An assessment for Public Hospitals Associations' performance measurement approach<p>Kamu Hastaneleri Birlikleri performans ölçüm yöntemi üzerine bir değerlendirme
Keywords:
Health Transformation Program, Public Hospitals Associations, Balanced Score Card, Stochastic Frontier Analysis, Hospital Performance, Sağlıkta Dönüşüm Programı, Kamu Hastaneleri Birlikleri, Dengeli Skor Kartı, Stokastik Sınır Analizi, Hastane PerformansıAbstract
Health Transformation Program (HTP) was launched in 2003 with the primary aim of achieving effectiveness, efficiency, and equity in organization, delivery, and financing of health care services in Turkey. In the final leg of the program, the Public Hospital Associations (PHA), which are basically the regional hospital unions, were announced in 2011 with the legislative decree no.663 and have been in operation since fall 2012. Establishment of the PHAs introduced a new management approach for Turkish public hospitals. This model based on a new managerial performance assessment approach, which was developed to evaluate the hospitals’ performances in many dimension, including medical, administrative, financial, quality, patient safety, employee-satisfaction and education aspects. In this regard, the Turkish Public Hospitals Institution (PHI), which is the highest institution that rules all the public hospitals, has begun to use modified version of Balanced Score Card (BSC) approach to assess the managerial performance of the PHAs. In this approach, production efficiency scores of hospitals, which are estimated with Stochastic Frontier Analysis (SFA), became a key or a target indicator for hospital performance assessment. In this paper, the performance measurement approach of the PHAs is assessed with respect to the theoretical methods used in this approach, i.e. BSC and SFA efficiency methods.
Özet
Sağlıkta Dönüşüm Programı (SDP), Türkiye’de sağlık hizmetlerinin organizasyon, sunum ve finansmanında etkililik, etkinlik ve hakkaniyet sağlamak amacıyla 2003 yılında uygulamaya konulmuştur. Programın son ayağında, basit anlamda hastanelerin yönetimsel olarak birleşmesi ifade eden Kamu Hastaneleri Birlikleri (KHB), 2011 yılında 663 nolu KHK ile kurulmuş ve 2012 yılında faaliyete başlamıştır. KHB’lerin kurulmasıyla birlikte Türkiye kamu hastaneleri için yeni bir yönetim yaklaşımı oluşturulmuştur. Bu yaklaşım, hastanelerin performansını, tıbbi, idari, mali, kalite, hasta ve Çalışan güvenliği-memnuniyeti ile eğitim boyutlarında değerlendirilmesini amacıyla geliştirilmiş olan yönetimsel performans modeli üzerine kurulmuştur. Uygulamaya konulan yeni sistemde, kamu hastanelerinin yönetici kuruluşu olan Türkiye Kamu Hastaneleri Kurumu (TKHK), KHB’lerin yönetimsel performansının değerlendirilmesi için, Dengeli Skor Kartı (DSK) yaklaşımının uyarlanmış bir şeklini kullanmaya başlamıştır. Bu yaklaşımda, Stokastik Sınır Analizi yöntemiyle hesaplanan hastane üretim etkinlik skorları, hastane performansının belirlenmesinde anahtar ya da hedef gösterge olmuştur. Bu çalışmada Kamu Hastaneleri Birlikleri performans değerlendirme modelinin, modelin kullandığı DSK ve SSA yöntemleri çerçevesinde bir değerlendirmesi sunulmaktadır.
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Aigner, D. J., Lovell, C. A. K. ve Schmidt, P. (1977). Formulation and estimation of stochastic frontier production function models. Journal of Econometrics, 6, 21–37. doi:10.1016/0304-4076(77)90052-5
Battese, G. E. ve Coelli, T. J. (1988). Prediction of firm-level technical efficiencies with a generalized frontier production function and panel data. Journal of econometrics, 38(3), 387–399.
Battese, G. ve Coelli, T.(1992). Frontier production functions, technical efficiency and panel data: with application to paddy farmers in India. The Journal of Productivity Analysis, 3, 153–169.
Battese, G. E. ve Coelli, T. J. (1995). A model for technical inefficiency effects in a stochastic frontier production function for panel data. Empirical Economics, 20, 325–332. doi:10.1007/BF01205442
Battese, G. E., Coelli, T. J. ve Colby, T. C. (1989). Estimation of frontier production functions and the efficiencies of Indian farms using panel data from ICRISAT’s village level studies. Journal of Quantitative Economics, 5, 327–348.
Carey, K. (2003). Hospital cost efficiency and system membership. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 40(1), 25–38.
Chambers, G. R. (1989). Applied Production Analysis: A Dual Approach. New York: Cambridge University Press.
Chirikos, T. (1998). Identifying efficiently and economically operated hospitals: The prospects and pitfalls of applying frontier regression techniques. Journal of Health Politics, Policy and Law, 23, 879-904.
Chirikos, T. N. ve Sear, A. M. (2000). Measuring hospital efficiency: a comparison of two approaches. Health Services Research, 34(6), 1389-1408.
