The Relationship Between the Health Transformation Program and Health Expenditures: Evidence From an Autoregressive Distributed Lag Testing Approach

OBJECTIVES

As health expenditure increases every year, countries try to provide accessible health services to society and try to protect individuals from the expenses they cannot overcome by investigating the reason for this increase. Especially with the arrangements made in the health systems in developing countries such as Turkey, it has been tried to take the control of dramatic increases in health expenditure. Based on this issue, in this study, we aimed to evaluate the effect of income per capita, annual inflation, and health reform called as Health Transformation Program on the health expenditure per capita in Turkey.

METHODS

This study reflected the effects of income, inflation, and the reform on the total health expenditure through the autoregressive distributed lag. This study covered the years between 1985 and 2016 for Turkey.

RESULTS

As a result of this study, there was a positive relationship between health expenditure and income and a negative relationship with the reform (P < .05).

CONCLUSION

According to the results of this study, it is suggested that health expenditures can be kept under control with improvements such as encouraging individuals to use more primary healthcare services than curative health services and increasing the quality of service without compromising the equity in financing.

Examination of Nurses’ Attitudes About Patient Safety According to Sociodemographic Characteristics

Background: Patient safety is a high priority for healthcare systems worldwide. It is considered an indicator of the quality of care. Establishing a patient safety attitude is the first priority in order to create a patient safety culture. Nurses play a critical role in protecting and supporting patients because of the nature of their job. In this way, especially nurses’ attitudes about patient safety will be determined, and threats to patient safety that may arise in the future will be prevented. Methods: In this regard, this study aimed to examine the nurses’ attitudes about patient safety according to certain sociodemographic characteristics. To accomplish this goal, the relevant data of the nurses were obtained by using the Patient Safety Attitude Scale consisting of 6 dimensions and 46 items. The research population consists of 245 nurses working in a University hospital in Ankara. The sample was not calculated, and a questionnaire was distributed to all employees of which 215 nurses completed the questionnaire. Data were collected between 1-30 April 2021. Ethics committee approval was obtained from the hospital. The data obtained were subjected to multivariate regression analysis. Results: The scale used was reliable (r=0.80). The mean of the general patient safety attitude scale is 3.22 with a standard deviation of 0.54. The majority of the participants were found to be between the age groups of 19-26 (38.1%), women (84.7%), and single (52.1%). We also found that the weekly working time of nurses and whether they got patient safety training or no had a statistically significant effect on patient safety attitudes (p<0.05). Therefore, it could be said that as the working time of nurses increased, a decrease in patient safety attitudes were observed, and they exhibited more patient safety attitudes as they got patient safety training. Conclusion: From this point of view, determining the weekly working hours of nurses more appropriately and making them more trained about patient safety may play a key role in creating a higher level of patient safety attitude.

Serial multiple mediation of treatment adherence and disease activity in the relationship between continuity of care and health outcomes among rheumatoid arthritis patients

OBJECTIVE

To evaluate the effect of continuity of care on health outcomes (quality of life and functionality) in patients with rheumatoid arthritis and to reveal whether treatment adherence and disease activity have a serial multiple mediator role on this relationship.

METHODS

The study was cross-sectional on 440 rheumatoid arthritis patients who applied to a university hospital rheumatology outpatient clinic. Research data were obtained from both the questionnaire method, which is the primary data source, and the patient files, which are the secondary data source. Process analysis was used in the analysis of the data.

RESULTS

It was found that the continuity of care has a direct effect on the quality of life and the functionality. In addition, it is seen that treatment adherence has a single partial mediator role on the relationship between continuity of care and quality of life; It has been determined that treatment adherence and disease activity have both partial single mediation and serial multiple mediation roles on the relationship between continuity of care and functionality.

CONCLUSION

It is thought that these findings will provide clinicians with important data and information in the management of rheumatoid arthritis.

