Efficiency in Healthcare: More Services or Better Care?
The New Paradigm of Health Tourism – Part 14
Behlül Ünver – President, World Health Tourism Platform
We have long used numbers to describe success in healthcare: consultations, operations, beds used, tests and billed revenue. All matter, but none alone shows whether care is truly efficient. Efficiency means delivering care to the right patient, at the right time and place, by the right professional and with the right resources. Perhaps our question should extend from “How much service did we produce?” to “How much value did it add for the patient?”
Volume and efficiency are different
A physician seeing many patients or a hospital performing many procedures may appear highly productive. But shorter consultations, unnecessary tests, repeat visits, inappropriate levels of care or returns caused by complications can mean high volume without real efficiency.
Healthcare volume is not the same as efficiency.
The objective should be the best possible health outcomes through appropriate resources. Alongside patient numbers, we must assess time to correct diagnosis, treatment outcomes, repeat visits, complications, readmissions, experience and resource use.
Payment models shape behaviour
Payment arrangements may appear technical, but are among management’s strongest tools. Over time, systems tend to produce more of the outputs for which providers and professionals are paid.
Fee-for-service may increase revenue as procedures increase. Bundled payment emphasises the cost and organisation of an entire treatment episode. Capitation can encourage prevention and resource management. Outcome- and quality-linked models recognise the result for the patient as well as the procedure.
No model is perfect; each has advantages and risks. The priority is alignment with health policy objectives. Payment shapes behaviour, organisation and even healthcare culture.
Why do SGK and SUT matter in Türkiye?
The Social Security Institution, SGK, and the Health Implementation Communiqué, SUT, are important determinants of healthcare financing. Institutions use this system to assess which services qualify for reimbursement and under what conditions.
Tariffs therefore influence investment, organisation, developing service areas and working practices, alongside revenue. The more important question, beyond whether prices are high or low, is whether payment encourages appropriate care.
Can an institution improving quality, reducing complications, maintaining the right level of care, preventing unnecessary procedures and reducing readmissions receive economic support? Or does the system mainly reward volume?
Without the right connection between payment and clinical quality, financially rational behaviour may differ from what is best for patients. Policy should bring these closer together.
More value beyond procedure numbers
Value-based healthcare is increasingly discussed internationally. It assesses the system’s value through patient outcomes alongside activity. Surgical success can include complications, readmissions, functional recovery, satisfaction and quality of life after treatment. This encourages providers to consider the whole journey.
Efficiency then takes on a different meaning. It means avoiding unnecessary care, reducing complications and repeat visits, and achieving the right outcome with appropriate resources.
How should public performance be measured?
Public hospital performance should include waiting times, outcomes, complications, readmissions, bed turnover, resources, patient and employee satisfaction, educational capacity and research, alongside consultations, surgery and revenue. The same applies to staff performance systems.
A system rewarding only greater activity can create an imbalance between quantity and quality. Quality, teamwork, safety, education and outcomes should carry weight. Care is a team result: physicians, nurses, technicians, pharmacists, physiotherapists, administrators and others contribute to the same journey.
The right care at the right level
Directing every problem to a hospital, every hospital visit to an advanced centre and every patient to a specialist may create unnecessary pressure. Strong primary care, referral pathways, chronic disease management, home care, remote care and prevention improve experience and reserve expensive hospital capacity for those who need it. Sometimes efficiency means preventing the need for services. Monitoring diabetes before complications, controlling hypertension before stroke and avoiding unnecessary elderly admissions are valuable, though less visible, outcomes.
Outcomes and bundled care in health tourism
Offering only a procedure price can trap Türkiye in price competition. We should aim for high healthcare value. An orthopaedic package could cover assessment, surgery, admission, rehabilitation, complication management and digital follow-up. An oncology journey could combine diagnosis, molecular assessment, planning, medicines, supportive care and monitoring. This offers price transparency, improves process management and builds an outcome-focused brand.
The “net health value” discussed last week is relevant here. Success should include the capacity, technology, workforce and clinical quality contributed to the system, alongside revenue.
The same question for public and private providers
Funding, responsibilities and patient profiles may differ, but the fundamental question remains: how much health value do we create for the resources spent?
Private providers must closely monitor investment sustainability, costs and experience. Public providers carry responsibility for access, equity and financial sustainability. Türkiye should discuss flexible combinations of payment methods according to service, disease group, institutional role and intended outcomes.
Bundled payment may suit some services, capitation others, and outcome- and quality-linked payment selected specialised treatments. What matters is the behaviour and results created.
After years of asking how much service we produce, perhaps it is time to ask how much value that service genuinely adds for patients.
The most successful system may be the one delivering the best outcomes to the right patient, at the right time and place, with the right resources.
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