Does Urbanization Induce the Health Expenditures? A Dynamic Macro-Panel Analysis for Developing Countries

Yıl 2019, Sayı: 61, 208 - 222, 23.07.2019

Mümin Atalay Çetin İbrahim Bakırtaş

Öz

Fast growing
urban population brings some opportunities while it can also causes significant
health costs, especially in developing countries. This study aims to
investigate the possible impact of urbanization on health expenditures in 89 developing
countries during the period 2006-2015 by using both static and dynamic panel
data techniques. Fixed Effects (FE) estimator results showed that the health
expenditures per capita has a positive relationship with income per capita, the
share of government expenditures, out-of-pocket payments per capita, the share
of population ages 65 and above. Furthermore, FE findings revealed that the
increased urbanization also induces the healthcare expenditures in developing
countries. In addition, dynamic panel estimation method is also applied in the
empirical analysis to avoid the possible endogeneity problem and to consider
the dynamic properties. Thus, Generalised Methods of Moments (GMM) findings
showed that the urbanization leads healthcare expenditures in developing
countries. Thereby, GMM results are coherence with the FE findings.
Consequently, the empirical results indicate the importance of urbanization as
a determinant of healthcare expenditures. Therefore, developing countries’
policy makers should re-consider their urban development policies to prevent
from the negative externalities of rapid urbanization.

Anahtar Kelimeler

Urbanization, Health Expenditures, Fixed Effects, GMM, Developing Countries

Kentleşme Sağlık Harcamalarını Arttırır mı? Gelişmekte Olan Ülkeler İçin Bir Dinamik Makro-Panel Analiz

Öz

Hızla artan
kentsel nüfus çeşitli fırsatları beraberinde getirdiği gibi, özellikle
gelişmekte olan ülkelerde, önemli sağlık maliyetlerine de neden olabilmektedir.
Bu çalışma, 89 gelişmekte olan ülke için 2006-2015 yılları arasında
kentleşmenin sağlık harcamaları üzerindeki olası etkisini statik ve dinamik
panel veri teknikleri ile incelemeyi amaçlamaktadır. Sabit Etkiler (FE)
tahminci sonuçları kişi başına düşen sağlık harcamalarının, kişi başına düşen
gelir, kamu harcamaları, sağlık harcamaları için gerçekleştirilen kişi başına
nakit ödemeler ve 65 yaş ve üstü nüfus ile doğru yönlü bir ilişki içinde
olduğunu göstermiştir. Ayrıca, FE bulguları gelişmekte olan ülkelerde
kentleşmede yaşanan artışın sağlık harcamalarını arttırdığını ortaya
çıkarmıştır. Buna ek olarak, bu çalışmada, olası içsellik sorunlarından
kaçınmak ve dinamik özellikleri göz önünde bulundurmak için dinamik panel
tahmin yöntemleri de uygulanmıştır. Bu bağlamda gerçekleştirilen Genelleştirilmiş
Momentler Yöntemi (GMM) bulguları kentleşme oranındaki artışın sağlık
harcamalarını arttırıcı bir etkisi olduğunu göstermiştir. Dolayısıyla, GMM
sonuçları FE bulguları ile uyumludur. Çalışmanın ampirik bulguları,
kentleşmenin, gelişmekte olan ülkelerde sağlık harcamalarının önemli bir
belirleyicisi olduğunu ortaya koymuştur. Bu nedenle, gelişmekte olan ülkelerin
politika yapıcıları, hızlı kentleşmenin negatif dışsallıklarını önlemek için
kentsel gelişim politikalarını yeniden gözden geçirmelidir.

