IDEAS home Printed from https://ideas.repec.org/a/sos/sosjrn/200212.html
   My bibliography  Save this article

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

Author

Listed:
  • Gökçe MANAVGAT
  • Ayhan DEMİRCİ

Abstract

The aim 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 employed conducted a two-dimensional analysis. First, public hospital performance at province level was determined. Second, it was investigated whether the decentralization of health services had a significant effect on the efficiency of bordering (contiguity) provinces, a measure taht captures spillover effects between performance scores. The results indicate that the efficiency scores of 81 province hospitals differ significantly according to the provision of service patterns. Moreover, the relative efficiency score in 2017 is found to be higher when compared 2014, which is the year that signifies the beginning of the decentralization shift in healthcare services in Turkey. Furthermore, there is a positive spatial spillover between public hospitals based on two types of hospital services. 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 to create a positive impact on the general health level in the future if supported by progressive economic and health policies for developing countries such as Turkey.

Suggested Citation

  • Gökçe MANAVGAT & Ayhan DEMİRCİ, 2020. "Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey," Sosyoekonomi Journal, Sosyoekonomi Society, issue 28(44).
    • Handle: RePEc:sos:sosjrn:200212
    as

    Download full text from publisher

    File URL: http://dergipark.gov.tr/download/article-file/1060195
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    2. Audibert, Martine & Mathonnat, Jacky & Pelissier, Aurore & Huang, Xiao Xian & Ma, Anning, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," China Economic Review, Elsevier, vol. 27(C), pages 326-338.
    3. Margherita Giannoni & Theodore Hitiris, 2002. "The regional impact of health care expenditure: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 34(14), pages 1829-1836.
    4. Yasar A. Ozcan, 2008. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, number 978-0-387-75448-2, January.
    5. Lucia Quadrado & Henk Folmer & Sudha Loman, 2001. "Regional Inequality in the Provision of Health Care in Spain," Environment and Planning A, , vol. 33(5), pages 783-798, May.
    6. Martine Audibert & Jacky Mathonnat & Aurore Pelissier & Xiao Xian Huang & Anning Ma, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," Post-Print halshs-01230210, HAL.
    7. Khushalani, Jaya & Ozcan, Yasar A., 2017. "Are hospitals producing quality care efficiently? An analysis using Dynamic Network Data Envelopment Analysis (DEA)," Socio-Economic Planning Sciences, Elsevier, vol. 60(C), pages 15-23.
    8. Yasar A. Ozcan & Jaya 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, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 25(2), pages 325-343, June.
    9. Alexander S. Preker & April Harding, 2003. "Innovations in Health Service Delivery : The Corporatization of Public Hospitals," World Bank Publications - Books, The World Bank Group, number 15145.
    10. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    11. William W. Cooper & Lawrence M. Seiford & Kaoru Tone, 2006. "Introduction to Data Envelopment Analysis and Its Uses," Springer Books, Springer, number 978-0-387-29122-2, June.
    12. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rafaela Oliveira & Gonçalo Santinha & Teresa Sá Marques, 2023. "The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review," Sustainability, MDPI, vol. 16(1), pages 1-32, December.
    2. Gökçe Manavgat & Martine Audibert, 2024. "Healthcare system efficiency and drivers: Re-evaluation of OECD countries for COVID-19," Post-Print hal-04350906, HAL.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    2. Alessandra Cepparulo & Luisa Giuriato, 2022. "The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 671-685, June.
    3. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    4. Habib Zare & Madjid Tavana & Abbas Mardani & Sepideh Masoudian & Mahyar Kamali Saraji, 2019. "A hybrid data envelopment analysis and game theory model for performance measurement in healthcare," Health Care Management Science, Springer, vol. 22(3), pages 475-488, September.
    5. Bo Li & Muhammad Mohiuddin & Qian Liu, 2019. "Determinants and Differences of Township Hospital Efficiency among Chinese Provinces," IJERPH, MDPI, vol. 16(9), pages 1-16, May.
    6. Jiaqi Chen & Song Xu & Jing Gao, 2020. "The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach," IJERPH, MDPI, vol. 17(5), pages 1-13, March.
    7. Jing You, 2016. "Lending to Parents and Insuring Children: Is There a Role for Microcredit in Complementing Health Insurance in Rural China?," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 543-558, May.
    8. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 411-431, May.
    9. Clemente, Jesús & Lazaro, Angelina & Montanes, Antonio, 2016. "Public health expenditure in Spain: is there partisan behaviour?," MPRA Paper 69781, University Library of Munich, Germany.
    10. See, Kok Fong & Ng, Ying Chu, 2021. "Do hospital reform and ownership matter to Shenzhen hospitals in China? A productivity analysis," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 145-155.
    11. Falavigna, G. & Ippoliti, R., 2020. "The socio-economic planning of a community nurses programme in mountain areas: A Directional Distance Function approach," Socio-Economic Planning Sciences, Elsevier, vol. 71(C).
    12. Marwa Hasni & Safa Bhar Layeb & Najla Omrane Aissaoui & Aymen Mannai, 2022. "Hybrid model for a cross‐department efficiency evaluation in healthcare systems," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 43(5), pages 1311-1329, July.
    13. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    14. Lorena Androutsou & Michail Kokkinos & Dimitra Latsou & Mary Geitona, 2022. "Assessing the Efficiency and Productivity of the Hospital Clinics on the Island of Rhodes during the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(23), pages 1-12, November.
    15. Martine AUDIBERT & Marlène GUILLON & Jacky MATHONNAT, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia," Working Papers P226, FERDI.
    16. Giardina, Emilio & Cavalieri, Marina & Guccio, Calogero & Mazza, Isidoro, 2009. "Federalism, Party Competition and Budget Outcome: Empirical Findings on Regional Health Expenditure in Italy," MPRA Paper 16437, University Library of Munich, Germany.
    17. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.
    18. Martine AUDIBERT & Marlène GUILLON & Jacky MATHONNAT, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia," Working Papers P226, FERDI.
    19. Mustapha D. Ibrahim & Sahand Daneshvar & Mevhibe B. Hocaoğlu & Olasehinde-Williams G. Oluseye, 2019. "An Estimation of the Efficiency and Productivity of Healthcare Systems in Sub-Saharan Africa: Health-Centred Millennium Development Goal-Based Evidence," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(1), pages 371-389, May.
    20. Xueli Chen & Vivian Valdmanis & Tuotuo Yu, 2020. "Productivity Growth in Chinese Medical Institutions during 2009–2018," Sustainability, MDPI, vol. 12(8), pages 1-17, April.

    More about this item

    Keywords

    Efficiency; DEA; Public Healthcare; Public Hospitals; Spillover Effect; Decentralization.;
    All these keywords.

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sos:sosjrn:200212. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Aysen Sivrikaya (email available below). General contact details of provider: http://www.sosyoekonomijournal.org/home.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.