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Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals

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Author Info

  • Davutyan, Nurhan

    ()
    (Kadir Has University and Fellow, Economic Research Forum)

  • Bilsel, Murat

    ()
    (Marmara University)

  • Tarcan, Menderes

    ()
    (Osmangazi University)

Abstract

We analyze the operational performance of 330 Turkish provincial general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based variable as bad output. Congested hospitals are those for whom the switch from strong to weak disposability of mortality is costly. Thus we are able to address the “quality or adequacy of care” issue. We identify congested hospitals using 3 different direction vectors and derive the associated congestion inefficiency scores. For each case, we show these scores are negatively related to patient satisfaction. We separate congested hospitals into two groups: (i) efficient ones requiring uniform sacrifice of good outputs and/or extra inputs in order to reduce mortality, and (ii) inefficient hospitals that do not. The latter ones free up some inputs in addition to requiring extra amounts of other inputs and/or produce more of some outputs but less of others as the price of reducing mortality. The first group can be said to operate at “capacity” whereas the latter can be said to display “negative marginal productivity”. Patient dissatisfaction is demonstrably higher in the latter group of hospitals, whereas mortality reduction is positively related to patient satisfaction in “capacity constrained” hospitals. The efficient group is more likely to be located in emigrating whereas the inefficient one in immigrating regions.

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Bibliographic Info

Paper provided by Galatasaray University Economic Research Center in its series GIAM Working Papers with number 13-7.

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Length: 22 pages
Date of creation: 09 Jul 2013
Date of revision:
Handle: RePEc:ris:giamwp:2013_007

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Keywords: Directional distance; bad outputs; hospital quality;

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  1. Fare, Rolf, et al, 1989. "Multilateral Productivity Comparisons When Some Outputs Are Undesirable: A Nonparametric Approach," The Review of Economics and Statistics, MIT Press, vol. 71(1), pages 90-98, February.
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  8. Pablo Arocena & Ariadna Garc�a-Prado, 2007. "Accounting for quality in the measurement of hospital performance: evidence from Costa Rica," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 667-685.
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