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Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals


  • Davutyan, Nurhan
  • Bilsel, Murat
  • Tarcan, Menderes


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) those requiring uniform sacrifice of good outputs and/or extra inputs in order to reduce mortality, and (ii) those 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 first group is more likely to be located in emigrating whereas the second one in immigrating regions.

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  • Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2012. "Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals," MPRA Paper 37437, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:37437

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    1. Murty, Sushama & Russell, R. Robert, 2010. "On modeling pollution-generating technologies," The Warwick Economics Research Paper Series (TWERPS) 931, University of Warwick, Department of Economics.
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    5. W. Liu & W. Meng & X. Li & D. Zhang, 2010. "DEA models with undesirable inputs and outputs," Annals of Operations Research, Springer, vol. 173(1), pages 177-194, January.
    6. Pablo Arocena & Ariadna García-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.
    7. Jean Spinks & Bruce Hollingsworth, 2009. "Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 417-427.
    8. repec:bbe:wpaper:200502 is not listed on IDEAS
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    More about this item


    Directional distance; bad outputs; hospital quality;

    JEL classification:

    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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