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.

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.

What are the socioeconomic determinants of mental disorders?

PURPOSE: This study examines the influence of socioeconomic factors on the prevalence of depression and anxiety and on the number of years lived with disability (YLD) of depression and anxiety. DESIGN AND METHODS: This is an exploratory study. The study analyzed data from 160 member countries of the World Health Organization (WHO). FINDINGS: Except for alcohol consumption and unemployment rate, Gini coefficient, age dependency, rural population, and population aged 65 and above have statistically significant effects on both depression and anxiety prevalence. Also, Gini coefficient and rural population have significant effects on YLD of depression and anxiety. PRACTICE IMPLICATIONS: The study results will allow psychiatrists, psychologists, and other mental health professionals to focus on policy reforms that address the social determinants of mental health.

Does Efficiency of Oral and Dental Health Centers Change by the Development Level of Regions?

OBJECTIVES: This study aimed to analyze the efficiency levels of oral and dental health centers (ODHCs) affiliated to the Ministry of Health from the perspective of the development levels in the regions. METHODS: Within the framework of this study, the efficiencies of 127 ODHCs are evaluated with the data envelopment analysis based on Charnes, Cooper, Rhodes (CCR); Banker, Charnes, Cooper (BCC); and scale efficiency methods. RESULTS: It is found that CCR, BCC, and scale efficiencies of the 42 ODHCs located in the first region, the highest development region, are efficient by 31%, 50%, and 38% whereas 13%, 26%, and 26% of other 85 ODHCs located in other regions are efficient, respectively. Additionally, the average efficiency scores of 42 ODHCs in the first region by CCR (0.82), BCC (0.89), and score efficiency (0.93) are much higher than the average efficiency scores of 85 ODHCs in other regions by CCR (0.73), BCC (0.80), and scale efficiency (0.92). CONCLUSIONS: According to the findings, it is considered that the individuals from the first region use the oral and dental healthcare more than the individuals do in other regions because the access to oral and dental healthcare is higher in the first region and the individuals living in this region have better predisposing and enabling factors. The study results are thought to present evidence-based information to health policy makers regarding the regional planning of oral and dental healthcare.

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.

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.

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.

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.

Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis.

This study aimed to reflect the efficiency of hospitals under the Ministry of Health (MoH) before and after the implementation of Public Hospital Associations (PHAs). This study covered 3 years before (2010-2012) and 3 years after (2013-2015) the implementation. The population of the study included 865 hospitals under the MoH providing health care services in 81 provinces. No sample was selected; all hospitals were included under the scope of study. The provinces were chosen as the decision-making unit. Changes in the efficiency values of hospitals were analyzed with the Malmquist Total Factor Efficiency Index. The results showed that, for the pre-PHAs period, 24 provinces in 2010, 27 provinces from 2010 to 2011, and 32 provinces from 2011 to 2012 were assessed as efficient. From 2012, the year of implementation, to 2013, the number of efficient provinces dropped to 16. However, 20 provinces were subsequently found to be efficient from 2013 to 2014, and 26 from 2014 to 2015. The efficiency scores average of all provinces were found to be 0.89, 0.92, 0.92, 0.82, 0.88, and 0.90, respectively. Further, the efficiency score average of the 3 years before PHAs (0.91 ± 0.09) was significantly higher than the score obtained 3 years after PHAs (0.86 ± 0.11; p < 0.05). In consideration of such finding, the PHAs established at the provinces were identified as hampering increased efficiency.

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.