The Granger Causality Between Health Expenditure and Gross Domestic Product in OECD Countries

The aim of this study is to reflect the causality relationship between the exchange ratio in gross domestic product (dGDP) and health expenditures per capita (HEPC) among OECD countries based on purchasing power parity in dollars through Granger causality test. Within this perspective, HEPC data of 26 OECD member countries between the years 1992 and 2014 and GDP exchange ratio between the periods 1992–1993 and 2014–2015 were analysed. As a result of the analysis, the relation between the exchange ratio in GDP and HEPC is unilateral in 9 countries and bilateral in 2 countries while there has not been any relation in 15 countries. There are strong relations between the revenues of countries and their health expenditures. The results from this study is considered to lead the health policy makers and planners in taking administrative decisions.

Measuring the efficiency of Turkish maternal and child health hospitals: A two-stage data envelopment analysis

This study aims to examine the changes in efficiency and efficiency levels of the maternal and child health hospitals in Turkey from 2014 to 2017, by applying two-stage data envelopment analysis (DEA). At the first stage of the study, the efficiency of the hospitals was evaluated with input-oriented CCR (Charnes, Cooper, Rhodes) and Malmquist Productivity Index (MPI). At the second stage, panel Tobit regression analysis was utilized to find out the factors that affect the efficiency scores specified at the first stage. According to the results of the first stage, the mean efficiency values calculated for 2014, 2015, 2016, and 2017 were 0.83, 0.90, 0.86, and 0.80, respectively. At the second stage, it was revealed that the variables of not being in a metropolis and having 200 beds at least had statistically a significant effect on the efficiency score (p < 0.05) whereas being a training and research hospital was ineffective (p > 0.05). The number of the studies which assess the efficiency of maternal and child health hospitals in Turkey was quite limited. Moreover, such studies do not contain second-stage analyses. Lastly, it is thought that those results will provide health policy-makers substantial and evidence-based information in the allocation of the resources for the related services.

Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries

This study aims to identify the risk factors affecting deaths related to cardiovascular diseases. The research population comprised of 194 World Health Organization (WHO) member countries, but the data analysis was conducted with the data from 152 countries as 42 of them do not have any data on study variables. Multivariable regression analysis was utilised for this study to analyse the effect of factors regarding metabolism, lifestyle, economic, socio-demographic and health system on the cardiovascular diseases related to deaths. As a result of regression analysis, the number of deaths related to cardiovascular diseases increases with the increase in blood pressure (p < .001), blood glucose (p = .032), obesity rate (p < .001), salt consumption (p < .001), GINI index (p = .002) and dependent age ratio (p < .001); the frequency of cardiovascular disease-related deaths is higher in the countries within low (p < .001) and high (p < .001) middle-income levels; yet, the number of deaths based on cardiovascular diseases diminishes with the increase in the number of doctors (p = .005) and health expenditures per capita (p = .044). The research findings are considered to guide the countries in the determination of their steps towards the prevention of deaths related to cardiovascular diseases.

Determining the factors affecting the technical efficiency scores of public hospitals using different regression methods

Purpose

This study aims to identify the efficiency scores of hospitals affiliated to the Ministry of Health in Turkey between the years of 2010–2015 at provincial level and to reveal the factors that affect the efficiency scores.

Design/methodology/approach

The two-stage data envelopment analysis (DEA) method was used to achieve the study purpose. In the first stage, DEA method based on input-oriented Charnes–Cooper–Rhodes (CCR) model was performed to calculate the efficiency scores of public hospitals at the provincial level between 2010 and 2015, and in the second stage, Tobit regression and linear regression analyses were used to identify whether the efficiency scores of provinces are affected by the input, output and control variables.

Findings

Upon the analysis, the average efficiency scores of 81 provinces by years were found to vary between 0.79 and 0.89. According to both regression analyses, all of the input and output variables were found to have significant effects on the efficiency scores of provinces while only the population of province among the control variables was identified as the factor with an effect on the efficiency scores of provinces (p < 0.05).

Practical implications

The results of this study are thought to guide health policymakers and managers in terms of both determining efficient and inefficient hospitals at the provincial level and revealing which variables should be taken into account in order to increase efficiency.

Originality/value

The study differs from previous studies on the efficiency of hospitals. First, although previous studies were generally descriptive studies to determine the efficiency level of hospitals, this study is an analytical study that tries also to show the factors affecting the efficiency of hospitals. In addition, while examining the effect of input and output variables on efficiency scores, control variables were also included in the study.

