Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals

Abstract: We analyze the operational performance of 330 Turkish provincial general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based variable as “bad output”. Congested hospitals are those for whom the switch from strong to weak disposability of mortality is costly. Thus we are able to address the “quality or adequacy of care” issue. We identify congested hospitals using 3 different direction vectors and derive the associated congestion inefficiency scores. For each case, we show these scores are negatively related to patient satisfaction. We separate congested hospitals into two groups: (i) those requiring uniform sacrifice of good outputs and/or extra inputs in order to reduce mortality, and (ii) those that do not. The latter ones free up some inputs in addition to requiring extra amounts of other inputs and/or produce more of some outputs but less of others as the price of reducing mortality. The first group can be said to operate at “capacity” whereas the latter can be said to display “negative marginal productivity”. Patient dissatisfaction is demonstrably higher in the latter group of hospitals, whereas mortality reduction is positively related to patient satisfaction in “capacity constrained” hospitals. The first group is more likely to be located in emigrating whereas the second one in immigrating regions

Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case

We analyze the operational performance of 202 Turkish rural general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based measure as a needs indicator. We derive pure technical, scale and output congestion inefficiency measures and show how they vary across size classes. We show that reducing mortality involves sacrificing some good outputs. This is a trade off that holds at the potential output level. Second stage regressions of the inefficiency scores against hospital and rural district level variables, pinpoint critical areas for performance improvement. In particular we show the relative scarcity of nurses is linked to output congestion

Efficiency of state-owned general hospitals in Turkey

Anahtar Kelimeler : Etkinlik, Hastaneler, Veri Zarflama Analizi Sağlık harcamaları her gün artmakta ve sağlık sektöründe kaynakların ektin kullanımı önem kazanmaktadır. Hastaneler sağlık sisteminin en büyük parçasıdır ve bu yüzden verimliliği arttırıcı önemlerin bu alanda yoğunlaşması mantıklıdır. Verimli olmayan hastanelerin tespiti, idari çalışmaların hangi hastaneler üzerine yoğunlaşması gerektiğini belirleyeceği için önemlidir. İlk aşamada veri zarflama analizi yöntemi ile 418 devlet hastanesi incelenerek hangi hastanelerin verimli oldukları, verimli olmayanların ne derece verimsiz oldukları ve verimsizliklerinin türü tespit edilmiştir. İkinci aşamada ise Tobit regresyon yöntemi ile verimsizliği etkileyen dış faktörler incelenmiş; teknik verimsizliğin hastanenin yatak kapasitesi ve bulunduğu ilçenin eğitim olanakları endeksi ile; boyut verimsizliğinin ise uzman ve pratisyen doktor, yatan hasta oranı ve yatak kapasitesi ile ilişkisi olduğu gözlemlenmiştir. Elde edilen bulgular ışığında Sağlık Bakanlığı'nın yatak kapasitesi 200'den az olan küçük hastaneleri ve ağrılıklı olarak birinci kademe sağlık hizmetleri sunan hastaneleri işletmeyi gözden geçirmesi düşünülmelidir. Ayrıca, teknik verimliliği arttırıcı çalışmaların en büyük fayda göstereceği hastanelerin 200-500 yatak kapasitesine sahip orta büyüklükteki hastaneler olacağı öngörülmüştür. Keywords : Data Envelopment Analysis, Efficiency, Hospital ABSTRACT Using health care resources efficiently becomes more and more important as health care costs increase. Hospitals constitute the largest part of the health care system and therefore it is logical that efforts seeking to improve efficiency in health care are concentrated on hospitals. On the first stage, input oriented data envelopment analysis models are used to analyze technical and scale inefficiencies of 418 state owned general hospitals with at least 50 beds. The study has shown that only 54 of the 418 hospitals are efficient and the sector exhibited 17% technical and 12% scale inefficiency. On the second stage, factors effecting efficiency are analyzed via Tobit regression models. Evidence suggests that scale efficiency is effected by bed capacity, inpatient ratio, number of specialists and number of general practitioners while technical efficiency is effected by education means index and bed capacity. In the light of the findings, it is recommended that the Ministry of Health reconsiders operating small hospitals with less than 200 beds and hospitals that mainly provide primary care services. In addition, it is predicted that managerial and organizational efforts to improve efficiency would yield the best improvements on the medium sized hospitals with 200-500 beds