Anahtar Kelimeler

Kentleşme, Sağlık Harcamaları, Sabit Etkiler, GMM, Gelişmekte Olan Ülkeler

Kaynakça

• Abbas, F., & Hiemenz, U. (2011). Determinants of public health expenditures in Pakistan. (Center for Development Research (ZEF) Discussion Papers on Development Policy No. 158). Retrieved from https://www.econstor.eu/bitstream/10419/84800/1/679510230.pdf.
• Addo, J., Smeeth, L., & Leon, D.A. (2007). Hypertension in Sub-Saharan Africa a systematic review. Hypertension, 50, 1012-1018.
• Al-Mulali, U., Fereidouni, H.G., Lee, J.Y.M., & Che Sab, C.N.B. (2013). Exploring the relationship between urbanization,energy consumption, and CO2 emission in MENA countries. Renewable and Sustainable Energy Reviews, 23, 107-112.
• Allison, P.D. (2009). Fixed effects regression models. California: SAGE Publications.
• Arellano, M., & Bond, S. (1991). Some tests of specification for panel data: Monte Carlo evidence and an application to employment equations. The Review of Economic Studies, 58(2), 277-297.
• Arellano, M., & Bover, O. (1995). Another look at the instrumental variable estimation of error-components models. Journal of Econometrics, 68, 29-51.
• Bac, C., & Le Pen, Y. (2002, July). An international comparison of healthcare expenditure determinants. Paper presented at the 10th International Conference on Panel Data. Retrieved from https://econpapers.repec.org/paper/cpdpd2002/c5-1.htm.
• Baltagi, B.H., & Moscone, F. (2010). Healthcare expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling, 27, 804-811.
• Barros, P.P. (1998). The black box of healthcare expenditure growth determinants. Health Economics, 7, 533-544.
• Beck, T., & Levine, R. (2004). Stock markets, banks, and growth: Panel evidence. Journal of Banking and Finance, 28, 423-442.
• Bedir, S. (2016). Healthcare expenditure and economic growth in developing countries. Advances in Economics and Business, 4(2), 76-86.
• Bhugra, D., & Mastrogianni, A. (2004). Globalisation andmental disorders overview with relation to depression. British Journal of Psychiatry, 184, 10-20.
• Bilgili, F., Koçak, E., Bulut, Ü., & Kuloğlu, A. (2017). The impact of urbanization on energy intensity: Panel data evidence considering cross-sectional dependence and heterogeneity. Energy, 133, 242-256.
• Blomqvist, A.G., & Carter, R.A.L. (1997). Is healthcare really a luxury?. Journal of Health Economics, 16, 207-229.
• Blundell, R., & Bond, S. (1998). Initial conditions and moment restrictions in dynamic panel data models. Journal of Econometrics, 87, 115-143.
• Boachie, M.K., Mensah, I.O., Sobiesuo, P., Immurana, M., Iddrisu, A.A., & Kyei-Brobbey, I. (2014). Determinants of public health expenditure in Ghana: A cointegration analysis. Journal of Behavioural Economics, Finance, Entrepreneurship, Accounting and Transport, 2(2), 35-40.
• Breusch, T.S., & Pagan, A.R. (1980). The Lagrange multiplier test and its applications to model specification in econometrics. The Review of Economic Studies, 47(1), 239-253.
• Cantarero, D., & Lago-Penas, S. (2010). The determinants of healthcare expenditure: a reexamination. Applied Economics Letters, 17(7), 723-726.
• Cantarero-Prieto, D., & Lago-Penas, S. (2012). Decomposing the determinants of healthcare expenditure: The case of Spain. The European Journal of Health Economics, 13, 19-27.
• Crivelli, L., Filippini, M., & Mosca, H. (2006). Federalism and regional healthcare expenditures: an empirical analysis for the Swiss cantons. Health Economics, 15, 535-541.
• Devlin, N., & Hansen, P. (2001). Healthcare spending and economic output: Granger causality. Applied Economics Letters, 8(8), 561-564.
• Di Matteo, L. (2004). What drives provincial health expenditure?. Canadian Tax Journal, 52(4), 1102-1120.
• Di Matteo, L. (2005). The macro determinants of health expenditure in the United States and Canada: Assessing the impact of income, age distribution and time. Health Policy, 71, 23-42.
• Dormont, B., Grignon, M., & Huber, H. (2006). Health expenditure growth: reassessing the threat of ageing. Health Economics, 15, 947-963.
• Dreger, C., & Reimers, H.E (2005). Healthcare expenditures in OECD countries: A panel unit root and cointegration analysis. (Institute for the Study of Labor (IZA) Discussion Paper Series No. 1469). Retrieved from https://pdfs.semanticscholar.org/e1d9/b3e148b409e6d8b3cb29f237c99d67b2912a.pdf.
• Eckert, S., & Kohler, S. (2014). Urbanization and health in developing countries: A systematic review. World Health and Population, 15(1), 7-20.
• Erdil, E., & Yetkiner, I.H. (2009). The Granger-causality between healthcare expenditure and output: a panel data approach. Applied Economics, 41(4), 511-518.
