DÖNÜŞEN TÜRKİYE SAĞLIK SİSTEMİNDE HASTANELERİN KAPASİTE ARTIŞININ İNCELENMESİ

Year 2025, Volume: 47 Issue: 1, 1 - 24, 14.04.2025

İsrafil Boyacı

https://doi.org/10.14780/muiibd.1344103

Abstract

Bu makale, Türkiye yerel hastane piyasalarındaki kapasite artışının belirleyicilerini ampirik olarak analiz etmektedir. Makalenin amacı, Sağlıkta Dönüşüm Programı (2003-2013) kapsamındaki sağlık reformlarının son aşamalarında Türkiye'nin yerel ilçelerindeki özel ve kamu hastanelerinin yatak kapasitelerindeki değişiklikleri açıklamaktır. Ampirik analizler, 2010-2014 döneminde hastaneler, talep koşulları ve yerel pazar özellikleriyle ilgili yıllık ülke çapındaki verilere dayanmaktadır. Tahminleme sonuçları Türkiye'nin yerel ilçelerinin hastane yatak kapasitesindeki büyüme üzerinde yerel piyasadaki rekabet baskısının varlığına dair kanıt göstermemektedir. Dolayısıyla, makalenin bulgularına dayanarak hastaneler arasındaki yerel rekabetin yatak kapasitelerini artırma yarışına yol açtığı söylenememektedir. Özel hastanelerin kapasite artışının, kamu tarafından finanse edilen genel sağlık sigortası sistemi kapsamında özel sektörün sağlık hizmetleri sunumuna daha fazla dâhil edilmesinin ve sağlık reformları sayesinde elverişli piyasa ortamının bir neticesi olarak yorumlanması daha uygun görünmektedir.

Keywords

sağlık reformları, hastane kapasite büyümesi, piyasa yapısı, hastane sahipliği

EXAMINING THE CAPACITY EXPANSION OF HOSPITALS IN THE TRANSFORMED TURKISH HEALTH SYSTEM

Abstract

This article empirically analyzes the determinants of capacity expansion in the local hospital markets in Türkiye. The aim of the paper is to explain changes in bed capacities of privately- and publicly-owned hospitals in local districts of Türkiye over the late stages of health reforms under the Health Transformation Program (2003-2013). The empirical analyses rely on the yearly countrywide data on hospitals, demand conditions, and local market characteristics over the period of 2010-2014. The estimation results did not show evidence for the presence of local market competitive pressure on the growth in hospital bed capacity of local districts in Türkiye. Thus, based on the findings of the article, it cannot be concluded that the local competition among hospitals led to a rivalry to expand their bed capacities. It appears more appropriate to interpret the capacity expansion of private hospitals as a consequence of the increased inclusion of the private sector in healthcare provision within the publicly-funded universal health insurance system and favorable market environment thanks to the health reforms.

