University hospitals in Turkey: Structural crisis in financing or consequence of mismanagement?

Abstract

University hospitals in Turkey have a prominent role especially in treatment of complex cases and research. However, despite their indispensible place in the health care system, their financial status has long been on the agendas of the Turkish health policy-makers and is seen as a major threat to the financial sustainability of the whole system. It has been reported that the total debt of university hospitals has reached to 4.5 billion TRY (1.1 billion €) in 2016. This debt is to the third parties that provide medical devices, pharmaceuticals or services to these hospitals. There is also an increasing trend in university hospital debts calling for an urgent attention from the government. This article aims at exploring the financial status of university hospitals and showing that with a new management approach focusing on efficiency and effectiveness measures, the problem could be overcome. The example from Hacettepe University Hospital showed that a problem solving management approach and a reformist vision between December 2011-January 2016 has resulted in major improvements in the financial status of the hospital. The debts of the hospital were stabilized in this period by policies focusing on increasing number of patients and procedures, by decreasing the cost of purchasing goods and materials and by following the Social Security Institution’s (SSI) payment procedures. Starting from January 2016 a new management took the office and abandoned the measures taken by the previous administration. This led to an increase in hospital debts again. The article concluded that despite a volatile reimbursement environment, good management practices could help university hospitals to sustain their financial status.