Background
Indicator | OECD34 average | Turkey | Ranka (out of 34 OECD countries) | |
---|---|---|---|---|
Life expectancy at birth | 80.5 | 76.6 | 31 | |
Infant mortality (per 1000 live births) | 3.8 | 10.2 | 34 | |
Total expenditure on health, % GDP | 8.9 | 5.1 | 34 | |
Total expenditure on health, per capita, US$ PPP | 3453 | 941 | 34 | |
Physicians, per 1000 population | 3.3 | 1.8 | 34 | |
Nurses, per 1000 population | 9.1 | 1.8 | 34 | |
Hospital beds, per 1000 population | 4.8 | 2.7 | 31 | |
MRI units per 1 million population | 14.1 | 10.5 | 20b | |
CT scanners per million population | 24.4 | 14.2 | 25b |
Centraleast Anatolia | Central Anatolia | Northeast Anatolia | Istanbul | Southeast Anatolia | Aegean | East Marmara | East Black Sea | West Marmara | West Black Sea | West Anatolia | Mediterranean | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Perinatal Mortality per 1000 live birth | 10.9 | 7.1 | 10.9 | 6.7 | 11.3 | 7.5 | 7.5 | 7.0 | 7.8 | 8.4 | 6.7 | 7.6 |
Neonatal Mortality per 1000 live birth | 6.5 | 3.9 | 6.3 | 3.2 | 6.2 | 3.5 | 3.7 | 3.8 | 3.9 | 3.9 | 3.0 | 3.7 |
Post-neonatal Mortality per 1000 live birth | 4.6 | 3.3 | 4.1 | 2.2 | 4.4 | 2.3 | 2.2 | 3.0 | 2.5 | 3.0 | 2.5 | 3.3 |
Mortality under 5 years per 1000 live birth | 16.7 | 10.8 | 13.9 | 8.2 | 16.1 | 8.7 | 9.0 | 9.9 | 9.1 | 9.9 | 8.3 | 10.8 |
Maternal Mortality per 1000 live birth | 25.5 | 25.9 | 32.2 | 15.1 | 14.7 | 13.6 | 7.7 | 21.5 | 7.8 | 17.2 | 12.7 | 10.7 |
Poverty rate (%), 50% poverty risk threshold | 13.4 | 12.4 | 13.2 | 9.6 | 12.8 | 11.6 | 10.8 | 11.1 | 13.0 | 12.0 | 12.9 | 13.7 |
Number of hospital beds per 10,000 | 26.7 | 28.4 | 28.8 | 23.3 | 19.7 | 27.2 | 26.1 | 33.1 | 27.4 | 30.3 | 35.8 | 23.8 |
Number of ICU beds per 10,000 | 2.9 | 2.9 | 2.0 | 3.3 | 3.1 | 3.1 | 3.0 | 2.9 | 2.4 | 2.8 | 3.8 | 3.3 |
Per Capita visits to hospitals | 4.5 | 4.9 | 4.7 | 4.2 | 4.1 | 4.9 | 4.8 | 5.8 | 5.0 | 5.4 | 5.0 | 4.6 |
Physicians per 100,000 population | 144 | 159 | 142 | 192 | 121 | 183 | 156 | 159 | 150 | 152 | 266 | 155 |
Nurses per 100,000 population | 257 | 277 | 253 | 191 | 184 | 279 | 254 | 339 | 278 | 296 | 302 | 242 |
Surgical operations per 1000 population | 49.5 | 63.4 | 57.2 | 56.3 | 49.6 | 58.0 | 59.1 | 59.8 | 44.4 | 53.6 | 73.8 | 64.7 |
Surgical operations per 1000 population (Group A)a | 3.1 | 5.0 | 3.5 | 6.8 | 2.8 | 6.4 | 6.8 | 6.0 | 3.5 | 5.4 | 8.9 | 5.5 |
Number of MRI exams per 1000 population in hospitals | 31.8 | 19.9 | 23.4 | 28.0 | 24.5 | 22.5 | 22.9 | 25.8 | 18.7 | 25.8 | 24.8 | 23.0 |
