Financial Impacts of Covid-19 Pandemic for Turkish Public Hospitals

Year 2022, Volume: 13 Issue: 34, 354 - 363, 20.05.2022

Aziz Küçük

https://doi.org/10.21076/vizyoner.993956

Cited By: 4

Abstract

The aim of the study is to assess financial implications of Covid-19 pandemic on Turkish public hospitals and to discuss Turkish government's responses. A comparative analysis is carried out with the medical and financial data of Turkish public hospitals between March-December 2019 and March-December 2020. Outpatient services decreased by approximately 49%, inpatient admissions dropped by %35. Due to this decrease in the number of patients, outpatient revenues decreased by 37.8%, while inpatient revenues increased by 6.3% thanks to reimbursement supports by the Social Security Institution (SSI). On the other hand, total hospital expenses increased by 24% with the impact of Covid-19-related expenses. This increase is largely caused by performance-based supplementary payments, drugs, and operating expenses. Prospective global budget model helps healthcare financing stability for Turkish public hospitals. Public hospitals receive their global budgets to compensate for revenue shortfalls. The SSI also try to compensate the financial losses of public and private hospitals with additional reimbursement supports. However, policymakers and managers should prepare for the change of paradigm in the healthcare system and should concentrate to cost-effective policies (such as tele-health services) in hospitals as a result of Covid-19 demands.

Keywords

Financial Challenges, Public Hospitals, Cost Control, Global Budget, Covid-19

Covid-19 Pandemisinin Türk Kamu Hastanelerine Finansal Etkileri

Abstract

Bu çalışma, Covid-19 salgınının Türk kamu hastaneleri üzerindeki mali etkilerini değerlendirmeyi ve Türk hükümetinin yanıtlarını tartışmayı amaçlamaktadır. Bunun için Mart-Aralık 2019 ile Mart-Aralık 2020 tarihleri arasında Sağlık Bakanlığına bağlı kamu hastanelerinin tıbbi ve finansal göstergeleri karşılaştırmalı bir biçimde analiz edilmiştir. Bu dönemde ayakta hasta başvuruları yaklaşık % 49, yatan hasta sayısı ise % 35 azalmıştır. Hasta sayısındaki bu düşüşe bağlı olarak ayakta hasta tedavi gelirleri % 37,8 azalırken, yatan hasta tedavi gelirleri ise Sosyal Güvenlik Kurumu’nun (SGK) geri ödeme destekleriyle % 6,3 oranında artmıştır. Öte yandan büyük ölçüde Covid-19 ile ilgili performansa dayalı ek ödemeler, ilaçlar ve işletme giderlerinin etkisiyle toplam hastane giderleri % 24 oranında artış göstermiştir. İleriye dönük bir ödeme yöntemi olan global bütçe uygulaması, kamu hastanelerinin gelir kayıplarını telafi ederek sağlık hizmetlerinin finansmanının sürdürülebilirliğini desteklemiştir. Aynı zamanda SGK ilave geri ödeme destekleriyle kamu ve özel hastanelerin finansal kayıplarını telafi etmeye çalışmıştır. Bununla birlikte, Covid-19 sonrası dönemde politika yapıcıların ve yöneticilerin pandeminin sağlık sisteminde yarattığı paradigma değişikliğinin bilincine vararak hastanelerde uygun maliyetli politikalara (telesağlık hizmetleri gibi) yönelmeleri gerektiği önerilmektedir.

