IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v27y2024i1d10.1007_s10729-023-09661-4.html
   My bibliography  Save this article

Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis

Author

Listed:
  • Songul Cinaroglu

    (Hacettepe University)

Abstract

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

Suggested Citation

  • Songul Cinaroglu, 2024. "Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis," Health Care Management Science, Springer, vol. 27(1), pages 88-113, March.
    • Handle: RePEc:kap:hcarem:v:27:y:2024:i:1:d:10.1007_s10729-023-09661-4
    DOI: 10.1007/s10729-023-09661-4
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-023-09661-4
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10729-023-09661-4?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Leopold Simar & Paul Wilson, 2000. "A general methodology for bootstrapping in non-parametric frontier models," Journal of Applied Statistics, Taylor & Francis Journals, vol. 27(6), pages 779-802.
    2. Keeler, Theodore E & Ying, John S, 1996. "Hospital Costs and Excess Bed Capacity: A Statistical Analysis," The Review of Economics and Statistics, MIT Press, vol. 78(3), pages 470-481, August.
    3. Avdic, Daniel, 2016. "Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden," Journal of Health Economics, Elsevier, vol. 48(C), pages 44-60.
    4. Valdmanis, Vivian & Bernet, Patrick & Moises, James, 2010. "Hospital capacity, capability, and emergency preparedness," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1628-1634, December.
    5. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    6. Mehmet Top & Cuma Sungur, 2019. "Opinions and evaluations of stakeholders in the implementation of the public‐private partnership (PPP) model in integrated health campuses (city hospitals) in Turkey," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 241-263, January.
    7. Mullner, Ross M. & Whiteis, David G., 1988. "Rural community hospital closure and health policy," Health Policy, Elsevier, vol. 10(2), pages 123-135, October.
    8. Kerstens, Kristiaan & Shen, Zhiyang, 2021. "Using COVID-19 mortality to select among hospital plant capacity models: An exploratory empirical application to Hubei province," Technological Forecasting and Social Change, Elsevier, vol. 166(C).
    9. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(2), pages 457-489.
    10. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
    11. Bogetoft, Peter & Kromann, Lene, 2018. "Evaluating treatment effects using data envelopment analysis on matched samples: An analysis of electronic information sharing and firm performance," European Journal of Operational Research, Elsevier, vol. 270(1), pages 302-313.
    12. Ismet Sahin & Yasar Ozcan & Hacer Ozgen, 2011. "Assessment of hospital efficiency under health transformation program in Turkey," 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. 19(1), pages 19-37, March.
    13. Annika Herr, 2008. "Cost and technical efficiency of German hospitals: does ownership matter?," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1057-1071, September.
    14. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    15. Mehmet Gok & Erkut Altındağ, 2015. "Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 459-469, June.
    16. Javier Cerezo-Espinosa de los Monteros & Antonio Castro-Torres & Juan Gómez-Salgado & Javier Fagundo-Rivera & Carlos Gómez-Salgado & Valle Coronado-Vázquez, 2021. "Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions," IJERPH, MDPI, vol. 18(8), pages 1-18, April.
    17. Cinzia Daraio & Léopold Simar, 2007. "Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach," Journal of Productivity Analysis, Springer, vol. 28(1), pages 13-32, October.
    18. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
    19. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    20. Istemi Demirag & Cemil Eren Fırtın & Ebru Tekin Bilbil, 2020. "Managing expectations with emotional accountability: making City Hospitals accountable during the COVID-19 pandemic in Turkey," Journal of Public Budgeting, Accounting & Financial Management, Emerald Group Publishing Limited, vol. 32(5), pages 889-901, October.
    21. Lindrooth, Richard C. & Lo Sasso, Anthony T. & Bazzoli, Gloria J., 2003. "The effect of urban hospital closure on markets," Journal of Health Economics, Elsevier, vol. 22(5), pages 691-712, September.
    22. Andrés Alonso & Daniel Peña & Juan Romo, 2006. "Introducing model uncertainty by moving blocks bootstrap," Statistical Papers, Springer, vol. 47(2), pages 167-179, March.
    23. Murat Bilsel & Nurhan Davutyan, 2014. "Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case," Annals of Operations Research, Springer, vol. 221(1), pages 73-88, October.
    24. Dinesh R. Pai & Hengameh Hosseini & Richard S. Brown, 2019. "Does efficiency and quality of care affect hospital closures?," Health Systems, Taylor & Francis Journals, vol. 8(1), pages 17-30, January.
    25. Federico Ciliberto & Richard C. Lindrooth, 2007. "Exit From The Hospital Industry," Economic Inquiry, Western Economic Association International, vol. 45(1), pages 71-81, January.
    26. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    27. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.
    28. Kostas Kounetas & Fotis Papathanassopoulos, 2013. "How efficient are Greek hospitals? A case study using a double bootstrap DEA approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 979-994, December.
    29. Bayram Şahin & Gülnur İlgün, 2019. "Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis," Health Care Management Science, Springer, vol. 22(3), pages 437-446, September.
    30. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
    31. Hacer Özgen Narcı & Yasar A. Ozcan & İsmet Şahin & Menderes Tarcan & Mustafa Narcı, 2015. "An examination of competition and efficiency for hospital industry in Turkey," Health Care Management Science, Springer, vol. 18(4), pages 407-418, December.
    Full references (including those not matched with items on IDEAS)