Prioritization of the policies and practices applied in Turkey to fight against covid-19 through AHP technique

Abstract Concerns about covid-19 become deeper globally. Due to these concerns, all countries, international health institutions, health authorities and health care professionals in the world take several measures through policies or practices to control and handle covid-19 pandemic. For example; different types of policies in the fight against covid-19 have been launched in Turkey. Therefore, in this study, we sought to determine how policies and practices against covid-19 were prioritized by health care professionals and other segments of society via AHP method. We observed that the order of importance of health care professionals and other segments of the society regarding the policies and practices used in combating the covid-19 outbreak was quite similar between the groups. The covid-19 test policy was revealed as the most important one of both groups. However, social welfare programs have more significance than economic measures for society, while health care professionals are more concerned with economic measures. With this study, we intend to provide evidence-based information to decision-makers in combating the pandemic.

Individual and socio-demographic determinants of suicide: An examination on WHO countries

BACKGROUND

Suicide cases have psychological, socio-economic and cultural aspects, and such cases may have catastrophic impacts in societies due to their outcomes.

PURPOSE

This study was aimed to reflect the effect of psychological, behavioral, socio-demographic and economic determinants on suicide.

METHODS

The Ordinary Least Square (OLS) Regression Analysis was utilized for the purposes of this study. Five models were established. In this contex, the first model includes the variables on psychological determinants; the second model with the variables on behavioral determinants; the third model with the variables on socio-demographic determinants; the fourth model with the variables on economic determinants and finally the fifth model with all of the independent variables.

CONCLUSION

According to the results, the variables of depression prevalence, alcohol consumption and unemployment rates had statistically significant effect on the suicide cases (p < .05). The study's outcomes are considered to contribute on the evidence-based policy development process.

Effect of economic crisis on suicide cases: An ARDL bounds testing approach

BACKGROUND

Suicide events observed in various groups, community or countries, especially in the periods of economic recession. It is thought that suicide cases increase when people's income decreases dramatically and they lose their jobs.

AIM/OBJECTIVE

In this study, it was aimed to investigate whether the 2008 economic crisis had any effect on suicides in the United States.

METHODS

Autoregressive distributed lag method was used. For the purpose of the study, the number of suicide-related deaths was taken as the dependent variable, while unemployment rates and 2008 economic crisis were taken as independent variables.

FINDINGS

The short-term and long-term relationships obtained within the scope of the study indicated that the 2008 economic crisis had a statistically significant effect on suicide cases in the United States.

RESULTS AND CONCLUSION

It can be said that the results of this study are consistent with the information which emphasizes that economic crises increase suicide cases in the literature.

Violence Against Doctors and Nurses in Hospitals in Turkey

PURPOSE

This study shows the rates of violence experienced by doctors and nurses and their ensuing responses including reporting rates and any effects experienced because of the violence.

METHOD

The Survey for Investigating the Violence on Medical Employees was administered to 254 doctors and nurses. Data were analyzed using chi-square and logistic regression analysis.

RESULTS

Of the participants, 74.4% had been exposed to some form of violence. Most of the participants, 87.3%, experienced verbal violence; 12.2% experienced physical violence; and 0.5% experienced sexual violence. Logistic regression analysis indicated that married doctors and nurses are at risk of experiencing violence 0.5 times greater when compared with unmarried or widowed doctors and nurses (p = 0.026). The experience of violence differs by hospital type (p = 0.038) and years working in the healthcare industry (p = 0.042). Differences were also found regarding exposure to violence between doctors and nurses in terms of time of day (p = 0.031) and the work being performed (p < 0.001). The most cited cause of violence (50.8%) was the healthcare system. Verbal response was the most frequent reaction to violence (24.4%), with loss of occupational performance (58.2%) being the most cited negative outcome. Approximately 9.3% of the victims reported the violence to judicial authorities. A lengthy judicial proceeding was chosen as the most significant hindrance to reporting the violence (45.8%).

DISCUSSION

This study reveals the effects of violence and reporting rates at two hospitals in Turkey, and it implies that underreporting of violence is an important issue. Therefore, hospital management should take measures to increase reporting and take necessary actions when violence is reported.