Monitor_Economies_of_Scale_and_Scope_-_FINAL_REPORT_0_0.pdf, (Erişim Tarihi: 05.10.2021)
• Gandhi, A.V. ve Sharma, D. (2018). “Technical Efficiency of Private Sector Hospitals in India Using Data Envelopment Analysis”, Benchmarking: An International Journal, 25(9), 3570-3591.
• Giancotti, M., Guglielmo, A. ve Mauro, M. (2017). “Efficiency and Optimal Size of Hospitals: Results of a Systematic Search”, PloS One, 12(3), e0174533.
• Golany B, ve Roll Y. (1989). “An Application Procedure for DEA”, Omega, 17, 237-250.
• Gülsevin, G. ve Türkan, A.H. (2012). “Afyonkarahisar Hastanelerinin Etkinliklerinin Veri Zarflama Analizi ile Değerlendirilmesi”, Afyon Kocatepe Üniversitesi Fen ve Mühendislik Bilimleri Dergisi, 12(2), 1-8.
• Guo, H., Zhao, Y., Niu, T. ve Tsui, K.L. (2017). “Hong Kong Hospital Authority Resource Efficiency Evaluation: Via a Novel DEA-Malmquist Model and Tobit Regression Model”, PLoS One 12 (9), e0184211.
• Hollingsworth B., Dawson P.J. ve Maniadakis N. (1999). “Efficiency Measurement of Health Care: A Review of Non-Parametric Methods and Applications”, Health Care Management Science, 2,161-172.
• Ilgün G. ve M. Konca. (2019). “Assessment of Efficiency Levels of Training and Research Hospitals in Turkey and the Factors Affecting Their Efficiencies”, Health Policy and Technology, 8 (4), 343-348.
• Jehu-Appiah, C., Sekidde, S., Adjuik, M., Akazili, J., D Almeida, S., Nyonator, F., Baltussen, R., Asbu, E.Z., Kirigia, M. (2014). “Ownership and Technical Efficiency of Hospitals: Evidence from Ghana Using Data Envelopment Analysis”. Cost Effectiveness and Resource Allocation, 12(1), 1-13.
• Jing, R., Xu, T., Lai, X., Mahmoudi, E. ve Fang, H. (2020). “Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study”, International Journal of Environmental Research and Public Health, 17(1), 82.
• Khushalani, J. ve Ozcan, Y.A. (2017). “Are Hospitals Producing Quality Care Efficiently? An Analysis Using Dynamic Network Data Envelopment Analysis (DEA)”, Socio-Economic Planning Sciences, 60, 15-23.
• Konca, M. ve Top, M. (2021). “Ekonomik Faktörler ve Ulusal Sağlık Sistemlerinde Teknik Etkinlik: Panel Veriye Dayalı Bir Uygulama”, Verimlilik Dergisi, 3, 21-33.
• Konca, M. ve Top, M. (2022). “What Predicts the Technical Efficiency in Healthcare Systems of OECD Countries? A Two-Stage DEA Approach”, International Journal of Healthcare Management, DOI: 10.1080/20479700.2022.2077510.
• Marrakchi, M.D. ve Essid, H. (2019). “Efficiency Assessment of Tunisian Public Hospitals Using Data Envelopment Analysis (DEA)”, Working Papers 1291, Economic Research Forum (ERF).
• Mujasi, P.N., Asbu, E.Z. ve Puig-Junoy, J. (2016). “How Efficient are Referral Hospitals in Uganda? A Data Envelopment Analysis and Tobit Regression Approach”, BMC Health Services Research, 16, 230.
• OECD (2020). “Health Expenditure”, https://www.oecd.org/els/health-systems/health-expenditure.htm, (Erişim Tarihi: 20.05.2020).
• Omrani, H., Shafaat, K. ve Emrouznejad, A. (2018). “An Integrated Fuzzy Clustering Cooperative Game Data Envelopment Analysis Model with Application in Hospital Efficiency”, Expert Systems with Applications, 114, 615-628.
• Ozcan, Y.A. (2008). “Health Care Benchmarkıng and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA)”, Springer, USA.
• Ozcan, Y.A. (2014). Health Care Benchmarkıng and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA). Second Edition, USA: Springer.
• Polyzos, N., Karanikas, H., Thireos, E., Kastanioti, C. ve Kontodimopoulos, N. (2013). “Reforming Reimbursement of Public Hospitals in Greece During the Economic Crisis: Implementation of a DRG System”, Health Policy, 109(1),14-22.
• Sağlık Bakanlığı (2009). “Hastane Rolleri”, https://khgmsaglikhizmetleridb.saglik.gov.tr/Eklenti/40424/0/hastane-rolleri-1pdf.pdf, (Erişim Tarihi: 20.05.2020).
• Sherman, H. ve Zhu, J. (2006). “Service Productivity Management: Improving Service Performance Using Data Envelopment Analysis (DEA)”, Springer, USA.
• Sultan, W.I. ve Crispim, J. (2018). “Measuring the Efficiency of Palestinian Public Hospitals During 2010–2015: An Application of a Two-Stage DEA Method”, BMC Health Services Research, 18(1), 1-17.
• Tobin, J. (1958). “Estimation of Relationships for Limited Dependent Variables”, Econometrica: Journal of the Econometric Society, 24-36.
• Yiğit, V. ve Esen, H. (2017). “Pabon Lasso Modeli ve Veri Zarflama Analizi ile Hastanelerde Performans Ölçümü”, Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 8(2), 26-32.
• Younis, M.Z. (2012). “A Comparison Study of Urban and Small Rural Hospitals Financial and Economic Performance”, Online Journal of Rural Nursing and Health Care, 3(1), 38-48.
• Zere E, Mcintyre D, ve Addison T. (2001). “Technical Efficiency and Productivity of Public Sector Hospitals in Three South African Provinces”, South African Journal of Economics, 69(2), 336-358.
• Zhang, X., Tone, K. ve Lu, Y. (2018). “Impact of the Local Public Hospital Reform on the Efficiency of Medium‐Sized Hospitals in Japan: An Improved Slacks‐Based Measure Data Envelopment Analysis Approach”, Health Services Research, 53(2), 896-918.