A mixed method research on the investigation of performance changes of affiliated hospitals

Affiliation is a sectoral merger or partnership model in the health sector. It means integration among institutions. Affiliation was introduced in 2011 and implemented in 2013 by public hospitals in Türkiye. This study had two objectives: (1) addressing the economic and organizational changes in performance in affiliated hospitals and (2) identifying its positive and negative aspects in practice. The study adopted a mixedmethod research design. Quantitative data were analyzed using data envelopment analysis. Qualitative data were analyzed through interviews with hospital administrators. The quantitative sample consisted of ten public hospitals, while the qualitative sample consisted of 30 hospital administrators. The quantitative findings showed that the hospitals had a partial decrease in expenses and a partial increase in revenues. The higher the number of patients, the more the healthcare services. The hospital administrators believed that hospitals needed affiliation. They stated that organizational problems arose in practice, that affiliation had positive and negative aspects, and that all these caused changes in performance. The results indicate that all stakeholders in the affiliation model have great returns. However, they should collaborate to turn affiliation into an ideal structure.