Data Envelopment Analysis Journal > Vol 1 > Issue 2

Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals

Nurhan Davutyan, Faculty of Economics, Administrative and Social Sciences, Kadir Has University, Turkey, Murat Bilsel, Department of Industrial Engineering, Marmara University, Turkey, Menderes Tarcan, Department of Health Institutions Management, Osmangazi University, Turkey,
Suggested Citation
Nurhan Davutyan, Murat Bilsel and Menderes Tarcan (2015), "Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals", Data Envelopment Analysis Journal: Vol. 1: No. 2, pp 135-169.

Published: 30 Jul 2015
© 2015 N. Davutyan, M. Bilsel, and M. Tarcan
Management control,  Performance measurement,  Measurement error in survey data,  Government programs and public policy,  Management structure, governance and performance,  Health Economics,  Health Economics:Insurance Economics,  Health Economics:Medical Care Markets,  Industrial Organization:Regulatory Economics,  Public Economics:Public Finance,  Public Economics:Public Goods,  Customer Relationship Management,  Individual Decision Making,  Capacity Planning,  Health Care
Directional distance functionBad outputsCapacity vs. "negative marginal productivity"Health care quality

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In this article:
1. Introduction
2. Literature Review
3. Directional Distance Function
4. Data-Inputs and Outputs
5. Inefficiency Estimates
6. Congestion and Its Determinants
7. Summary and Conclusions


We analyze the performance of 330 hospitals using a directional distance approach. We use mortality as bad output treating its weak vs. strong disposability as a 'quality of care issue'. We identify congested hospitals, derive their inefficiency scores and show them to be negatively related to patient satisfaction. We separate congested hospitals into two: (i) efficient ones requiring uniform sacrifice of good outputs and/or extra inputs to reduce mortality, and (ii) inefficient hospitals that do not. The latter free up some inputs but require extra amounts of others and/or produce more of some outputs but less of others to reduce mortality. The first group operates at 'capacity', the second displays 'negative marginal productivity'. Patient dissatisfaction is higher in the latter group, whereas mortality reduction relates positively to patient satisfaction in 'capacity constrained' hospitals. The efficient group is more likely to be located in emigrating, the inefficient one in immigrating regions.