Yusuf Celik

The socio-economic determinants of maternal health care utilization in Turkey.

The purpose of this study is to investigate the individual-, household- and community-level factors that affect womens use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.

The socio-economic determinants of alternative sources of antenatal care in Turkey.

This paper tries to ascertain the factors affecting the choice of alternative sources for antenatal care. The analysis is based on data collected from ever-married women in the 1998 Turkey Demographic and Health Survey (TDHS). The developing country setting provides substantial variation in the type of facility chosen, ranging from no antenatal care, to formal health care personnel, to modern private hospitals. The alternatives vary greatly in quality and price, making this an ideal context for examining the role of these variables in choosing a facility. The logit model specifications estimated individual, household-level and community-level characteristics of the women in the urban and rural sample as well as in the total sample in this study. The estimation results indicate that individual characteristics such as educational attainment and birth order are significant determinants of choosing alternative sources for antenatal care. The results also indicate that household-level characteristics such as health insurance coverage, car ownership, household assets and community-level characteristics are the other significant determinants of using alternative sources for antenatal care.

Cost of nosocomial infection in Turkey: an estimate based on the university hospital data

Nosocomial infections significantly affect the resource needs of hospitalized patients. They increase the mortality and morbidity of affected individuals and expose hospital staff to increased risk of infection. To estimate the additional resources needed in the hospital sector to deal with such infections, a sample of infection cases was selected from the Hacettepe University Hospital in Ankara, Turkey. Each case of nosocomial infection was matched with a noninfected case after controlling for age, sex, clinical diagnosis etc. of the patients. The empirical results indicate that hospital infection increases the average hospital stay by about four days. Total cost of an infected case, on average, was found to be

Factors Affecting Satisfaction Level with the Food Services in a Military Hospital

442 higher than that for a matched noninfected case. Using this incremental cost estimate, projections for Turkey implies that the hospital sector had to spend an additional

Effects of Antenatal Care Services on Birthweight: Importance of Model Specification and Empirical Procedure Used in Estimating the Marginal Productivity of Health Inputs

48 million in 1995 for medical management of nosocomial infections. The benefit:cost ratio for a hospital-based infection control programme is found to be about 4.6. Clearly, a programme for preventing nosocomial infections will not only pay for itself but also will generate other direct and indirect benefits to patients and society as a whole.

How Responsive Turkish Health Care System Is to Its Citizens: The Views of Hospital Managers

Objective: To determine the factors affecting general satisfaction level of patients with the food services in a military hospital in Turkey. Study design: The study was carried out in a military hospital providing tertiary health care services with the capacity of 1000 hospital bed. A questionnaire was used as data collection tool on measuring satisfaction of the patients with the food services. Results: The results showed that of 374 patients 51.3% evaluated food service quality adequate, 32.4% said that the food quality was inadequate, and 16.3% stated that they were uncertain. A logistic regression model was estimated in determining the most important and statistically significant factors affecting patient satisfaction with hospital foods and food services. The results showed that patient-specific demographic characteristics were insignificant in explaining satisfaction level with food services, but the variables of taste (OR = 9.853, p = 0.000) and appearance (OR = 2.687, p = 0.014) of the food were statistically significant and important determinants of patient satisfaction with the foods served at the hospital. Conclusions: The results of this study would be helpful in making decision on increasing the level of satisfaction of patients with the food services for hospital managers and the food (nutrition) departments. On the other hand, the results can also be used in benchmarking the hospitals food services quality with other hospitals, and in monitoring improvements in food services quality in the future.

Achieving value for money in health: a comparative analysis of OECD countries and regional countries

This paper is an attempt to examine the effects of antenatal care (ANC) utilization on birthweight. The analysis is based on the data collected from ever-married women by Turkey Demographic and Health Survey 1998 (TDHS). Cost-effectiveness based health sector reform requires careful estimation of costs and productivity of health interventions as well as the substitution possibility among health inputs. If the parameters of production function are known, policy makers can estimate the health outcome effects of various input-mix. Two-stage least squares (TSLS) and ordinary least squares (OLS) estimation procedures are used in this paper to estimate the effect of health care input, namely antenatal care visits, on birthweight. Since the utilization of medical care itself may be dependent on womens expectation about the pregnancy outcome, the parameters estimated through OLS may underestimate the true productivity of the input. The estimated functions indicate that antenatal care, womans health status, and birth order are significant determinants in birthweight. The TSLS estimate of marginal productivity of ANC visits was about four times the marginal productivity estimate in the OLS model. The sensitivity of the parameter estimates to model specifications and empirical procedures followed demonstrates the importance of selecting the right model from both theoretical and empirical point of view.

Comparison of Computing Capability and Information System Abilities of State Hospitals Owned by Ministry of Labor and Social Security and Ministry of Health

With this paper it was tried to give a broad perspective about the responsiveness level of Turkish health care system, and how Turkish health care system meets the expectations of its citizens. For achieving the main purpose of this study a sample of hospital managers (n = 172) was selected, and the responsiveness questionnaire developed by WHO was administered. If the responsiveness level of Turkish health care system is measured on the basis of the Turkish hospital managers’ views in the sample by using the weights reported in the World Health Report 2000, responsiveness level is calculated as 6.14, and Turkeys place should be 35 rather than 93 among 191 countries. The findings showed that Turkish health care system met confidentiality expectations of Turkish citizens better than other expectations for other aspects of responsiveness. In light of the main results of this study we conclude that the economic status, demographic structure, culture, and some other regional and country-specific factors should be taken into account by calculating and especially ranking the countries according to responsiveness level of their health care systems, and each country should carry out this kind of studies by using the views of their own key informants or preferably citizens, if possible.

Evaluation of patient wristbands and patient identification process in a training hospital in Turkey.

OBJECTIVE To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. METHODS An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. RESULTS Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. CONCLUSIONS Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright

The Factors Affecting Length of Stay of the Patients Undergoing Appendectomy Surgery in a Military Teaching Hospital

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool.The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.