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Sağlık Hizmetlerinde Yerinden Yönetimin Hizmet Performansı Üzerindeki Etkisi: Türkiye Örneği

Yıl 2020, , 261 - 281, 19.04.2020
https://doi.org/10.17233/sosyoekonomi.2020.02.12

Öz

Bu çalışmanın amacı, yerinden yönetim modelinin Türkiye’deki kamu sağlık hizmetlerinin performansı üzerindeki etkisini incelemektir. Kamu hastanelerinin etkinlikleri; 2014 ve 2017 yıllarına ait veriler kullanılarak, 81 il düzeyinde (İBBS-3) “genel sağlık hizmetleri” ile “ağız ve diş hizmetleri” için Veri Zarflama Analiziyle belirlenmiştir. Sağlık hizmetlerinde yerinden yönetim modeline geçiş sürecinde hizmet etkinliğinin, bölgesel sağlık düzeyine olası etkileri analiz edilmiştir. Bu kapsamda çalışmada; öncelikle il düzeyinde kamu hastaneleri hizmet etkinlikleri belirlenmiş, ardından sağlık hizmetlerinde yerinden yönetim modelinin bölge sağlık düzeyi üzerinde bir etkisinin olup olmadığı incelenmiştir. Diğer bir ifadeyle, elde edilen etkinlik skorlarında mekânsal yayılma (spatial spillover) etkisi araştırılmıştır. Çalışma sonucunda belirlenen kamu hastaneleri etkinlik skorlarının sağlık hizmet sunumuna göre farklılık gösterdiği tespit edilmiştir. Yerinden yönetim uygulaması sonrasında, 2017 yılı, 2014 yılına göre göreli etkinlik skorlarında artış gözlenmiştir. Ayrıca her iki sağlık hizmeti bakımından kamu hastaneleri arasında pozitif mekânsal yayılmanın varlığına belirlenmiştir. Bu durum, bir ilin elde ettiği etkinlik skorunun, komşu illerin etkinlik skorlarından etkilendiğini ortaya koymaktadır. Dolayısıyla, sağlık hizmetlerinde yerinden yönetim modelinin, ilerici ekonomik ve sağlık politikalarıyla desteklenmesi halinde, sağlık düzeyi üzerinde olumlu bir etki yaratma potansiyeline sahip olduğu söylenebilir.

