Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: The case of public hospitals in Turkey

• Published in: Health policy (Amsterdam) Vol. 111; no. 3; pp. 290 - 300
• Main Authors: Gok, Mehmet Sahin, Sezen, Bulent
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01-08-2013; Elsevier
• Subjects: Biological and medical sciences; Comparative analysis; Data envelopment analysis; Efficiency, Organizational; Health administration; Health Care Surveys; Health policy; Health services; Hospital efficiency; Hospitals; Hospitals, Public - standards; Humans; Internal Medicine; Medical sciences; Medical treatment; Miscellaneous; Moderator variables; Moderators; Patient Satisfaction; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Quality of Health Care; Quality standards; Regression Analysis; Structural quality; Total quality management; Turkey; Asia; Turkey; Structural quality; Patient satisfaction; Hospital efficiency; Data envelopment analysis; Human; Data analysis; Efficiency; Quality; Satisfaction; Patient; Health service; Hospital
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2013.05.010

Abstract Objective This paper empirically analyzes the effects of efficiency and structural quality on patient satisfaction in Turkish public hospitals. It also investigates the controversial relationship between hospital efficiency and structural quality for small, medium and large size hospitals in a comparative perspective. Methods Data envelopment analysis (DEA) is used to analyze the efficiencies of hospitals. Data concerning 523 public hospitals is obtained from Turkish Ministry of Health. Due to the missing data of some hospitals, the sample of this study is composed of the remaining 348 observations. Multiple regression analysis is used to evaluate the relationship between patient satisfaction as a dependent variable and structural quality, hospital efficiency and institutional factors as independent variables. Furthermore, stepwise process multiple regression analysis is used to analyze the moderator effects of hospital efficiency on the form of the relationship between quality and satisfaction. Findings The findings indicate that hospital efficiency changes the form of the relationship between structural quality and patient satisfaction as a moderator variable. The trade-off between quality and efficiency is found to vary depending on the hospital size. Negative correlation is found between quality and efficiency for small-size hospitals. However, positive correlation between efficiency and quality is found significant as indicated by Total Quality Management (TQM) approach for large-size hospitals. This study also provides the empirical evidence on the negative relationship between patient satisfaction and hospital size. Conclusions The effect of hospital efficiency on patient satisfaction might be improved for inefficient small and medium size hospitals by taking successful large hospitals as role models.