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Halk sağlığı hizmetlerinin sağlık sistemlerinin performansı üzerindeki etkileri: Dinamik network veri zarflama analizi ile bir uygulama

Amaç: Küresel olarak sağlık sistemlerinin, artan talep ve maliyetler gibi etkenler nedeniyle sağlık hizmetlerinin sürdürülebilirliği ile ilgili endişeleri artmaktadır. Ülkeler bir yandan güvenli ve kaliteli sağlık hizmetini güvence altına almaya gayret ederken diğer yandan artan maliyetlerle mücadele etmek zorundadırlar. Artık sağlık sistemlerinin tedavi edici rolünün ötesine geçmesi gerektiği anlaşılmıştır. Bireyi hastalandırmadan tedavi etmeye ilke edinen halk sağlığı hizmetleri söz konusu problemleri telafi etmek için kullanılabilecek en rasyonel ve maliyet etkili araçtır. Halk sağlığı, sağlık hizmetlerinin organizasyonuna toplumsal bir bakış açısı getirerek hizmetlerin etkililiğini artırmaya yardımcı olabilir. Yöntem: Çalışmada 27 OECD ülkesindeki sağlık sistemlerinin 2010 ile 2018 yılları arasındaki etkinlikleri Dinamik Network Veri Zarflama Analizi yöntemi kullanılarak hesaplanmıştır. Halk sağlığı ve hastane hizmetleri sistemleri, etkinlikleri ve genel sağlık sistemi performansları gözden geçilmiştir. Analiz edilecek değişkenler halk sağlığı sistemi için alkol tüketimi, birinci basamak sağlık harcamaları, beklenen ortalama süreleri ve anne ölüm oranları iken hastane hizmet sistemi için hastane yatak sayıları ve hekim sayıları, yatan hasta sayıları ve ayakta tedavi edilen hasta sayıları olarak belirlenmiştir. Halk sağlığı sistemi ile hastane hizmet sistemi arasındaki bağlantı bebek aşılama oranları ile diyabete bağlı hastane yatış sayıları temel alınarak sağlanmıştır. Ayrıca dönemler arasındaki ilişki halk sağlığı sistemi için önlenebilir ölüm oranları ile hastane hizmet sistemi ise tedavi edilebilir ölüm oranları ile sağlanmıştır. Bulgular: Ülkelerin ortalama etkinlik skorları hesaplandığında dokuz ülke etkin olarak hesaplanmıştır. Halk sağlığı sistemi etkin olarak değerlendirilen ülke sayısı 11, hastane hizmet sistemi etkin olarak değerlendirilen ülke sayısı 18 olarak hesaplanmıştır. Malmquist indeks sonuçlarına göre beş ülke hariç tüm ülkelerin toplam faktör verimliliği artmıştır. Sonuç: Etkin olmayan sağlık sistemlerinin girdi ve bağlantı projeksiyonlarına bakıldığında sağlık sistemlerinin girdi kullanımlarını iyileştirmesi, yaşam tarzına bağlı hastalıklar, anne ölümleri ile önlenebilir ve tedavi edilebilir ölümler konularında önlem almaları gerekmektedir. Sekiz yıllık süreçte sağlanan ilerlemelere rağmen daha gidilecek çok yol olduğu ortadadır.

Effects of public health services on health systems performance: An application with dynamic network data envelopment analysis

Objective: Health systems are increasingly concerned about the sustainability of health services due to factors such as increasing demand and costs worldwide. While countries seek to secure safe and quality health care, they also struggle with increasing costs. It is now recognized that health systems must go beyond their therapeutic role. Public health services adopting the principle of keeping individuals healthy are the most rational and cost-effective tools that can be used to compensate for these problems. Public health can help improve the effectiveness of health services by bringing a societal perspective to the organization of health services. Methods: Efficiencies of the health systems of 27 OECD countries between 2010 and 2018 were calculated using the Dynamic Network Data Envelopment Analysis method. Public health and hospital services system efficiencies and overall system performance are examined. The variables to be analyzed were alcohol consumption, primary health care expenditures, average life expectancy, maternal mortality rates for the public health system, hospital beds, physicians, inpatients and outpatient numbers for the hospital service system. The connection between the public health system and the hospital service system is based on vaccination rates and diabetes-based hospitalization numbers. In addition, the relationship between the periods is provided by preventive mortality rates for the public health system and the treatment of the hospital service system. Results: The average efficiency scores of the countries were calculated, nine countries were efficient. The number of public health systems evaluated as efficient was 11, and the number of efficient hospital service systems was 18. According to Malmquist index results, the total factor productivity of all countries has increased except for five countries. Conclusion: Considering the input and connection projections of ineffective health systems, health systems need to improve their use of inputs and take precautions against lifestyle-related diseases, maternal mortality, and preventable and treatable mortalities. Despite the progress made in the eight-year period, it is clear that there is still a long way to go.

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