Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey

Abstract

The aim of the current study is to examine the impact of regional decentralization model on the performance of public healthcare services in Turkey. The efficiency of public hospitals has been determined by the type of healthcare services, “general healthcare” and “oral-dental healthcare”, with Data Envelopment Analysis at the level of 81 provinces (NUTS-3) for 2014 and 2017. By continuing the transition to decentralization in public health services, the possible effects on the regional health level were analyzed. Notably, this study employed conducted a two-dimensional analysis. First, public hospital performance at province level was determined. Second, it was investigated whether the decentralization of health services had a significant effect on the efficiency of bordering (contiguity) provinces, a measure taht captures spillover effects between performance scores. The results indicate that the efficiency scores of 81 province hospitals differ significantly according to the provision of service patterns. Moreover, the relative efficiency score in 2017 is found to be higher when compared 2014, which is the year that signifies the beginning of the decentralization shift in healthcare services in Turkey. Furthermore, there is a positive spatial spillover between public hospitals based on two types of hospital services. This means that the hospital efficiency in the contiguous province has an effect of increasing the efficiency score of the region. This suggests that the decentralization model in public health services may have the potential to create a positive impact on the general health level in the future if supported by progressive economic and health policies for developing countries such as Turkey.