Exploring the nexus of equality and efficiency in healthcare

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Çinaroğlu S.

International Journal of Productivity and Performance Management, vol.71, no.2, pp.1-20, 2022 (ESCI)

  • Publication Type: Article / Article
  • Volume: 71 Issue: 2
  • Publication Date: 2022
  • Journal Name: International Journal of Productivity and Performance Management
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, ABI/INFORM, Aerospace Database, Business Source Elite, Business Source Premier, Communication Abstracts, EBSCO Education Source, INSPEC, Metadex, Civil Engineering Abstracts
  • Page Numbers: pp.1-20
  • Hacettepe University Affiliated: Yes


Purpose – This study aims to explore the nexus of equality and efficiency by considering public hospitals’ development dynamics, capacity and technology indicators. Design/methodology/approach – Data was collected from the Ministry of Health Public Hospital Almanacs from 2014 to 2017. The Gini index (GI) is used to estimate the inequality of distribution of hospital performance indicators. A bias-corrected efficiency analysis is calculated to obtain efficiency scores of public hospitals for the year 2017. A path analysis is then constructed to better identify patterns of causation among a set of development, equality and efficiency variables. Findings – A redefined path model highlights that development dynamics, equality and efficiency are causally related and health technology (path coefficient 5 0.57; t 5 19.07; p < 0.01) and health services utilization (path coefficient50.24; t58; p <0.01) effects public hospital efficiency. The final path model fit well (X2/df 5 50.99/8 5 6; RMSEA 5 0.089; NFI 5 0.95; CFI 5 0.96; GFI 5 0.98; AGFI 5 0.94). Study findings indicate high inequalities in distribution of health technologies (GI > 0.85), number of surgical operations (GI >0.70) and number of inpatients (GI > 0.60) among public hospitals for the years 2014–2017. Originality/value – Study results highlight that, hospital managers should prioritize equal distribution of health technology and health services utilization indicators to better orchestrate equity-efficiency trade-off in their operations.