Kaynakça

  • Anselin, L. & A.K. Bera (1998), “Spatial Dependence in Linear Regression Models with an Introduction to Spatial Econometrics”, in: A. Ullah & D.E.A. Giles (eds.), Handbook of Applied Economic Statistics, Marcel Dekker, NY., 237-289.
  • Anselin, L. (1988), Spatial Econometrics: Methods and Models, Kluwer, Boston, London, Academic Publishers.
  • Atılgan, E. (2016), “Kamu Hastaneleri Birlikleri Performans Ölçüm Yöntemi Üzerine Bir Değerlendirme”, Journal of Human Sciences, 13(1), 695-712.
  • Audibert, M. & J. Mathonnat & A. Pelissier & X.X. Huang & A. Ma (2013), “Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data”, China Economic Review, 27, 326-338.
  • Beylik, U. & H.İ. Kayral & Ü. Naldöken (2015), “Sağlık Hizmet Etkinliği Açısından Kamu Hastane Birlikleri Performans Analizi”, C.Ü. Sosyal Bilimler Dergisi, 39(2), 203-224.
  • Castano, R. & R. Bitran & U. Giedion (2004), Monitoring and Evaluating Hospital Autonomization and Its Effects on Priority Health Services, Partners for Health Reform plus, <http://www.phrplus.org/Pubs/Tech052_fin.pdf>, 25.01.2019.
  • Chernichovsky, D. (1995), “Health System Reforms in Industrialized Democracies: An Emerging Paradigm”, Milbank Quarterly, 73, 339-372.
  • Cooper, W.W. & L.M. Seiford & K. Tone (2002), Data Envelopment Analysis - A Comprehensive Text with Models, Applications, References and DEA-Solver Software, Kluwer Academic Publishers, USA.
  • Cooper, W.W. & L.M. Seiford & K. Tone (2006), Introduction to Data Envelopment Analysis and Its Uses With DEA-Solver Software and References, Springer Science+Business Media, USA.
  • Costa-Font, J. & A. Rico (2006), “Devolution and The Interregional Inequalities In Health and Healthcare In Spain”, Regional Studies, 40(8), 875-887.
  • Costa-Font, J. & G. Turati (2018), “Regional Healthcare Decentralization in Unitary States: Equal Spending, Equal Satisfaction?”, Regional Studies, 52(7), 974-985.
  • Demirci, A. (2018), Teori ve Uygulamalarla Veri Zarflama Analizi, Gazi Kitapevi, Ankara-Turkey.
  • Giannoni, M. & T. Hitiris (2002), “The Regional Impact of Health Care Expenditure: The Case of Italy”, Applied Economics, 34(14), 1829-1836.
  • Harding A. & A.S. Preker (2003), “A Conceptual Framework for the Organizational Reforms of Hospitals”, in: A. Preker & A. Harding (eds.), Innovations in Health Services Delivery: The Corporatization of Public Hospitals, World Bank, Washington D.C., 23-78.
  • Joumard, I. & C. André & C. Nicq & O. Chatal (2008), “Health Status Determinants Lifestyle, Environment, Health Care Resources and Efficiency”, OECD Economics Department Working Papers, No. 627, OECD Publishing.
  • Khushalani, J. & Y.A. Ozcan (2017), “Are Hospitals Producing Quality Care Efficiently? An Analysis Using Dynamic Network Data Envelopment Analysis (DEA)”, Socio-Economic Planning Sciences, 60, 15-23.
  • Küçük, Y.S & B. Şahin (2015), “Kamu Hastane Birlikleri Uygulamasına İlişkin Sağlık Yöneticilerinin Görüşlerinin Değerlendirilmesi”, Hacettepe Sağlık İdaresi Dergisi, 18(2), 103-121.
  • Lamba, M. & Y. Altan & M. Aktel & U. Kerman (2014), “Yeni Kamu Yönetimi Perspektifinden Türkiye’de Kamu Yönetimi Reformları: Genel Gerekçeler Üzerinden Bir İnceleme”, SDÜ İİBF Dergisi, 19(3), 135-152.
  • lo Storto, C. & A.G. Goncharuk (2017), “Efficiency vs Effectiveness: A Benchmarking Study on European Healthcare Systems”, Economics and Sociology, 10(3), 102-115. MoH (2003), Transformation in Health, <https://www.saglik.gov.tr/TR,11415/saglikta-donusum-programi.html>, 25.01.2019.
  • MoH (2014), Public Hospitals Statistical Yearbook -2014, Public Hospitals Authority, <https://khgm.saglik.gov.tr/Dosyalar/1b6f1adfa6c54b17ba5827a1ea1733c6.pdf>, 25.01.2019.
  • MoH (2017), Public Hospitals Statistical Report, <https://dosyamerkez.saglik.gov.tr/Eklenti/21853,kamu-hastaneleri-istatistik-raporu-2017pdf.pdf?0>, 12.01.2019.
  • O’Donnell, O. (2007), “Access to Health Care in Developing Countries: Breaking Down Demand Side Barriers”, Cad Saude Publica, 23, 2820-34.
  • Oates, W.E. (1972), Fiscal Federalism, New York: Harcourt Brace Jovanovich.
  • Osborne, D. & T. Gaebler (1993), Reinventing Government, How the Entrepreneurial Spirit is Transforming the Public Sector, Plume, USA.
  • Ozcan, Y.A. & J. Khushalani (2017), “Assessing Efficiency of Public Health and Medical Care Provision in OECD Countries After A Decade of Reform”, Central European Journal of Operations Research, 25(2), 325-343.
  • Ozcan, Y.A. (2008), Health Care Benchmarking and Performance Evaluation - An Assessment Using Data Envelopment Analysis (DEA), (Edit. Hillier Fred), Springer Science+Business Media, USA.
  • Quadrado, L. & H. Folmer & S. Loman (2001), “Regional Inequality in The Provision of Health Care in Spain”, Environment and Planning, 33(5), 783-798.
  • Ramanathan, R. (2003), An Introduction to Data Envelopment Analysis - A Tool for Performance Measurement, Sage Publications, New Delhi, India.
  • Şenol, O. & M. Gençtürk (2017), “Veri Zarflama Analiziyle Kamu Hastaneleri Birliklerinde Verimlilik Analizi”, SDÜ Sosyal Bilimler Enstitüsü Dergisi, 4(29), 265-286.
  • Türkiye Kamu Hastaneleri Kurumu (2012), Birlik Değerlendirme El Kitabı, Ankara, <https://khgm.saglik.gov.tr/Dosyalar/4fe4e47c4c9c4a2e99ae675dcc3c0713.pdf>, 25.01.2019.
  • WHO (2017), World Health Statistics 2017: Monitoring health for the SDGs, Part 2: Status of the Health -Related SDGs. 29:35. <http://www.who.int/gho/publications/world_health_statistics/2017/EN_WHS2017_Part2.pdf?ua=1>, 25.01.2019.
  • Wigley, S. & A. Akkoyunlu-Wigley (2011), “The Impact of Regime Type on Health: Does Redistribution Explain Everything?”, World Politics, 63(4), 647-77.
  • Yiğit, V. (2016), “Hastanelerde Teknik Verimlilik Analizi: Kamu Hastane Birliklerinde Bir Uygulama”, SDÜ Sağlık Bilimleri Enstitüsü Dergisi, 7(2), 9-15.
  • Zhong, H. (2010), “The Impact of Decentralization of Health Care Administration on Equity in Health and Health Care in Canada”, International Journal of Health Care Finance and Economics, 10(3), 219-237.

Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey

Yıl 2020, , 261 - 281, 19.04.2020
https://doi.org/10.17233/sosyoekonomi.2020.02.12

Öz

The research object of the current study is to examine the impact of regional decentralization model on the performance of public healthcare services in Turkey. The efficiency of public hospitals has been determined by the type of healthcare services, “general healthcare” and “oral-dental healthcare”, with Data Envelopment Analysis at the level of 81 provinces (NUTS-3) for 2014 and 2017. By continuing the transition to decentralization in public health services, the possible effects on the regional health level were analyzed. Notably, this study proposes a two-dimensional approach, one of them is to determine public hospital performance at province level, and the other one is to examine whether the decentralization of health services had a significant effect on the efficiency of bounder (contiguity) provinces other means to catch spillover between performance scores. In the results of the study, the efficiency scores of 81 province hospitals differed significantly according to the provision of service patterns. And the relative efficiency scores are increasing with decentration approaches when is compared 2014 and 2017. Furthermore, there is a positive spatial spillover between every two types of hospital service province unit among public hospitals. This means that the hospital efficiency in the contiguous province has an effect of increasing the efficiency score of the region. This suggests that the decentralization model in public health services may have the potential tool to create a positive impact on the health level in the future if supported by progressive economic and health policies for developing countries.