    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. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    2. Akkan, Can & Karadayi, Melis Almula & Ekinci, Yeliz & Ülengin, Füsun & Uray, Nimet & Karaosmanoğlu, Elif, 2020. "Efficiency analysis of emergency departments in metropolitan areas," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).
    3. Cinaroglu, Songul, 2021. "Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    4. Halkos, George & Tzeremes, Nickolaos, 2008. "Measuring regional public health provision," MPRA Paper 23762, University Library of Munich, Germany.
    5. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    6. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    7. José M. Cordero & Agustín García-García & Enrique Lau-Cortés & Cristina Polo, 2021. "Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter?," IJERPH, MDPI, vol. 18(16), pages 1-21, August.
    8. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    9. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.
    10. Ivonne Lindlbauer & Jonas Schreyögg, 2014. "The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?," Health Care Management Science, Springer, vol. 17(4), pages 365-378, December.
    11. Halkos, George & Tzeremes, Nickolaos, 2009. "Exploring the effect of countries’ economic prosperity on their biodiversity performance," MPRA Paper 32102, University Library of Munich, Germany.
    12. Halkos, George & Tzeremes, Nickolaos, 2013. "Renewable energy consumption and economic efficiency: Evidence from European countries," MPRA Paper 44136, University Library of Munich, Germany.
    13. Alexandre Marinho & Claudia Affonso Silva Araújo, 2021. "Using data envelopment analysis and the bootstrap method to evaluate organ transplantation efficiency in Brazil," Health Care Management Science, Springer, vol. 24(3), pages 569-581, September.
    14. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    15. Léopold Simar & Paul W. Wilson, 2015. "Statistical Approaches for Non-parametric Frontier Models: A Guided Tour," International Statistical Review, International Statistical Institute, vol. 83(1), pages 77-110, April.
    16. Halkos, George & Tzeremes, Nickolaos, 2011. "A conditional full frontier modelling for analyzing environmental efficiency and economic growth," MPRA Paper 32839, University Library of Munich, Germany.
    17. Kostas Kounetas & Fotis Papathanassopoulos, 2013. "How efficient are Greek hospitals? A case study using a double bootstrap DEA approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 979-994, December.
    18. Halkos, George E. & Tzeremes, Nickolaos G., 2011. "A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures," Health Policy, Elsevier, vol. 103(1), pages 73-82.
    19. Bampatsou, Christina & Halkos, George, 2018. "Dynamics of productivity taking into consideration the impact of energy consumption and environmental degradation," Energy Policy, Elsevier, vol. 120(C), pages 276-283.
    20. Valentin Zelenyuk, 2019. "Data Envelopment Analysis and Business Analytics: The Big Data Challenges and Some Solutions," CEPA Working Papers Series WP072019, School of Economics, University of Queensland, Australia.

    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:kap:hcarem:v:27:y:2024:i:1:d:10.1007_s10729-023-09661-4. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.