Keywords

hospital capacity growth, competition, hospital ownership, health reforms

References

• Boyacı, İ. (2021). Türkiye sağlık sisteminin dönüşümü (2003-13): sağlık hizmet bölgeleri planlaması ve şehir hastaneleri. İstanbul Ticaret Üniversitesi Sosyal Bilimler Dergisi, 20(40), 358-376. Doi:10.46928/iticusbe.769087
• Boyacı, İ. (2022). Essays on Turkish private hospital industry: dynamics of market structure, health reforms and regulations. Unpublished Ph.D. thesis, Department of Economics, Boğaziçi University, Türkiye.
• Boyacı, İ. (2023). Healthcare reforms and competition in private hospital markets in Türkiye. Bogazici Journal: Review of Social, Economic and Administrative Studies, 37(2),118-146. Doi:10.21773/boun.37.2.4
• Boyacı, İ. (2024). Dönüşen Türkiye sağlık sisteminde özel hastanelerin yayılımı. Yönetim Bilimleri Dergisi, 22(53), 1017-1037. Doi:10.35408/comuybd.1407511
• Brekke, K. R. (2000). Hospital reimbursement in an oligopolistic industry. Department of Economics, University of Bergen 0200, University of Bergen, Norway.
• Bresnahan, T., & Reiss, P. (1991). Entry and competition in concentrated markets. Journal of Political Economy, 99(5), 977-1009.
• Caves, R., & Porter, M. (1977). From entry barriers to mobility barriers: conjectural decisions and contrived deterrence to new competition. The Quarterly Journal of Economics, 91(2), 241-261.
• Conlin, M., & Kadiyali, V. (2006). Entry-deterring capacity in the Texas lodging industry. Journal of Economics & Management Strategy, 15(1), 167-185. Doi:10.1111/j.1530-9134.2006.00096.x
• Donabedian, A. (1980). Explorations in quality assessment and monitoring, volume i: the definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
• Dranove, D., Shanley, M., & Simon, C. (1992). Is hospital competition wasteful? The RAND Journal of Economics, 23(2), 247-262.
• Gaynor, M. (2006). What do we know about competition and quality in health care markets? Doi:10.3386/w12301
• Gal-Or, E. (1994). Excessive investment in hospital capacities. Journal of Economics Management Strategy, 3(1), 53-70. Doi:10.1111/j.1430-9134.1994.00053.x
• Hansmann, H., Kessler, D., & Mcclellan, M. (2003). Ownership form and trapped capital in the hospital industry. The Governance of Not-for-Profit Organizations, 45-70.
• Held, P. J., & Pauly, M. V. (1983). Competition and efficiency in the end-stage renal disease program. Journal of Health Economics, 2(2), 95-118.
• Hodgkin, D., & McGuire, T. G. (1994). Payment levels and hospital response to prospective payment. Journal of health economics, 13(1), 1-29.
• Joskow, P. (1980). The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. The Bell Journal of Economics, 11(2), 421-447.
• Kesteloot, K., & Voet, N. (1998). Incentives for cooperation in quality improvement among hospitals: the impact of the reimbursement system. Journal of Health Economics, 17(6), 701-728. Doi:10.1016/s0167-6296(98)00026-5
• Lieberman, M. (1987). Excess capacity as a barrier to entry: an empirical appraisal. The Journal of Industrial Economics, 35(4), 607-627. Doi:10.2307/2098590
• Ministry of Development of the Republic of Türkiye. 2004. İlçelerin sosyo-ekonomik gelişmişlik sıralaması araştırması (2004) [Research on socio-economic development index of districts SEGE]. Ankara, Türkiye: Bülent Dincer, Metin Özaslan.
• Ministry of Health of the Republic of Türkiye. (2002-2019). Health statistics yearbook. Ankara.
• Ministry of Health of the Republic of Türkiye. (2012). Turkey Health Transformation Program Assessment Report (2003-2011). Ankara, Türkiye: Recep Akdağ.
• Noether, M. (1988). Competition among hospitals. Journal of Health Economics, 7(3), 259–284.
• Pope, G. C. (1989). Hospital nonprice competition and Medicare reimbursement policy. Journal of Health Economics, 8(2), 147–172. Doi: 10.1016/0167-6296(89)90001-5
• Rhoades, S. A. (1995). Market share inequality, the HHI, and other measures of the firm-composition of a market. Review of Industrial Organization, 10(6), 657-674.
• Robinson, J. C., & Luft, H. S. (1985). The impact of hospital market structure on patient volume, average length of stay, and the cost of care. Journal of Health Economics, 4(4), 333-356. Doi:10.1016/0167-6296(85)90012-8
• Schwierz, C. (2011). Expansion in markets with decreasing demand-for-profits in the German hospital industry. Health Economics, 20(6), 675-687. Doi:10.1002/hec.1624
• Spence, A. (1979). Investment strategy and growth in a new market. The Bell Journal of Economics, 10(1), 1-19. Doi:10.2307/3003316
• Wang, C., & Chen, Y. (2017). Reimbursement and hospital competition in China. Economic Research-Ekonomska Istraživanja, 30(1), 1209-1223. Doi:10.1080/1331677x.2017.1340177