Kaynakça

  • Anselin, L. & A.K. Bera (1998), “Spatial Dependence in Linear Regression Models with an Introduction to Spatial Econometrics”, in: A. Ullah & D.E.A. Giles (eds.), Handbook of Applied Economic Statistics, Marcel Dekker, NY., 237-289.
  • Anselin, L. (1988), Spatial Econometrics: Methods and Models, Kluwer, Boston, London, Academic Publishers.
  • Atılgan, E. (2016), “Kamu Hastaneleri Birlikleri Performans Ölçüm Yöntemi Üzerine Bir Değerlendirme”, Journal of Human Sciences, 13(1), 695-712.
  • Audibert, M. & J. Mathonnat & A. Pelissier & X.X. Huang & A. Ma (2013), “Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data”, China Economic Review, 27, 326-338.
  • Beylik, U. & H.İ. Kayral & Ü. Naldöken (2015), “Sağlık Hizmet Etkinliği Açısından Kamu Hastane Birlikleri Performans Analizi”, C.Ü. Sosyal Bilimler Dergisi, 39(2), 203-224.
  • Castano, R. & R. Bitran & U. Giedion (2004), Monitoring and Evaluating Hospital Autonomization and Its Effects on Priority Health Services, Partners for Health Reform plus, <http://www.phrplus.org/Pubs/Tech052_fin.pdf>, 25.01.2019.
  • Chernichovsky, D. (1995), “Health System Reforms in Industrialized Democracies: An Emerging Paradigm”, Milbank Quarterly, 73, 339-372.
  • Cooper, W.W. & L.M. Seiford & K. Tone (2002), Data Envelopment Analysis - A Comprehensive Text with Models, Applications, References and DEA-Solver Software, Kluwer Academic Publishers, USA.
  • Cooper, W.W. & L.M. Seiford & K. Tone (2006), Introduction to Data Envelopment Analysis and Its Uses With DEA-Solver Software and References, Springer Science+Business Media, USA.
  • Costa-Font, J. & A. Rico (2006), “Devolution and The Interregional Inequalities In Health and Healthcare In Spain”, Regional Studies, 40(8), 875-887.
  • Costa-Font, J. & G. Turati (2018), “Regional Healthcare Decentralization in Unitary States: Equal Spending, Equal Satisfaction?”, Regional Studies, 52(7), 974-985.
  • Demirci, A. (2018), Teori ve Uygulamalarla Veri Zarflama Analizi, Gazi Kitapevi, Ankara-Turkey.
  • Giannoni, M. & T. Hitiris (2002), “The Regional Impact of Health Care Expenditure: The Case of Italy”, Applied Economics, 34(14), 1829-1836.
  • Harding A. & A.S. Preker (2003), “A Conceptual Framework for the Organizational Reforms of Hospitals”, in: A. Preker & A. Harding (eds.), Innovations in Health Services Delivery: The Corporatization of Public Hospitals, World Bank, Washington D.C., 23-78.
  • Joumard, I. & C. André & C. Nicq & O. Chatal (2008), “Health Status Determinants Lifestyle, Environment, Health Care Resources and Efficiency”, OECD Economics Department Working Papers, No. 627, OECD Publishing.
  • Khushalani, J. & Y.A. Ozcan (2017), “Are Hospitals Producing Quality Care Efficiently? An Analysis Using Dynamic Network Data Envelopment Analysis (DEA)”, Socio-Economic Planning Sciences, 60, 15-23.
  • Küçük, Y.S & B. Şahin (2015), “Kamu Hastane Birlikleri Uygulamasına İlişkin Sağlık Yöneticilerinin Görüşlerinin Değerlendirilmesi”, Hacettepe Sağlık İdaresi Dergisi, 18(2), 103-121.
  • Lamba, M. & Y. Altan & M. Aktel & U. Kerman (2014), “Yeni Kamu Yönetimi Perspektifinden Türkiye’de Kamu Yönetimi Reformları: Genel Gerekçeler Üzerinden Bir İnceleme”, SDÜ İİBF Dergisi, 19(3), 135-152.
  • lo Storto, C. & A.G. Goncharuk (2017), “Efficiency vs Effectiveness: A Benchmarking Study on European Healthcare Systems”, Economics and Sociology, 10(3), 102-115. MoH (2003), Transformation in Health, <https://www.saglik.gov.tr/TR,11415/saglikta-donusum-programi.html>, 25.01.2019.
  • MoH (2014), Public Hospitals Statistical Yearbook -2014, Public Hospitals Authority, <https://khgm.saglik.gov.tr/Dosyalar/1b6f1adfa6c54b17ba5827a1ea1733c6.pdf>, 25.01.2019.
  • MoH (2017), Public Hospitals Statistical Report, <https://dosyamerkez.saglik.gov.tr/Eklenti/21853,kamu-hastaneleri-istatistik-raporu-2017pdf.pdf?0>, 12.01.2019.
  • O’Donnell, O. (2007), “Access to Health Care in Developing Countries: Breaking Down Demand Side Barriers”, Cad Saude Publica, 23, 2820-34.
  • Oates, W.E. (1972), Fiscal Federalism, New York: Harcourt Brace Jovanovich.
  • Osborne, D. & T. Gaebler (1993), Reinventing Government, How the Entrepreneurial Spirit is Transforming the Public Sector, Plume, USA.
  • Ozcan, Y.A. & J. Khushalani (2017), “Assessing Efficiency of Public Health and Medical Care Provision in OECD Countries After A Decade of Reform”, Central European Journal of Operations Research, 25(2), 325-343.
  • Ozcan, Y.A. (2008), Health Care Benchmarking and Performance Evaluation - An Assessment Using Data Envelopment Analysis (DEA), (Edit. Hillier Fred), Springer Science+Business Media, USA.
  • Quadrado, L. & H. Folmer & S. Loman (2001), “Regional Inequality in The Provision of Health Care in Spain”, Environment and Planning, 33(5), 783-798.
  • Ramanathan, R. (2003), An Introduction to Data Envelopment Analysis - A Tool for Performance Measurement, Sage Publications, New Delhi, India.
  • Şenol, O. & M. Gençtürk (2017), “Veri Zarflama Analiziyle Kamu Hastaneleri Birliklerinde Verimlilik Analizi”, SDÜ Sosyal Bilimler Enstitüsü Dergisi, 4(29), 265-286.
  • Türkiye Kamu Hastaneleri Kurumu (2012), Birlik Değerlendirme El Kitabı, Ankara, <https://khgm.saglik.gov.tr/Dosyalar/4fe4e47c4c9c4a2e99ae675dcc3c0713.pdf>, 25.01.2019.
  • WHO (2017), World Health Statistics 2017: Monitoring health for the SDGs, Part 2: Status of the Health -Related SDGs. 29:35. <http://www.who.int/gho/publications/world_health_statistics/2017/EN_WHS2017_Part2.pdf?ua=1>, 25.01.2019.
  • Wigley, S. & A. Akkoyunlu-Wigley (2011), “The Impact of Regime Type on Health: Does Redistribution Explain Everything?”, World Politics, 63(4), 647-77.
  • Yiğit, V. (2016), “Hastanelerde Teknik Verimlilik Analizi: Kamu Hastane Birliklerinde Bir Uygulama”, SDÜ Sağlık Bilimleri Enstitüsü Dergisi, 7(2), 9-15.
  • Zhong, H. (2010), “The Impact of Decentralization of Health Care Administration on Equity in Health and Health Care in Canada”, International Journal of Health Care Finance and Economics, 10(3), 219-237.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Makaleler
Yazarlar

