Regional performance evaluation of healthcare services in Türkiye with cross-efficiency approach.

Objective: Monitoring and comparing regional service performance is inevitable to use resources effectively and allocate resources without creating interregional inequalities. With the Health Transformation Program, there has been an increase in the amount and quality of the service provided throughout the country. In addition, there has been a decrease in the inequalities between regions due to its implementation. In order to ensure continuity in health service delivery, health service activities in provinces and regions should be followed regularly, and their performance should be evaluated. Methods: The study calculated Data Envelopment Analysis efficiencies and Cross-efficiency for 26 subregions in the NUTS-II classification in Turkey. The number of hospital beds and primary care units were the inputs of the research; the number of primary, secondary and tertiary care visits and the number of inpatients are also the output of the study. Subregions are reordered and grouped according to their cross-efficiency. Decisionmaking units with unusual production structures were investigated by calculating Maverick Index scores. Results: Regarding DEA efficiency, the average efficiency score of the ten subregions classified as efficient is 0.97 (sd. 0.0395). The average crossefficiency score obtained from the benevolent method is 0.89 (sd. 0.058), while the average score achieved through the aggressive method is 0.86 (sd. 0.574). Maverick index scores had a balanced distribution. The average maverick index score for aggressive and benevolent are 0.13 (std. 0.0474), and 0.0871 (std. 0.0420), respectively. Although only the Malatya subregion was classified as efficient in the traditional DEA method, it had low scores in the cross-efficiency evaluation and was classified as a maverick decision unit with an MI score of 0.21. Conclusion: The cross-efficiency method yields more valuable results because it employs more realistic weights for peer evaluation. These outcomes are simpler for decision-makers to comprehend and assess. The regions of Kocaeli, Adana, Aydın, Hatay, Şanlıurfa, and Tekirdağ exhibit notable performance in the cross-efficiency examination, as they have attained the most significant efficiency scores. The regions of Kastamonu, Erzurum, Van, and Ağrı exhibit poor levels of efficiency, thereby requiring the implementation of precautionary measures. [ABSTRACT FROM AUTHOR]