Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, 06800, Ankara, Turkey.
Health Care Manag Sci. 2019 Sep;22(3):437-446. doi: 10.1007/s10729-018-9463-5. Epub 2018 Nov 21.
This study aimed to reflect the efficiency of hospitals under the Ministry of Health (MoH) before and after the implementation of Public Hospital Associations (PHAs). This study covered 3 years before (2010-2012) and 3 years after (2013-2015) the implementation. The population of the study included 865 hospitals under the MoH providing health care services in 81 provinces. No sample was selected; all hospitals were included under the scope of study. The provinces were chosen as the decision-making unit. Changes in the efficiency values of hospitals were analyzed with the Malmquist Total Factor Efficiency Index. The results showed that, for the pre-PHAs period, 24 provinces in 2010, 27 provinces from 2010 to 2011, and 32 provinces from 2011 to 2012 were assessed as efficient. From 2012, the year of implementation, to 2013, the number of efficient provinces dropped to 16. However, 20 provinces were subsequently found to be efficient from 2013 to 2014, and 26 from 2014 to 2015. The efficiency scores average of all provinces were found to be 0.89, 0.92, 0.92, 0.82, 0.88, and 0.90, respectively. Further, the efficiency score average of the 3 years before PHAs (0.91 ± 0.09) was significantly higher than the score obtained 3 years after PHAs (0.86 ± 0.11; p < 0.05). In consideration of such finding, the PHAs established at the provinces were identified as hampering increased efficiency.
本研究旨在反映卫生部（MoH）下属医院在实施公立医院协会（PHAs）前后的效率。本研究涵盖了实施前的 3 年（2010-2012 年）和实施后的 3 年（2013-2015 年）。研究人群包括在 81 个省份提供医疗服务的 865 家 MoH 下属医院。没有选择样本；所有医院都在研究范围内。选择省份作为决策单位。使用 Malmquist 全要素效率指数分析医院效率值的变化。结果表明，在 PHAs 实施前的 2010 年，有 24 个省份，2010 年至 2011 年有 27 个省份，2011 年至 2012 年有 32 个省份被评估为有效。从 2012 年，即实施之年，到 2013 年，有效省份的数量减少到 16 个。然而，从 2013 年到 2014 年，有 20 个省份被发现是有效的，从 2014 年到 2015 年，有 26 个省份被发现是有效的。所有省份的效率得分平均值分别为 0.89、0.92、0.92、0.82、0.88 和 0.90。此外，PHAs 实施前 3 年的效率得分平均值（0.91±0.09）显著高于 PHAs 实施后 3 年的得分（0.86±0.11；p<0.05）。考虑到这一发现，认为省一级设立的 PHAs 阻碍了效率的提高。