Bed Occupancy Ratio | 65.4 | 60.8 | 65.0 | 70.1 | 67.9 | 67.5 | 67.8 | 62.2 | 67.8 | 62.2 | 68.5 | 68.6 |
Health system in Turkey
№ | Indicator | 1995–2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Total expenditure on health as a percentage of gross domestic product | 4.13 | 5.16 | 5.36 | 5.34 | 5.37 | 5.45 | 5.81 | 6.04 | 6.07 | 6.75 | 6.67 | 6.66 |
2 | General government expenditure on health as a percentage of total government expenditure | 10.52 | 9.54 | 9.07 | 9.73 | 10.75 | 11.28 | 11.95 | 12.13 | 12.79 | 12.79 | 12.79 | 12.79 |
3 | General government expenditure on health as a percentage of total expenditure on health | 67.85 | 68.07 | 70.68 | 71.92 | 71.25 | 67.84 | 68.34 | 67.83 | 73.02 | 75.14 | 74.79 | 74.94 |
4 | Private expenditure on health as a percentage of total expenditure on health | 32.15 | 31.93 | 29.32 | 28.08 | 28.75 | 32.16 | 31.66 | 32.17 | 26.98 | 24.86 | 25.21 | 25.06 |
5 | External resources for health as a percentage of total expenditure on health | 0.80 | 0.27 | 0.01 | 0.12 | 0.01 | 0.01 | 0.03 | 0.09 | 0.07 | 0.01 | 0.00 | .. |
6 | Out-of-pocket expenditure as a percentage of private expenditure on health | 91.42 | 71.55 | 67.68 | 65.75 | 66.91 | 70.78 | 69.4 | 67.82 | 64.41 | 64.41 | 64.41 | 64.41 |
7 | Private prepaid plans as a percentage of private expenditure on health | .. | .. | .. | .. | 5.63 | 5.91 | 5.99 | 6.11 | 7.31 | 7.31 | 7.31 | 7.31 |
8 | Social security expenditure on health as a percentage of general government expenditure on health | 43.55 | 54.46 | 57.51 | 59.91 | 60.85 | 56.08 | 56.63 | 54.44 | 57.04 | 57.04 | 57.04 | 57.04 |
Methods
Estimation methodology
Zero-value problem
Data source and empirical model specification
Data
Functional form
Variable | Description | Mean | SD | Min | Max |
---|---|---|---|---|---|
Variables in Frontier Model | |||||
output
| Hospital composite output (see Eq. 9) | 14.3 M | 29.0 M | 2885 | 287 M |
bed
| Number of inpatient hospital beds | 144 | 215 | 2 | 1816 |
doctors
| Number of doctors except residents | 55 | 83 | 1 | 1030 |
clinicians
| Number of non-doctor health professionals (nurses, midwives, technicians, etc.) | 174 | 231 | 7 | 2006 |
devices
| Number of X-Ray, MR, CT, ECG, Doppler | 12 | 17 | 0 | 458 |
devices_d
| Dummy to control for zero-value problem | ||||
admin
| Number of administrative staff | 39 | 53 | 1 | 489 |
icubeds
| Intensive Care Unit (ICU) Beds | 17 | 25 | 0 | 230 |
icubeds_d
| Dummy to control for zero-value problem | ||||
Variables in Inefficiency term model | |||||
type
| Hospital ownership type (%) | ||||
