Analysis of Hospital Admissions and Invoice Amounts in Turkey within the Context of the Referral Chain Based on Social Security Institution Data: A Retrospective Study

This study aims to examine the number of referrals to second-tier public hospitals, third-tier hospitals, and private hospitals, as well as the total invoice amounts, within the context of the referral chain, using data from the Social Security Institution data application between 2019 and 2024. First, a correlation analysis was performed on the data. To elaborate on the significant correlations identified in the correlation analysis, a structural equation model (SEM) was developed. The total number of hospital visits is positively and directly influenced by the total number of third-tier hospital visits (β =0.421) and the number of second-tier hospital visits (β =0.625). Second-level hospital visits have a direct negative effect on total visit total invoice amounts (β = −0.620). Third-level hospital visits have a direct positive effect on total visit total invoice amounts (β =1.305). The total number of third-level hospital visits directly negatively affects the total number of private hospital visits (β =-0.550). The number of second-level hospital visits has an indirect negative effect on the total number of private hospital visits through the number of third-level hospital visits (β =-0.449). Our study shows that to reduce the total invoice amount, it is necessary to improve the quality of secondary and tertiary healthcare services and implement a referral chain. Improving the quality of secondary and tertiary healthcare services and reducing unnecessary referrals will decrease citizens’ preference for private hospitals over public hospitals due to reasons such as service quality and long examination times.