Türkiye’deki Sağlık Hizmetleri Sektörünün Şehirlerin Panel Verilerine Dayalı Olarak Etkinlik ve Verimliliklerinin Ölçümü

Erhan Berk, Hakan Çerçioğlu
114 12

Öz


Türkiye, "Sağlıkta Dönüşüm Programı" ile büyük değişikliklerin olduğu önemli bir dönüşüm süreci gerçekleştirdi. Bununla birlikte, sağlıkta dönüşüm programının uygulanmasından bu yana Türkiye'de hastanelerin uygulamaları ve davranışlarıyla ilgili birçok şeyin istatistik kayıtları elde edilebildi. Bu kayıtlar, reformlardan kaynaklanan çeşitli sorunlara işaret ederken, bunlara ilişkin metodolojik bir analiz nadiren gözlemlenmiştir. Çalışmada, il düzeyindeki sağlık hizmetlerinin beş yıllık verilerine dayalı olarak, Türkiye'nin sağlık reformu sonrasındaki dönemde sağlık hizmetleri sektörünün üretken verimliliği analiz edilmektedir. Etkinlik ölçümlerinin elde edilmesinde, Veri Zarflama Analizi olarak bilinen parametrik olmayan bir yaklaşım kullanılmıştır. 2009 ve 2013 yılları arasındaki verimliliğin bulunmasında, Malmquist Endeksi kullanılmıştır. Ayrıca, değerlendirme değerleri 1'e eşit olan illerin sıralanması için süper etkinlik modeli uygulanmaktadır. Hesaplanan Malmquist endeksine göre sonuçlar incelendiğinde, sağlık hizmetleri sektöründe 47 ilin verimliliğini arttırdığı ancak 34 ilin verimliliğini azalttığı gözlemlenmektedir. Öte yandan, sonuçların değerlendirilmesi ile ekonomik kalkınma düzeyinin ve hastanelerin etkinlik performansının mutlaka birlikte hareket etmediğini göstermektedir.


Anahtar kelimeler


Sağlık hizmetleri, Veri Zarflama analizi, Malmquist verimlilik endeksi, Süper etkinlik

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Referanslar


MOH (Ministry of Health), Turkey Health Transformation Program: Assessment Report (2003-2011). Minister of Health of Turkey, 2011.

MOH (Ministry of Health), Strategic Plan 2013-2017. Minister of Health of Turkey, 2012.

Ozcan, Y.A., Efficiency of hospital service production in local markets: the balance sheet of US medical armament. Socio-Economic Planning Sciences, 29(1), 139-50, 1995.

Ersoy, K., Kavuncubasi, S., Ozcan, Y.A., and Harris II, J.M., Technical efficiency of Turkish hospitals: DEA approach. Journal of Medical Systems, 21(2), 67–74, 1997.

Sahin, I., and Ozcan, Y.A., Public sector hospitals efficiency for provincial markets in Turkey. Journal of Medical Systems, 24(6), 307-320, 2000.

Kirigia, J.M., Emrouznejad, A., and Sambo, L.G., Measurement of technical efficiency of public hospitals in Kenya: using data envelopment analysis. Journal of Medical Systems, 26(1), 39–45, 2002.

Watcharariroj, B., and Tang, J.C.S., The effects of size and information technology on hospital efficiency. Journal of High Technology Management Research, 15(1), 1–16, 2004.

Osei, D., d'Almeida, S., George, M.O., Kirigia, J.M., Mensah, A.O., and Kainyu, L.H., Technical efficiency of public district hospitals and health care centres in Ghana: a pilot study. Cost Effectiveness and Resource Allocation, 3(9), 1-13, 2005.

Ferrier, G.D., Rosko, M.D., and Valdmanis, V.G., Analysis of uncompensated hospital care using a DEA model of output congestion. Health Care Management Science, 9(2), 181-188, 2006.

Kundurjiev, T. and Salchev, P., Technical efficiency of hospital psychiatric care in Bulgaria - assessment using data envelopment analysis. University Library of Munich, Munich, MPRA Paper 28953. http://mpra.ub.uni-muenchen.de/id/eprint/28953, 2011.

Narci HO, Ozcan YA, Sahin I, Tarcan M, Narci M (2014) An examination of competition and efficiency for hospital industry in Turkey. Health Care Management Science 18 (4):1-12

Jehu-Appiah, C., Sekidde, S., Adjuik, M., Akazili, J., D Almeida, S., Nyonator, F., Baltussen, R., Asbu, E.Z., and Kirigia J.M., Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis, 12(9), 1-13. http://www.resource-allocation.com/content/12/1/9, 2014.

Färe, R., Grosskopf, S., Lindgren, B. and Poullier, J.P., Productivity growth in health care delivery. Medical Care, 35(4), 354–366, 1997.

Sommersguter-Reichmann, M., The impact of the Austrian hospital financing reform on hospital productivity: Empirical evidence on efficiency and technology changes using a non- parametric input-based Malmquist approach. Health Care Management Science, 3(4), 309-321, 2000.

McCallion, G., Glass, J.C., Jackson, R., Kerr, C.A., and McKillop, D.G., Investigating productivity change and hospital size: a nonparametric frontier approach. Applied Economics, 32(2), 161-174, 2000.

Maniadakis, N., and Thanassoulis, E., Assessing productivity changes in UK hospitals reflecting technology and input prices. Applied Economics, 32(12), 1575-1589, 2000.

