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

Abstract

The research object 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 proposes a two-dimensional approach, one of them is to determine public hospital performance at province level, and the other one is to examine whether the decentralization of health services had a significant effect on the efficiency of bounder (contiguity) provinces other means to catch spillover between performance scores. In the results of the study, the efficiency scores of 81 province hospitals differed significantly according to the provision of service patterns. And the relative efficiency scores are increasing with decentration approaches when is compared 2014 and 2017. Furthermore, there is a positive spatial spillover between every two types of hospital service province unit among public hospitals. 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 tool to create a positive impact on the health level in the future if supported by progressive economic and health policies for developing countries.