Keywords

Finansal Zorluklar, Kamu Hastaneleri, Maliyet Kontrolü, Global Bütçe, Covid-19

References

• Abor, P. A., & Abor, J. Y. (2020). Implications of COVID-19 pandemic for health financing system in Ghana. Journal of Health Management. 22(4), 559-569.
• American Hospital Association. (2020). Hospitals and health systems continue to face unprecedented financial challenges due to COVID-19. June, 1-7. Retrieved March 16, 2021 from www.aha.org
• Bai, G., & Zare, H. (2020). Hospital cost structure and the implications on cost management during COVID-19. Journal of General Internal Medicine, 35(9), 2807-2809.
• Beck da Silva Etges, A. P., Bertoglio Cardoso, R., Marcolino, M. S., Brasil Ruschel, K., Coutinho, A. P., Pereira, E. C., Anschau, F., Aranha, F., Carrilho, F., Vietta, G., Nader Bastos, G. A., Lyra Batista, J. D., Chatkin, J. M., da Silva Nogueira, J., Moreira, L. B., Haddad, L., Floriani, M., Teixeira de Siqueira, M., Ziegelmann, P., de Lima Martelli, P. J., … Kopittke, L. (2021). The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals. Journal of Health Economics and Outcomes Research, 8(1), 36-41.
• Carroll, N. W., & Dean, G. S. (2020). Financial implications of the COVID-19 epidemic for hospitals: A case study. Journal of Health Care Finance, 46(4), 11-22.
• Cyclus, J., & Irwin, R. (2010). “The Challenges of hospital payment systems”, Euro Observer-The Health Policy Bulletin of the European Observatory on Health Systems and Policies, 12(3), Retrieved February 12, 2021 from http://www.euro.who.int/data/assets/pdf_file/0018/121743/euroObserver_Autumn2010.pdf
• Dredge, R. (2004). Hospital global budgeting, (Health, Nutrition and Population (HNP) Discussion Paper), The World Bank.
• Fried, J. E., Liebers, D. T., & Roberts E. T. (2020). Sustaining rural hospitals after COVID-19: The case for global budgets. JAMA, 324(2), 137-138.
• Gondi, S., & Chokshi, D. A. (2020). Financial stability as a goal of payment reform - A lesson from COVID-19. JAMA, 324(16), 1596-1597.
• Kaye, A. D., Okeagu, C. N, Pham, A. D., Silva, R. A., Hurley, J. J., Arron, B. L., Sarfraz, N., Lee, H. N., Ghali, G. E., Gamble, J. W., Liu, H., Urman, R. D., & Cornett, E. M. (2020). Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Practice & Research Clinical Anaesthesiology, 35(3), 293-306.
• Khullar, D., Bond, A. M., & Schpero, W. L. (2020). COVID-19 and the financial health of US hospitals. JAMA, 323(21), 2127-2128.
• Koca, F. (2021). 2022 Yılı Bütçe Sunumu, TBMM Plan ve Bütçe Komisyonu, (25.11.2021).
• Kruse, F., & Jeurissen, P. (2020). For-profit hospitals out of business? Financial sustainability during the COVID-19 epidemic emergency response. International Journal of Health Policy and Management, 9(10), 423-428.
• Küçük, A. (2018). Public hospital reform in Turkey: the ‘‘public hospital union’’ case (2012-2017). International Journal of Health Planning and Management, 33, e971–984.
• Levy, J. F., Ippolito, B. N., & Jain, A. (2021). Hospital revenue under Maryland’s total cost of care model during the COVID-19 pandemic. JAMA, 325(4), 398-400.
• Melnick, G., & Maerki, S. (2020). The financial impact of COVID-19 on California hospitals, California Health Care Foundation, Retrieved January 12, 2021 from www.chcf.org
• Ministry of Health. (2021). Health Statistics Yearbook 2019, General Directorate of Health Information Systems.
• OECD. (2014). OECD reviews of health care quality: Turkey 2014: Raising standards, OECD Publishing. Retrieved April 17, 2021 from http://dx.doi.org/10.1787/9789264202054-en
• OECD. (2019). Health at a Glance 2019: OECD indicators, OECD Publishing. Retrieved April 13, 2021 from https://doi.org/10.1787/4dd50c09-en
• Quentin, W., Albreht, T., Bezzina, A., Bryndova, L., Dimova, A., Gerkens, S., Kowalska-Bobko, I., Mantwill, S., Or, Z., Rajan, S., Theodorou, M., Tynkkynen, L., Waitzberg R., & Winkelmann. J. (2020). Adjusting hospital inpatient payment systems for Covid-19. Eurohealth, 26(2), 88-92.
• Pan, F., Ye, T., Sun, P., Gui, S., Liang, B., Li, L., Zheng, D., Wang, J., Hesketh, R. L., Yang, L., & Zheng, C. (2020). Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology, 295(3), 715-721.
• Patel, S. Y, Mehrotra, A., Huskamp, H. A., Uscher-Pines, L., Ganguli, I., & Barnett, M. L. (2021). Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med, 181(3), 388-391.
• Provenzano, D. A., Sitzman, B. T., Florentino, S. A., & Buterbaugh, G. A. (2020). Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic. Regional Anesthesia & Pain Medicine, 45(8), 579-585.
• Shin, J. H., Takada, D., Morishita, T., Lin, H., Bun, S., Teraoka, E., Okuno, T., Itoshima, H., Nagano, H., Kishimoto, K., Segawa, H., Asami, Y., Higuchi, T., Minato, K., Kunisawa, S., & Imanaka, Y. (2020). Economic impact of the first wave of the COVID-19 pandemic on acute care hospitals in Japan. PloS one, 15(12), e0244852.
• Snoswell, C. L., Caffery, L. J., Haydon, H. M., Thomas, E. E., & Smith, A. C. (2020). Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic. Australian Health Review, 44(5), 737-740.
• Story, D., Coyle, E., Devapalasundaram, A., Sidiropoulos, S., Ou Yang, B., & Coulson, T. (2020). Documenting COVID-19 screening before surgery during lockdown (COVID Screen): An audit with routinely collected health data. Australian Health Review, 44(5), 723-727.
• Tonna, J. E., Hanson, H. A., Cohan, J. N., McCrum, M. L., Horns, J. J., Brooke, B. S., Das, R., Kelly, B. C., Campbell, A. J., & Hotaling, J. (2020). Balancing revenue generation with capacity generation: Case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19. BMC Health Serv Res, 20(1), 1119.
• WHO. (2020a). Turkey’s response to Covid-19: First impressions, WHO Regional Office for Europe.
• WHO. (2020b). Covid-19: Health system response monitor-Turkey. Retrieved October 16, 2020 from https://www.covid19healthsystem.org/mainpage.aspx