MoH General | 42.02 | ||||
MoH Integrated County Hospitals | 11.97 | ||||
MoH Teaching | 3.99 | ||||
Private General | 36.83 | ||||
Private University | 1.21 | ||||
Public University | 3.99 | ||||
income
| Per capita income proxied by Regional per capita Gross Domestic Product | ||||
Less than $5000 | 4.36 | ||||
$ 5001–10,000 | 12.64 | ||||
$ 10,001–15,000 | 28.94 | ||||
$ 15,001–20,000 | 39.33 | ||||
$ 20,001 and above | 13.73 | ||||
region
| Statistical regions and percent of hospitals in each region | ||||
Istanbul | 15.31 | ||||
West Marmara | 5.94 | ||||
Aegean | 12.8 | ||||
East Marmara | 8.91 | ||||
West Anatolia | 8.91 | ||||
Mediterranean | 11.41 | ||||
Central Anatolia | 5.94 | ||||
West Black Sea | 7.88 | ||||
East Black Sea | 4.92 | ||||
North East Anatolia | 3.53 | ||||
Central East Anatolia | 6.22 | ||||
South East Anatolia | 8.26 |
Variable | Description | Mean | SD | Min | Max | Price index |
---|---|---|---|---|---|---|
operations
| Number of annual surgical operationsa | |||||
Type A | 332 | 667 | 0 | 6485 | 266.53 | |
Type B | 1190 | 1887 | 0 | 14,757 | 75.73 | |
Type C | 1797 | 2490 | 0 | 20,611 | 37.60 | |
Type D | 1639 | 2776 | 0 | 25,107 | 23.13 | |
Type E | 2921 | 7284 | 0 | 109,748 | 11.07 | |
icubeds
| Number of beds in the ICU units | |||||
Adult level 1 | 70,254 | 163,681 | 0 | 1,617,388 | 16.67 | |
Adult level 2 | 75,591 | 175,739 | 0 | 2,385,640 | 30.00 | |
Adult level 3 | 117,145 | 316,273 | 0 | 3,403,698 | 50.00 | |
Neonatal level 1 | 16,690 | 64,281 | 0 | 903,375 | 16.67 | |
Neonatal level 2 | 28,028 | 95,935 | 0 | 1,151,502 | 30.00 | |
Neonatal level 3 | 52,077 | 160,709 | 0 | 1,292,319 | 50.00 | |
Pediatric | 11,885 | 66,458 | 0 | 949,000 | 30.00 | |
inpatient
| Number of inpatient-day (inpatient bed) utilization at each hospital. | |||||
33,072 | 58,193 | 0 | 470,287 | 1.00 | ||
Rate
| Average percentage of daily occupancy rates of the beds at the ICU units. | |||||
Adult | 32.18 | 34.07 | 0 | 100 | na | |
Neonatal | 19.22 | 30.95 | 0 | 100 | na | |
Pediatric | 3.39 | 15.79 | 0 | 100 | na | |
delivery
| Number of annual child deliveries | |||||
Normal | 328 | 589 | 0 | 7381 | 6.67 | |
Operation | 22 | 107 | 0 | 1595 | 12.00 | |
C-section | 396 | 527 | 0 | 4692 | 12.00 | |
Tech
| Number of annual utilization of the diagnostics equipment | |||||
ECG | 365 | 601 | 0 | 5352 | 4.80 | |
MR | 653 | 1047 | 0 | 7371 | 4.80 | |
BT | 701 | 1244 | 0 | 10,220 | 4.00 | |
Doppler | 2120 | 6172 | 0 | 180,153 | 2.00 | |
X-ray | 4044 | 6324 | 0 | 54,205 | 1.00 | |
Visits
