Efficiency measurement for public hospitals in Turkey: Dynamic network approach application

In the health management literature, many theoretical and empirical studies have been conducted on performance and efficiency measurement in hospitals. It can be seen that the internal dynamics of health institutions, the effectiveness of which has been extensively investigated in research, has been overlooked. When we want to examine the effectiveness of a system, we also need to look at the activity process of its sub-units. The aim of this thesis is to measure the efficiency of a hospital responsible for performing many sub-activities by examining the performance of their sub-activities individually. In this context, data from Turkish Training and Research Hospitals in 2016-2017 were used. The Dynamic Network Data Envelopment Analysis (DN-DEA) model was used to investigate whether there is a difference between the overall efficiency of the hospitals and the efficiency of their sub-units. Furthermore, this study is the first to apply the DN-DEA model to the measurement of Turkish health business efficiency. In the study, two main activities of hospitals, which are decision units, were evaluated as sub-decision units. These sub-units are the management services decision unit where the management activity is carried out and the medical care sub-decision unit where the medical care services are carried out. According to the results obtained from hospital efficiency measurement, it has been revealed that the activities of management services and medical care services are very different from each other. Input sources, output elements, link variables and carry over variables that determine the performance of hospitals, which are decision units, and sub-decision units were examined and the factors affecting hospital activities were tried to be determined. It is seen that all of the internal factors examined have a certain level of effect on the efficiency of hospitals. In addition, it was concluded that the DN-DEA model could produce meaningful results in the measurement of hospital efficiency.