• Esteve, V., & Martinez-Zahonero, J.L. (2007). Testing the long-run relationship between health expenditures and GDP in the presence of structural change: The case of Spain. Applied Economics Letters, 14, 271–276.
• Fattahi, M. (2015). The role of urbanization rate in the relationship between air pollution and health expenditures: A dynamic panel data approach. International Letters of Social and Humanistic Sciences, 53, 68-72.
• French, D. (2012). Causation between health and income: a need to panic. Empirical Economics, 42, 583-601.
• Gbesemete, K.P., & Gerdtham, U.G. (1992). Determinants of healthcare expenditure in Africa: A cross-sectional study. World Development, 20(2), 303-308.
• Gerdtham, U.G., Søgaard, J., Andersson, F., & Jönsson, B. (1992a). An econometric analysis of healthcare expenditure: A cross-section study of the OECD countries. Journal of Health Economics, 11, 63-84.
• Gerdtham, U. G., Søgaard, J., Jönsson, B., & Andersson, F. (1992b). A pooled cross-section analysis of the healthcare expenditures of the OECD countries. In: P. Zweifel & H.E. Frech (Ed.), Health Economics Worldwide. Developments in Health Economics and Public Policy (pp.287-310). Dordrecht: Springer.
• Gerdtham, U.G., & Löthgren, M. (2000). On stationarity and cointegration of international health expenditure and GDP. Journal of Health Economics, 19, 461-475.
• Gerdtham, U.G., & Löthgren, M. (2002). New panel results on cointegration of international health expenditure and GDP. Applied Economics, 34(13), 1679-1686.
• Godfrey, R., & Julien, M. (2005). Urbanisation and health. Clinical Medicine, 5(2), 137-141.
• Hansen, P., & King, A. (1996). The determinants of healthcare expenditure: A cointegration approach. Journal of Health Economics, 15, 127-137.
• Harpham, T. (1994). Urbanization and mental health in developing countries: A research role for social scientists, public health professionals and social psychiatrists. Social Science and Medicine, 39(2), 233-245.
• Harpham, T., & Molyneux, C. (2001). Urban health in developing countries: a review. Progress in Development Studies, 1(2), 113–137.
• Hartwig, J. (2008). What drives healthcare expenditure?—Baumol’s model of ‘unbalanced growth’ revisited. Journal of Health Economics, 27, 603–623.
• Hausman, J.A. (1978). Specification tests in econometrics. Econometrica, 46(6), 1251-1271.
• Henderson, V. (2002). Urbanization in developing countries. The World Bank Research Observer, 17(1), 89-112.
• Herwartz, H., & Theilen, B. (2003). The determinants of healthcare expenditure: testing pooling restrictions in small samples. Health Economics, 12, 113-124.
• Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of Health Economics, 11, 173-181.
• Howdon, D., & Rice, N. (2018). Healthcare expenditures, age, proximity to death and morbidity: Implications for an ageing population. Journal of Health Economics, 57, 60-74.
• Kouassi, E., Akinkugbe, O., Kutlo, N.O., & Brou, J. M.B. (2018). Health expenditure and growth dynamics in the SADC region: Evidence from non-stationary panel data with cross section dependence and unobserved heterogeneity. International Journal of Health Economics and Management, 18, 47-66.
• Kiymaz, H., Akbulut, Y., & Demir, A. (2006).Tests of stationarity and cointegration of healthcare expenditure and gross domestic product: An application to Turkey. The European Journal of Health Economics, 7, 285-289.
• Kleiman, E. (1974). The determinants of national outlay on health. In: M. Perlman (Ed.), The Economics of Health and Medicalcare (pp. 66-88). London: McMillan.
• Lago-Penas, S., Cantarero-Prieto, D., & Blazquez-Fernandez, C. (2013). On the relationship between GDP and healthcare expenditure: A new look. Economic Modelling, 32, 124-129.
• Lee, H., Oh, D. Y., Meng, M. (2018). Stationarity and cointegration of healthcare expenditure and GDP: Evidence from tests with smooth structural shifts. Empirical Economics, https://doi.org/10.1007/s00181-018-1561-1.
• Leon, D. A. (2008). Cities, urbanization and health. International Journal of Epidemiology, 37, 4–8.
• Magazzino, C., & Mele, M. (2012). The determinants of health expenditure in Italian regions. International Journal of Economics and Finance, 4(3), 61-68.
• McDade, T.W., & Adair L.S. (2001). Defining the ‘‘urban’’ in urbanization and health: A factor analysis approach. Social Science and Medicine, 53, 55-70.
• Mendez, M.A., Monteiro, C.A., & Popkin, B.M. (2005). Overweight exceeds underweight among women in most developing countries. The American Journal of Clinical Nutrition, 81, 714-721.
• Moore, M., Gould, P., & Keary, B.S. (2003). Global urbanization and impact on health. International Journal of Hygiene and Environmental Health, 206, 269-278.