| Number of annual visits to | |||||
ER | 75,351 | 90,152 | 0 | 736,292 | 1.00 | |
Doctors | 267,580 | 320,679 | 1685 | 2,405,443 | 1.00 |
Results
Variable | Coef. | Std. Error | Z | P > z | 95% Conf. Interval | |
---|---|---|---|---|---|---|
Frontier Model: dependent variable = log(output) | ||||||
Inpatient hospital beds (log) | −0.3904 | 0.2548 | −1.5300 | 0.1250 | −0.8899 | 0.1090 |
Non-doctor clinicians (log) | 1.1531 | 0.3090 | 3.7300 | 0.0000 | 0.5474 | 1.7587 |
Doctors (log) | − 0.4522 | 0.2831 | −1.6000 | 0.1100 | −1.0071 | 0.1027 |
Devices (log) | 0.2977 | 0.2337 | 1.2700 | 0.2030 | −0.1602 | 0.7557 |
Devices dummy (=1 if no device) | −0.6614 | 0.2165 | −3.0600 | 0.0020 | −1.0857 | − 0.2372 |
ICU beds (log) | 2.5584 | 0.1710 | 14.9600 | 0.0000 | 2.2232 | 2.8937 |
ICU beds dummy (=1 if no beds) | −0.0167 | 0.1205 | −0.1400 | 0.8900 | −0.2528 | 0.2194 |
Administrative staff (log) | 0.3217 | 0.1278 | 2.5200 | 0.0120 | 0.0713 | 0.5722 |
lnbed2 | 0.0328 | 0.0436 | 0.7500 | 0.4510 | −0.0526 | 0.1183 |
lnclinicians2 | −0.1171 | 0.0752 | −1.5600 | 0.1190 | −0.2645 | 0.0302 |
lndoctors2 | 0.0903 | 0.0726 | 1.2400 | 0.2130 | −0.0519 | 0.2325 |
lndevices2 | 0.0221 | 0.0270 | 0.8200 | 0.4130 | −0.0308 | 0.0750 |
lnicubeds2 | 0.1862 | 0.0259 | 7.1800 | 0.0000 | 0.1354 | 0.2371 |
lnadmin2 | 0.0194 | 0.0196 | 0.9900 | 0.3210 | −0.0189 | 0.0578 |
lnbed × lnclinicians | 0.1086 | 0.1035 | 1.0500 | 0.2940 | −0.0942 | 0.3113 |
lnbed × lndoctors | −0.1246 | 0.1150 | −1.0800 | 0.2790 | −0.3500 | 0.1009 |
lnbed × lndevices | −0.0157 | 0.0941 | −0.1700 | 0.8670 | −0.2002 | 0.1687 |
lnbed × lnicubeds | −0.0876 | 0.0578 | −1.5200 | 0.1290 | −0.2008 | 0.0256 |
lnbed × lnadmin | 0.0598 | 0.0542 | 1.1000 | 0.2700 | −0.0464 | 0.1660 |
lnclinicians × lndoctors | 0.2428 | 0.1102 | 2.2000 | 0.0280 | 0.0269 | 0.4587 |
lnclinicians × lndevices | −0.0267 | 0.1076 | −0.2500 | 0.8040 | −0.2377 | 0.1842 |
lnclinicians × lnicubeds | −0.2386 | 0.0606 | −3.9400 | 0.0000 | −0.3574 | −0.1198 |
lnclinicians × lnadmin | −0.2112 | 0.0566 | −3.7300 | 0.0000 | −0.3221 | −0.1002 |
lndoctors × lndevices | −0.1513 | 0.1005 | −1.5100 | 0.1320 | −0.3483 | 0.0457 |
lndoctors × lnicubeds | −0.1510 | 0.0571 | −2.6400 | 0.0080 | −0.2629 | −0.0391 |
lndoctors × lnadmin | 0.0583 | 0.0691 | 0.8400 | 0.3990 | −0.0771 | 0.1938 |
lndevices × lnicubeds | 0.0362 | 0.0457 | 0.7900 | 0.4280 | −0.0533 | 0.1257 |
lndevices × lnadmin | 0.1196 | 0.0521 | 2.3000 | 0.0220 | 0.0176 | 0.2216 |
lnicubeds × lnadmin | −0.0522 | 0.0327 | −1.6000 | 0.1100 | −0.1162 | 0.0118 |
