The comparison of hospital efficiency andefficacy through multi-criteria decision-making anddata envelopment analyses: The Example of Eastern Marmara

Access to health services is one of the basic rights of all individuals in any given society. Hospitals are both the most important and one of the oldest institutions that serve to meet health service needs of communities. The sustainability of health services depend on the efficiency and efficacy of these institutions. The efficiency of hospitals has become even more important in recent years with the increasing demand for health services as well as the need to use limited resources efficaciously. The present study aimed to analyze and compare the efficiency and efficacy of hospitals in provinces that are categorized as Eastern Marmara Provinces in Yearbooks of the Ministry of Health, namely Bilecik, Bursa, Eskişehir, Bolu, Düzce, Kocaeli, Sakarya, and Yalova, at the provincial level through Data Envelopment Analysis, and Maut and Vikor statistical analysis methodology based on Entropy method, which is one of the multi-criteria decision making analysis methods. Data from the Health Statistics Yearbook of 2017 published by the Ministry of Health was examined through a two-stage analysis method. In the first stage, the variables of Number of Hospitals, Number of Inpatient Beds, Number of Inpatient Beds per 10,000 Patients, Number of Inpatient Beds in Intensive Care Units, Number of Physicians, and Number of Nurses were specified as input variables, whereas the Number of Surgeries, Hospital Bed Occupancy Rate, Hospital Bed Turnover Rate, Crude Mortality Rate, Number of Referrals, and Number of Inpatients were designated as output variables for the examination of hospital efficiency through Data Envelopment Analysis (DEA), and these were compared at a provincial level. The findings suggested that the hospitals in the provinces of Bursa, Eskişehir, and Kocaeli were efficacious, unlike the ones in Bilecik, Bolu, Sakarya, Yalova, and Düzce, which failed to meet minimum efficacy criteria. In the second stage, the degrees of significance of the twelve aforementioned variables were calculated through the multi-criteria decision making (MCDM) method of Entropy. The findings showed the most significant criteria to be the Number of Surgeries, Number of Inpatient Beds in Intensive Care Units, and Number of Inpatients, respectively. Hospital efficacy was examined through Maut and Vikor methods, which showed the most efficacious provinces to be Bursa, Kocaeli, and Eskişehir, respectively.