Comparative performance analysis of public-private partnership hospitals in Türkiye

Public-private partnership (PPP) initiatives in healthcare are being extended globally, often to reduce the government's financial burden in public infrastructure provision. One of the important reforms in the Turkish health system is the structural and functional transformation of public hospitals through the PPP model. This study is the first longitudinal bootstrap data envelopment analysis assessment comparing the performance of public hospitals in Türkiye before and after implementing the PPP model.

The efficiency of 14 PPP hospitals from 2015 to 2023 were obtained via bootstrap data envelopment analysis to correct bias in efficiency estimates. Two different models, called EQ (only equipment) and PH (only physicians) were designed to examine the performance of hospitals more comprehensively and to determine whether the reasons that negatively affect their performance are due to a lack of equipment or health professionals.

The findings indicated that hospitals managed on the basis of the PPP model in Türkiye generally achieved higher efficiency scores than when they were traditionally managed. Between 2015 and 2020, referred to as the pre-PPP period, the average EQ score decreased from 0.82 to 0.80, while between 2017 and 2023, referred to as the post-PPP period, this score increased from 0.76 to 0.91. Similarly, the average score of the PH model decreased from 0.93 to 0.90 in before PPP period and increased from 0.82 to 0.90 in after PPP period. Furthermore, the COVID-19 pandemic has also negatively affected the performance of the PPP model by causing a general reduction in the use of health services.

Public hospitals built under the PPP model have made a significant contribution to strengthening Türkiye's healthcare infrastructure. This study shows that more comprehensive assessments such as comparisons with non-PPP hospitals, however long-term cost-benefit studies are needed to reach definitive conclusions about the PPP model.