Constant
| 8.5814 | 0.5541 | 15.4900 | 0.0000 | 7.4953 | 9.6675 |
Inputs | Coef. |
---|---|
Inpatient hospital beds | −0.0399 |
Non-doctor clinicians | 0.2036a |
Doctors | 0.3308a |
Devices | 0.1212a |
ICU beds | 1.1816a |
Administrative staff | 0.0646a |
Total | 1.8618 |
Inefficiency term model | Coef. | Std. Error | Z | P > z | 95% Conf. Interval | |
---|---|---|---|---|---|---|
Hospital type (reference = MoH General Hospitals) | ||||||
MoH Integrated County | −0.3087 | 1.0999 | −0.2800 | 0.7790 | −2.4644 | 1.8471 |
MoH Teaching | −10.2968 | 6.2776 | −1.6400 | 0.1010 | −22.6007 | 2.0070 |
Private General | 5.7161 | 1.5593 | 3.6700 | 0.0000 | 2.6598 | 8.7723 |
Private University | 5.3802 | 1.7796 | 3.0200 | 0.0030 | 1.8923 | 8.8682 |
Public University | 1.9877 | 1.3731 | 1.4500 | 0.1480 | −0.7036 | 4.6790 |
Provincial per capita income (reference = less than $5000) | ||||||
$ 5001–10,000 | 1.1581 | 1.4513 | 0.8000 | 0.4250 | −1.6864 | 4.0026 |
$ 10,001–15,000 | 0.1728 | 1.0065 | 0.1700 | 0.8640 | −1.7999 | 2.1455 |
$ 15,001–20,000 | 0.2287 | 1.1706 | 0.2000 | 0.8450 | −2.0657 | 2.5231 |
Over $20,000 | 0.7793 | 1.2776 | 0.6100 | 0.5420 | −1.7247 | 3.2834 |
Regions (reference = Istanbul) | ||||||
West Marmara | 0.0169 | 0.8593 | 0.0200 | 0.9840 | −1.6673 | 1.7010 |
Aegean | 0.3144 | 0.7433 | 0.4200 | 0.6720 | −1.1424 | 1.7712 |
East Marmara | 0.9828 | 0.7174 | 1.3700 | 0.1710 | −0.4232 | 2.3888 |
West Anatolia | 1.3406 | 0.6433 | 2.0800 | 0.0370 | 0.0798 | 2.6014 |
Mediterranean | −0.5174 | 0.6444 | −0.8000 | 0.4220 | −1.7805 | 0.7456 |
Central Anatolia | 1.5293 | 0.9611 | 1.5900 | 0.1120 | −0.3543 | 3.4130 |
West Black Sea | −0.0208 | 1.0204 | −0.0200 | 0.9840 | −2.0209 | 1.9792 |
East Black Sea | −2.3229 | 1.7857 | −1.3000 | 0.1930 | −5.8228 | 1.1770 |
North East Anatolia | −0.2497 | 1.7456 | −0.1400 | 0.8860 | −3.6711 | 3.1717 |
Central East Anatolia | 2.2611 | 1.0253 | 2.2100 | 0.0270 | 0.2515 | 4.2708 |
South East Anatolia | 0.0522 | 1.3654 | 0.0400 | 0.9690 | −2.6240 | 2.7284 |
Constant
| −7.2108 | 2.6058 | −2.7700 | 0.0060 | −12.3182 | −2.1035 |
\( \mathit{\ln}\left({\sigma}_v^2\right) \)
| 1.0157 | 0.2782 | 3.6500 | 0.0000 | 0.4704 | 1.5610 |
exp(γ)/[exp(γ) + 1] | 3.6915 | 0.2975 | 12.4100 | 0.0000 | 3.1085 | 4.2745 |
\( {\sigma}_S^2={\sigma}_v^2+{\sigma}_v^2 \)
| 2.7613 | 0.7683 | 1.6006 | 4.7638 | ||
\( \gamma ={\sigma}_u^2/{\sigma}_v^2 \)
| 0.9757 | 0.0071 | 0.9572 | 0.9863 | ||
\( {\sigma}_u^2 \)
| 2.6942 | 0.7672 | 1.1905 | 4.1978 | ||
\( {\sigma}_v^2 \)
| 0.0672 | 0.0086 | 0.0503 | 0.0840 |