Efficiency of state-owned general hospitals in Turkey

Anahtar Kelimeler: Etkinlik, Hastaneler, Veri Zarflama AnaliziÖZETSağlık harcamaları her gün artmakta ve sağlık sektöründe kaynakların ektin kullanımı önem kazanmaktadır. Hastaneler sağlık sisteminin en büyük parçasıdır ve bu yüzden verimliliği arttırıcı önemlerin bu alanda yoğunlaşması mantıklıdır.Verimli olmayan hastanelerin tespiti, idari çalışmaların hangi hastaneler üzerine yoğunlaşması gerektiğini belirleyeceği için önemlidir. İlk aşamada veri zarflama analizi yöntemi ile 418 devlet hastanesi incelenerek hangi hastanelerin verimli oldukları, verimli olmayanların ne derece verimsiz oldukları ve verimsizliklerinin türü tespit edilmiştir.İkinci aşamada ise Tobit regresyon yöntemi ile verimsizliği etkileyen dış faktörler incelenmiş; teknik verimsizliğin hastanenin yatak kapasitesi ve bulunduğu ilçenin eğitim olanakları endeksi ile; boyut verimsizliğinin ise uzman ve pratisyen doktor, yatan hasta oranı ve yatak kapasitesi ile ilişkisi olduğu gözlemlenmiştir.Elde edilen bulgular ışığında Sağlık Bakanlığı'nın yatak kapasitesi 200'den az olan küçük hastaneleri ve ağrılıklı olarak birinci kademe sağlık hizmetleri sunan hastaneleri işletmeyi gözden geçirmesi düşünülmelidir. Ayrıca, teknik verimliliği arttırıcı çalışmaların en büyük fayda göstereceği hastanelerin 200-500 yatak kapasitesine sahip orta büyüklükteki hastaneler olacağı öngörülmüştür.Keywords: Data Envelopment Analysis, Efficiency, HospitalABSTRACTUsing health care resources efficiently becomes more and more important as health care costs increase. Hospitals constitute the largest part of the health care system and therefore it is logical that efforts seeking to improve efficiency in health care are concentrated on hospitals.On the first stage, input oriented data envelopment analysis models are used to analyze technical and scale inefficiencies of 418 state owned general hospitals with at least 50 beds. The study has shown that only 54 of the 418 hospitals are efficient and the sector exhibited 17% technical and 12% scale inefficiency.On the second stage, factors effecting efficiency are analyzed via Tobit regression models. Evidence suggests that scale efficiency is effected by bed capacity, inpatient ratio, number of specialists and number of general practitioners while technical efficiency is effected by education means index and bed capacity.In the light of the findings, it is recommended that the Ministry of Health reconsiders operating small hospitals with less than 200 beds and hospitals that mainly provide primary care services. In addition, it is predicted that managerial and organizational efforts to improve efficiency would yield the best improvements on the medium sized hospitals with 200-500 beds

Late onset Pott's paraplegia

Background: Pott's disease may cause late neurological involvement due to development of sharp kyphosis. Anterior decompression and fusion is the treatment of choice for this disorder

The relationship between the ratio of interpedicular distance increase and the ratio of spinal canal compromise in thoracolumbar burst fractures

BACKGROUND: The aim of the study was to investigate the relationship between the interpedicular distance increase ratio and the ratio of canal compromise in thoracolumbar burst fractures. METHODS: Thirty-one patients (18 male and 13 female) with an average age of 30.8 (14-57) who had been treated for thoraco-lumbar burst fractures in the Department of Orthopaedics and Traumatology were included in the study. The initial anteroposterior radiographs of the patients were used to calculate the increase ratio of interpedicular distance (both from medial-to-medial and from center-to-center). The area measurements from the computerized tomography or magnetic resonans images were used to calculate the canal compromise. The relationship between the increase ratio of interpedicular distance and the ratio of canal compromise was investigated by correlation and linear regression analysis. RESULTS: There was a "very good" correlation between the from medial-to-medial and from center-to-center measurements of interpedicular distance (Pearson correlation coefficient: 0.89, p<0.001). The correlation between the ratio of canal compromise and from medial-to-medial and from center-to-center measurements of interpedicular distance was "good" with Pearson correlation coef-ficients of 0.60 and 0.63, respectively (p<0.001). No statistically significant relationships were found between the fracture levels, types, neurologic status of the patients, and the increase ratio of interpedicular distance or the ratio of canal compromise. CONCLUSION: Depending on the correlation coefficients which were obtained in this study: To predict the canal compromise from the ratio of interpedicular distance increase is not a reliable method for all of the patients