Efficiency and intrinsic quality in healthcare: blending radial and non-radial measures of efficiency with a flashpoint of long-term health policy

Purpose Efficiency and quality are primary factors for the survival of health systems. The evaluation of the efficiency of the healthcare system is a crucial component of promoting long-term health policy actions. Healthcare capacity indicators provide a basis for evaluating and comparing the performance of different healthcare organizations. Intrinsic quality indicators are Donabedian (1980)’s structural and process elements of quality of healthcare. This study aims to integrate capacity and intrinsic quality indicators of healthcare while measuring the efficiency of provinces by using radial and non-radial efficiency measurement techniques. Design/methodology/approach Efficiency analysis performed in Turkey from 2015 to 2020 by performing input-oriented radial, nonradial, and super-efficiency estimates for 81 provinces of Turkey by incorporating capacity and intrinsic quality indicators into the different model specifications. Findings Radial and nonradial efficiency results have an increasing trend over the study years obtained from the efficiency models showing high average scores obtained from the models that include intrinsic quality of care indicators. Statistically significant mean rank differences are observed between different radial efficiency models for all study years ( p  < 0.001). Negative and moderate level correlations were observed between radial efficiency results and quality of care indicators (r < 0.70). Originality/value Under long-term centralized health policies, increases in efficiency result in decreased intrinsic quality of care indicators. A better synthesis of health system capacity and intrinsic healthcare quality indicators is necessary to generate evidence-based health systems.