Gebze Institute of Technology, Faculty of Business Administration, Gebze, Kocaeli, Turkey.
Health Policy. 2013 Aug;111(3):290-300. doi: 10.1016/j.healthpol.2013.05.010. Epub 2013 Jun 13.
This paper empirically analyzes the effects of efficiency and structural quality on patient satisfaction in Turkish public hospitals. It also investigates the controversial relationship between hospital efficiency and structural quality for small, medium and large size hospitals in a comparative perspective.
Data envelopment analysis (DEA) is used to analyze the efficiencies of hospitals. Data concerning 523 public hospitals is obtained from Turkish Ministry of Health. Due to the missing data of some hospitals, the sample of this study is composed of the remaining 348 observations. Multiple regression analysis is used to evaluate the relationship between patient satisfaction as a dependent variable and structural quality, hospital efficiency and institutional factors as independent variables. Furthermore, stepwise process multiple regression analysis is used to analyze the moderator effects of hospital efficiency on the form of the relationship between quality and satisfaction.
The findings indicate that hospital efficiency changes the form of the relationship between structural quality and patient satisfaction as a moderator variable. The trade-off between quality and efficiency is found to vary depending on the hospital size. Negative correlation is found between quality and efficiency for small-size hospitals. However, positive correlation between efficiency and quality is found significant as indicated by Total Quality Management (TQM) approach for large-size hospitals. This study also provides the empirical evidence on the negative relationship between patient satisfaction and hospital size.
The effect of hospital efficiency on patient satisfaction might be improved for inefficient small and medium size hospitals by taking successful large hospitals as role models.
本文通过实证分析土耳其公立医院的效率和结构质量对患者满意度的影响，探讨了在比较视角下小、中、大型医院中效率和结构质量之间存在争议的关系。
本研究采用数据包络分析（DEA）来分析医院的效率。数据来源于土耳其卫生部的 523 家公立医院。由于部分医院的数据缺失，本研究的样本由其余的 348 个观测值组成。多元回归分析用于评估患者满意度作为因变量与结构质量、医院效率和机构因素之间的关系。此外，逐步过程多元回归分析用于分析医院效率对质量与满意度关系形式的调节作用。
研究结果表明，医院效率作为一个调节变量改变了结构质量与患者满意度之间的关系形式。发现质量与效率之间的权衡因医院规模而异。对于小型医院，质量与效率之间呈负相关。然而，对于大型医院，按照全面质量管理（TQM）方法，效率与质量之间存在正相关关系。本研究还提供了患者满意度与医院规模之间存在负相关关系的实证证据。
通过以成功的大型医院为榜样，为效率低下的中小型医院提高医院效率可能会改善患者满意度。