Biørn, E., Hagen, T.P., Iversen, T., and Magnussen, J., The effect of activity-based financing on hospital efficiency: A panel data analysis of DEA efficiency scores 1992–2000. Health Care Management Science, 6(4), 271–283, 2003.

Harrison, J.P., Coppola, M.N., and Wakefield, M., Efficiency of federal hospitals in the United States. Journal of Medical Systems, 28(5), 411–422, 2004.

Chang, H., Cheng, M., and Das, S., Hospital ownership and operating efficiency: Evidence from Taiwan. European Journal of Operational Research, 159(1), 513–527, 2004.

Harrison, J.P., and Sexton, C., The improving efficiency frontier of religious not-for-profit hospitals. Hospital Topics, 84(1), 2-10, 2006.

Pilyavsky, A., and Staat, M., Health care in the CIS countries: The case of hospitals in Ukraine. European Journal of Health Economics, 7(3), 189-195, 2006.

Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B., and Kapenambili, W., Technical efficiency of district hospitals: Evidence from Namibia using data envelopment analysis. Cost Effectiveness and Resource Allocation, 4(5), 1-9, 2006.

Kirigia, J.M., Emrouznejad, A., Cassoma, B., Asbu, E.Z., and Barry, S., A performance assessment method for hospitals: The case of municipal hospitals in Angola. Journal of Medical Systems, 32(6), 509-519, 2008.

Ng, Y.C., The productive efficiency of Chinese hospitals, Chinese Economic Review, 22, 428-439, 2011.

Ineveld, M.V., Oostrum, J.V., Vermeulen, R., Steenhoek, A., and Klundert, J.V.D., Productivity and quality of Dutch hospitals during system reform, Health Care Management Science, 2015.

Charnes, A., Cooper, W.W., and Rhodes, E., Measuring the efficiency of decision making units. European Journal of Operational Research, 2, 429-444, 1978.

Banker, R.D., Charnes, A., and Cooper, W.W., Some models for the estimation of technical and scale inefficiencies in Data Envelopment Analysis. Management Science, 30(1), 1078-1092, 1984.

Prichard, R.D., Measuring and Improving Organizational Productivity. New York, NY: Praeger Publishers, 1990.

Youn, J.W., and Park, K., University development models and efficiency analysis. Journal of Service Science, 1, 9-30, 2009.

Ahn, Y-H, and Min, H., Evaluating the multi-period operating efficiency of international airports using data envelopment analysis and the Malmquist productivity index. Journal of Air Transport Management, 39(1), 12-22, 2014.

Tone, K., A slacks-based measure of efficiency in data envelopment analysis. European Journal of Operational Research, 130, 498-509, 2001.

Tone, K., A slacks-based measure of super-efficiency in data envelopment analysis. European Journal of Operational Research, 143, 32-41, 2002.

Adler, N., Friedman, L., and Sinuany-Stern, Z., Review of ranking methods in the data envelopment analysis context. European Journal of Operational Research, 140 (2), 249-265, 2002.

Xue, X., Wu, H., Zhang, X., Dai, J., and Su, C., Measuring energy consumption efficiency of the construction industry: the case of China, Journal of Cleaner Production, 30, 1-7, 2014.

Xue, X., Qiping, S., Yaowu, W., and Jinfeng L., Measuring the productivity of the construction industry in China by using dea-based Malmquist productivity indices, Journal of Construction Engineering and Management, 134 (1), 64-71, 2008.

Farrell, M.J., The measurement of productive efficiency. J. R. Stat. Soc. Ser. Gen., 253-290, 1957.

Färe, R., Grosskopf, S., Lovell, C.K., Production frontiers. Cambridge University Press, 1994.

Chen, Y., A non-radial Malmquist productivity index with an illustrative application to Chinese major industries. International Journal of Production Economics, 83, 27-35, 2003.

Zhu, J., Quantitative Models for Performance Evaluation and Benchmarking: Data Envelopment Analysis with Spreadsheets. Kluwer Academic, Boston, 2002.

Mollahaliloglu, S., Basara, B.B., and Eryilmaz, Z., Health Statistics Yearbook 2009. School of Public Health, Refik Saydam Hygiene Center Presidency, Ministry of Health of Turkey, Ankara, 2010.

Mollahaliloglu, S., Basara, B.B., and Eryilmaz, Z., Health Statistics Yearbook 2010. School of Public Health, Refik Saydam Hygiene Center Presidency, Ministry of Health of Turkey, Ankara, 2011.

Basara, B.B., Guler, C., Eryilmaz, Z., Yentur, G. K., and Pulgat, E., Health Statistics Yearbook 2011. General Directorate of Health Research, Ministry of Health, Ankara, 2012.

Basara, B.B., Guler, C., Yentur, G.K., Birge, B., Pulgat, E., and Ekinci, B. M., Health Statistics Yearbook 2012. General Directorate of Health Research, Ministry of Health, Ankara, 2013.

Basara, B.B., Guler, C., and Yentur, G.K., Health Statistics Yearbook 2013. General Directorate of Health Research, Ministry of Health, Ankara, 2014.

Ozcan Y.A. (2014) Health Care Benchmarking and Performance Evaluation: An Assessment using Data Envelopment Analysis (DEA) 2nd edition Springer, New York




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