Evaluation of the opinions and suggestions of the health personnel towards city hospitals as a public-private partnership practice in the Turkish health system

Developments and reforms in Turkey and in the world in recent years affect health systems. City hospitals, which have been implemented through the Public-Private Partnership model in Turkey, are an up-to-date model that has come to the fore in this context. In this study, it is aimed to evaluate city hospitals based on the opinions of health personnel and to present objective data and information. Qualitative and quantitative research approaches were used in the study. At the first stage, qualitative interviews were held with 40 participants and were obtained of the participants views on how they evaluated the city hospitals when compared to the previous period, their strengths and weaknesses, problems and solution suggestions. The questionnaire, which was prepared by making use of these opinions and literature, was applied to 557 healthcare personnel in Adana, Isparta and Yozgat city hospitals. Evaluating the structural validity of the questionnaire with explanatory and confirmatory factor analyzes, it has been observed that 7 dimensions are gathered in 58 statements as quality and efficiency, access to healthcare services, opportunities, risks, employees, transparency and management processes. Also observed that 13 suggestions to overcome the problems arising from the implementation of city hospitals are gathered in 2 dimensions as supervision-cooperation and employees. The reliability of the questionnaire was evaluated with the Cronbach alpha coefficient and it was found to be within acceptable values. Descriptive statistics has been used into analysis of the data and multivariate regression analyzes to test hypotheses. The participants; while expressing generally positive opinions on the dimensions on quality and efficiency, access to healthcare services and opportunities; they express negative opinions on the dimensions risks, employees, transparency and impacts on management processes. The participants agreed above average regarding to the suggestions for the solution of the problems of the dimensions supervision-cooperation and the personnel and stated that the implementation of city hospitals in these areas should be improved. Participants' opinions on the quality and efficiency of city hospitals show statistically significant differences are based on the ownership of the institution where they worked before, their being in an administrative position, their total service time and their level of knowledge about PPP. Their views on impacts on employees show statistically significant differences depends on the current institution, profession and on their level of knowledge about PPP. On the other hand, it was found that statistically significant differences about the suggestions for the elimination of the problems experienced in the personnel dimension based on the educational status and professions. In addition to this, statistically significant differences found about the opinions of the participants' regarding the dimension of transparency according to their managerial position and their level of knowledge about PPP. It is thought that the results obtained from the research will provide important clues to city hospital managers and policy makers in eliminating the problems arising due to the implementation of city hospitals and developing the application.