Gökçe Manavgat 0000-0003-3729-835X

Ayhan Demirci 0000-0003-3788-4586

Yayımlanma Tarihi 19 Nisan 2020
Gönderilme Tarihi 3 Temmuz 2019
Yayımlandığı Sayı Yıl 2020

Kaynak Göster

APA Manavgat, G., & Demirci, A. (2020). Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey. Sosyoekonomi, 28(44), 261-281. https://doi.org/10.17233/sosyoekonomi.2020.02.12
AMA Manavgat G, Demirci A. Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey. Sosyoekonomi. Nisan 2020;28(44):261-281. doi:10.17233/sosyoekonomi.2020.02.12
Chicago Manavgat, Gökçe, ve Ayhan Demirci. “Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey”. Sosyoekonomi 28, sy. 44 (Nisan 2020): 261-81. https://doi.org/10.17233/sosyoekonomi.2020.02.12.
EndNote Manavgat G, Demirci A (01 Nisan 2020) Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey. Sosyoekonomi 28 44 261–281.
IEEE G. Manavgat ve A. Demirci, “Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey”, Sosyoekonomi, c. 28, sy. 44, ss. 261–281, 2020, doi: 10.17233/sosyoekonomi.2020.02.12.
ISNAD Manavgat, Gökçe - Demirci, Ayhan. “Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey”. Sosyoekonomi 28/44 (Nisan 2020), 261-281. https://doi.org/10.17233/sosyoekonomi.2020.02.12.
JAMA Manavgat G, Demirci A. Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey. Sosyoekonomi. 2020;28:261–281.
MLA Manavgat, Gökçe ve Ayhan Demirci. “Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey”. Sosyoekonomi, c. 28, sy. 44, 2020, ss. 261-8, doi:10.17233/sosyoekonomi.2020.02.12.
Vancouver Manavgat G, Demirci A. Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey. Sosyoekonomi. 2020;28(44):261-8.