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Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case

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Abstract

We analyze the operational performance of 202 Turkish rural general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based measure as a “needs indicator”. We derive pure technical, scale and output congestion inefficiency measures and show how they vary across size classes. We show that “reducing mortality” involves sacrificing some good outputs. This is a trade off that holds at the potential output level. Second stage regressions of the inefficiency scores against hospital and rural district level variables, pinpoint critical areas for performance improvement. In particular we show the relative scarcity of nurses is linked to output congestion.

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References

  • Arocena, P., & Prado, A. G. (2007). Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. Health Economics, 16, 667–685.

    Article  Google Scholar 

  • Buyukkayikci, H., & Sahin, I. (2000). The comparative analysis of patients’ costs with reimbursement in surgical services. Hacettepe Saglik Idaresi Dergisi, 5(3), 119–138 (in Turkish).

    Google Scholar 

  • Chung, Y., Fare, R., & Grosskopf, S. (1997). Productivity and undesirable outputs: a directional distance function approach. Journal of Environmental Management, 51, 229–240.

    Article  Google Scholar 

  • Dismuke, C. E., & Sena, V. (2001). Is there a trade-off between quality and productivity? The case of diagnostic technologies in Portugal. Annals of Operation Research, 107, 101–116.

    Article  Google Scholar 

  • Ersoy, K., Kavuncubasi, S., Ozcan, Y., & Harris, J. (1997). Technical efficiencies of Turkish Hospitals: DEA approach. Journal of Medical Systems, 21(2), 67–74.

    Article  Google Scholar 

  • Fare, R., & Grosskopf, S. (2004). New directions: efficiency and productivity. New York: Springer.

    Google Scholar 

  • Fried, H. O., Lovell, C. A. K., & Turner, J. A. (1996). An analysis of the performance of university-affiliated credit unions. Computers & Operations Research, 23(4), 375–384.

    Article  Google Scholar 

  • Hollingsworth, B. (2008). The measurement of efficiency and productivity of health care delivery. Health Economics, 17, 1107–1128.

    Article  Google Scholar 

  • Hollingsworth, B., & Spinks, J. (2009). Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls. Applied Economics, 41, 417–427.

    Article  Google Scholar 

  • Hua, Z., & Bian, Y. (2007). DEA with undesirable factors. In W. Cook, & J. Zhu (Eds.), Data irregularities and structural complexities in DEA. New York: Springer.

    Google Scholar 

  • Jacobs, R., Smith, P. C., & Street, A. (2006). Measuring efficiency in health care. New York: Cambridge University Press.

    Book  Google Scholar 

  • Kuosmanen, T. (2002). Modeling blank entries in data envelopment analysis. (EconWPA working paper at WUSTL, no. 0210001).

    Google Scholar 

  • Liu, W. B., Meng, W., Li, X. X., & Zhang, D. Q. (2010). DEA models with undesirable inputs and outputs. Annals of Operation Research, 173, 177–194.

    Article  Google Scholar 

  • Mo, H. (2003). Ministry of Health. Transformation in health. http://www.saglik.gov.tr/TR/Genel/BelgeGoster.aspx?=donusum%20programi.

  • Mo, H. (2006). Ministry of Health, health statistics 2006. Ankara: Office of Strategy Development. Ministry of Health.

    Google Scholar 

  • Mo, H. (2009). Ministry of Health. Progress report on health transformation program in Turkey. http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/TurkeySPDEng.pdf.

  • Nunamaker, T. R., & Lewin, A. Y. (1983). Measuring routine nursing efficiency: a comparison of cost per patient day and data envelopment analysis models/comment. Health Services Research, 18(2), 183–208.

    Google Scholar 

  • OECD (2008). OECD review of health systems: TURKEY. Paris: OECD/World Bank.

    Google Scholar 

  • OECD (2009). OECD Health Data 2009. http://www.oecd.org/health/healthdata.

  • O’Neill, L., Rauner, M., Heidelberger, K., & Kraus, M. (2008). A cross national comparison and taxonomy of DEA based hospital efficiency studies. Socio-Economic Planning Sciences, 42, 158–189.

    Article  Google Scholar 

  • Ozcan, Y. (2008). Health care benchmarking and performance evaluation: an assessment using data envelopment analysis. New York: Springer.

    Book  Google Scholar 

  • Pastor, J. T. (1996). Translation invariance in data envelopment analysis: A generalization. Annals of Operation Research, 66, 93–102.

    Article  Google Scholar 

  • Picazo-Tadeo, A. J., & Prior, D. (2005). Efficiency and environmental regulation: a ‘complex’ situation (WP 2005/2). Universidad Autonoma de Barcelona.

  • Ray, S. (2004). Data envelopment analysis: theory and techniques for economics and operations research. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Sahin, I. (2009). Total factor productivity analysis of Turkish Social Security hospitals that were transferred to the Health Ministry”. Iktisat Isletme ve Finans, 24, 9–40 (in Turkish).

    Google Scholar 

  • Sahin, I., & Ozcan, Y. (2000). Public sector hospital efficiency for provincial markets in Turkey. Journal of Medical Systems, 24(6), 307–320.

    Article  Google Scholar 

  • Sahin, I., Ozcan, Y., & Ozgen, H. (2011). Assessment of hospital efficiency under health transformation program in Turkey. Central European Journal of Operations Research, 19, 19–37.

    Article  Google Scholar 

  • Scheel, H. (2001). Undesirable outputs in efficiency evaluations. European Journal of Operational Research, 132(2), 400–410.

    Article  Google Scholar 

  • Seiford, L., & Zhu, J. (2002). Modeling undesirable factors in efficiency evaluation. European Journal of Operational Research, 142, 16–20.

    Article  Google Scholar 

  • Sherman, H. D. (1984). Hospital efficiency measurement and evaluation: empirical test of a new technique. Medical Care, 22(10), 922–938.

    Article  Google Scholar 

  • SPO (2004). Ilcelerin sosyoekonomik gelismislik siralamasi arastirmasi. Ankara: DPT.

    Google Scholar 

  • Tas, H. I., & Lightfoot, D. R. (2005). Gecekondu settlements in Turkey: rural-urban migration in the developing European periphery. Journal of Geography, 106(4), 263–271.

    Article  Google Scholar 

  • Thanassoulis, E., Portela, M. C. S., & Despic, O. (2008). DEA: the mathematical programming approach to efficiency analysis. In H. Fried, C. A. Knox Lovell, & S. S. Schmidt (Eds.), The measurement of productive efficiency and productivity growth. New York: Oxford University Press.

    Google Scholar 

  • World Bank (2003). Turkey: reforming the health sector for improved access and efficiency. IBRD (Vols. 1 and 2). Washington DC.

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Correspondence to Nurhan Davutyan.

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N. Davutyan is ERF Fellow.

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Bilsel, M., Davutyan, N. Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case. Ann Oper Res 221, 73–88 (2014). https://doi.org/10.1007/s10479-011-0951-y

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