Coelli, T. J., Rao, D. S. P., O’Donnell, C. J. ve Battese, G. E. (2005). An introduction to efficiency and productivity analysis, (2nd ed.), New York: Springer.
Cornes, R. (1992). Duality and Modern Economics. New York: Cambridge University Press.
Coşkun, A. (2006). Stratejik performans yönetimi ve performans karnesi. Literatür Yayınları.
Farrell, M. J. (1957). The measurement of productive efficiency. Journal of the Royal Statistical Society. Series A (General), 253–290.
Folland, S. T. ve Hofler, R. A. (2001). How reliable are hospital efficiency estimates? Exploiting the dual to homothetic production. Health economics, 10, 683–698. doi:10.1002/hec.600
Greene, W. H. (1980a). On the estimation of a flexible frontier production model. Journal of Econometrics, 13, 101–115.
Greene, W. H. (1980b). Maximum likelihood estimation of econometric frontier functions. Journal of Econometrics, 13, 27–56.
Jacobs, R., Smith, P. ve Street, A. (2006). Measuring efficiency in health care: Analytical techniques and health policy. Cambridge: Cambridge University Press.
Kaplan, R. S. ve Norton, D. P. (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review.
Kumbhakar, S. ve Lovell, C. (2000). Stochastic Frontier Analysis.
Cambridge: Cambridge University Press.
Lamba, M., Altan, Y., Aktel, M. ve Kerman, U. (2014). Sağlık Bakanlığı’nda Yeniden Yapılanma: Yeni Kamu Yönetimi Açısından Bir Değerlendirme. Amme İdaresi Dergisi, 47(1), 53–78.
Linna, M. (1998). Measuring hospital cost efficiency with panel data models. Health economics, 7, 415–427.
Li, T. ve Rosenman, R. (2001). Cost inefficiency in Washington hospitals: a stochastic frontier approach using panel data. Health Care Management Science, 4, 73–81.
Lovell, C. A. K. (1992). Production frontiers and productive efficiency. H. 0. Fried, C. A. K Lovell, ve S. S. Schmidt (ed.) The Measurement of Productive Efficiency, New York: Oxford University Press.
Malmquist, S. (1953). Index Numbers and Indifference Surfaces, (4), 209–242.
Meeusen, W. ve Van den Broeck, J. (1977). Efficiency estimation from Cobb-Douglas production functions with composed error. International Economic Review, 18, 435–444. doi:10.2307/2525757
Pitt, M. M. ve Lee, L.-F. (1981). The measurement and sources of technical inefficiency in the Indonesian weaving industry. Journal of development economics, 9(1), 43–64.
Rosko, M. D. (1998). Impact of mission and operating environment on hospital X-inefficiency: A frontier approach. International Conference on Strategic Issues in Health Care Management., sunulmuş bildiri, St. Andrews, İskoçya.
Rosko, M. D. (1999). Impact of internal and external environmental pressures on hospital inefficiency. Health Care Management Science, 2, 63–74.
Rosko, M. D. (2001). Cost efficiency of US hospitals: a stochastic frontier approach. Health economics, 551, 539 – 551. doi:10.1002/hec.607
Rosko, M. D. (2004). Performance of US teaching hospitals: A panel analysis of cost inefficiency. Health Care Management Science, 7, 7–16.
Rosko, M. D. ve Mutter, R. L. (2008). Stochastic Frontier Analysis of Hospital Inefficiency A Review of Empirical Issues and an Assessment of Robustness. Medical Care Research and Review, 65, 131–166.
Rosko, M. D. ve Proenca, J. (2005). Impact of network and system use on hospital X-inefficiency. Health Care Management Review, 69–79.
Sağlık Bakanlığı. (2007). Türkiye’de Sağlığa Bakış. Ankara: Refik Saydam Hıfzısıhha Merkezi Başkanlığı.
Schmidt, P. (1985). Frontier production functions. Econometric reviews, 4(2), 289–328.
Shepherd, R. W. (2015). Theory of cost and production functions. Princeton University Press.
Stevenson, R. E. (1980). Likelihood functions for generalized stochastic frontier estimation. Journal of Econometrics, 13, 57–66.
Tatar, M. ve Kanavos, P. (2006). Health care reform in Turkey. EUROHEALTH-LONDON-, 12(1), 20.
TKHK. (2012). Birlik Değerlendirme El Kitabı. Ankara: Türkiye Kamu Hastaneleri Kurumu. http://www.tkhk.gov.tr/Dosyalar/8a23bd13a60f402cb1fe2e38c79ca3e7.pdf adresinden erişildi.
Vitaliano, D. F. ve Toren, M. (1996). Hospital cost and efficiency in a regime of stringent regulation. Eastern Economic Journal, 161–175.
Zuckerman, S., Hadley, J. ve Iezzoni, L. (1994). Measuring hospital efficiency with frontier cost functions. Journal of Health Economics, 13, 255–280.
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