The effect of COVID-19 pandemic on the efficiency of training and research hospitals in Turkey

The Coronavirus disease 2019 (COVID-19), which emerged in December 2019, caused an increase in the demand for healthcare services globally. Hospitals' operational and financial performances are thought to have been negatively affected by COVID-19 because they had to postpone providing non -urgent healthcare services to prevent infection. This study aimed to evaluate how the COVID-19 pandemic has affected the efficiency of training and research hospitals in Turkey. The study population comprised 51 training and research hospitals. The Malmquist Total Factor Productivity index was used to examine the changes in the efficiency of the training and research hospitals between 2017-2018, 2018-2019, 2019-2020, and 2020-2021. In addition, a repeatedmeasures ANOVA test was used to evaluate whether a significant difference existed in the efficiency levels of the hospitals in the pre-COVID-19 pandemic periods (2017-2018 and 2018-2019) and during them (2019-2020 and 2020-2021). No significant difference was found between hospitals' technical and scale efficiency levels before and during the pandemic, but the change in total factor productivity was significant (F = 34.18; p < 0.001). Our research findings provide clues about how hospitals' behaviours changed during the pandemic compared to before the pandemic. It was observed that efficiency decreases in hospitals at the onset of the pandemic disappeared with the adaptation process to the new normal. Technical efficiency decreased in two periods (2017-2018 and 2020-2021) when total factor productivity increased. Reverse changes in total factor productivity and technical efficiency indicate that technological change drives total factor productivity. This study identified differences in hospital efficiency during both ordinary and extraordinary periods. It would benefit managers and policymakers to recognise these differences and focus on managerial skills that ensure technical efficiency in extraordinary circumstances to mitigate possible efficiency losses.