• Moscone, F., & Tosetti, E. (2010). Health expenditure and income in the United States. Health Economics, 19, 1385-1403.
• Murthy, V.N.R., & Okunade, A.A. (2009). The core determinants of health expenditure in the African context: Some econometric evidence for policy. Health Policy, 91, 57-62.
• Musgrove, P., Zeramdini, R., & Carrin, G. (2002). Basic patterns in national health expenditure. Bulletin of the World Health Organization, 80(2), 134-146.
• Newhouse, J.P. (1977). Medical-care expenditure: A cross-national survey. The Journal of Human Resources, 12(1), 115-125.
• Nickell, S. (1981). Biases in dynamic models with fixed effects. Econometrica, 49(6), 1417-1426.
• Nixon, J., & Ulmann, P. (2006). The relationship between healthcare expenditure and health outcomes. The European Journal of Health Economics, 7, 7-18.
• Okunade, A.A., & Karakus, M.C. (2001). Unit root and cointegration tests: Timeseries versus panel estimates for international health expenditure models. Applied Economics, 33(9): 1131-1137.
• Okunade, A.A., Karakus, M.C., & Okeke, C. (2004). Determinants of health expenditure growth of the OECD countries: Jackknife resampling plan estimates. Health Care Management Science, 7, 173–183.
• Pan, J., & Liu, G.G. (2012). The determinants of Chinese provincial government health expenditures: Evidence from 2002-2006 data. Health Economics, 21, 757-777.
• Park, H.M. (2011). Practical guides to panel data modeling: A step-by-step analysis using Stata. (International University of Japan Tutorial Working Paper) Retrieved from https://www.iuj.ac.jp/faculty/kucc625/method/panel/panel_iuj.pdf.
• Parkin, D., McGuire, A., & Yule, B. (1987). Aggregate healthcare expenditures and national income. Journal of Health Economics, 6, 109-127.
• Roberts, J. (1999). Sensitivity of elasticity estimates for OECD healthcare spending: Analysis of a dynamic heterogeneous data field. Health Economics, 8, 459-472.
• Samadi, A., & Rad, E.H. (2013). Determinants of healthcare expenditure in Economic Cooperation Organization (ECO) countries: Evidence from panel cointegration tests. International Journal of Health Policy and Management, 1(1), 63-68.
• Sen, A. (2005). Is healthcare a luxury? New evidence from OECD Data. International Journal of Health Care Finance and Economics, 5, 147–164.
• Siddiqui, R., Afridi, U., Haq, R., & Tirmazi, S.H. (1995). Determinants of expenditure on health in Pakistan. The Pakistan Development Review, 34(4), 959-970.
• Sülkü, S.N., & Caner, A. (2011). Healthcare expenditures and gross domestic product: The Turkish case. The European Journal of Health Economics, 12, 29-38.
• Thomas, L. (2006). Social capital and mental health of women living in informal settlements in Durban, South Africa, and Lusaka, Zambia. In K. McKenzie & T.
• Harpham (Ed.), Social Capital and Mental Health (pp. 124-137). London: Jessica Kingsley Publishers.
• Thornton, J.A, & Rice, J.L. (2008). Determinants of healthcare spending: a state level analysis. Applied Economics, 40(22), 2873-2889.
• Toor, I.A., & Butt, M.S. (2005). Determinants of healhcare expenditure in Pakistan. Pakistan Economic and Social Review, 43(1), 133-150.
• United Nations Human Settlements Programme (2016). Urbanization and development: Emerging futures (World Cities Report 2016). Retrieved from https://unhabitat.org/wp-content/uploads/2014/03/WCR-%20Full-Report-2016.pdf.
• Wang, Y., Mi, J., Shan, X-y., Wang, Q.J., & Ge, K-y. (2007). Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. International Journal of Obesity, 31, 177–188.
• Wang, Z. (2009). The determinants of health expenditures: evidence from US state-level data. Applied Economics, 41(4), 429-435.
• Wang, K.M. (2011). Healthcare expenditure and economic growth: Quantile panel-type analysis. Economic Modelling, 28, 1536-1549.
• Wang, Y., Chen, L., & Kubota, J. (2016). The relationship between urbanization, energy use and carbon emissions: evidence from a panel of Association of Southeast Asian Nations (ASEAN) countries. Journal of Cleaner Production, 112, 1368-1374.
• World Health Organization, Urbanization and Health. (2010). Bulletin of the World Health Organization, 88(4), 241-320.
• World Health Organization (2014). Urban population growth. Global health observatory (GHO) data. Retrieved from http://www.who.int/gho/urban_health/situation_trends/urban_population_growth/en/.
• Xu, K., & Saksena, P. (2011). The determinants of health expenditure: A country-level panel data analysis. World Health Organization Working Paper. Retrieved from http://www.who.int/health_financing/documents/cov-report_e_11-deter-he/en/