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The Effect of Universal Health Coverage on Health Outcomes: The Case of Türkiye

Year 2024, Volume: 8 Issue: 2, 490 - 502, 31.05.2024
https://doi.org/10.29023/alanyaakademik.1342126

Abstract

Bu çalışmanın amacı, Türkiye'de Genel Sağlık Sigortası uygulamasının doğumda beklenen yaşam süresi (yıl olarak) üzerindeki etkisini incelemektir. Çalışmada, Otoregresif Dağıtılmış Gecikme Sınırları (ARDL) testi modeli kullanılmıştır. Çalışma modelinin bağımsız değişkenleri, hekim sayısı (1.000 kişi başına), sağlık harcamalarının gayri safi yurt içi hasılaya oranı ve Genel Sağlık Sigortası uygulamasıdır. Bağımlı değişken olarak ise, doğumda beklenen yaşam süresi seçilmiştir. Sağlık harcamalarının gayri safi yurtiçi hasılaya oranının (p=0,001) ve Genel Sağlık Sigortası uygulamasının (p=0,011) uzun dönemde doğumda beklenen yaşam süresi üzerinde istatistiksel olarak anlamlı ve pozitif etkileri olduğu bulunmuştur. Ayrıca, Genel Sağlık Sigortası uygulamasının kısa dönemde doğumda beklenen yaşam süresi üzerinde istatistiksel olarak anlamlı ve pozitif bir etkisi olduğu bulunmuştur (p=0,001). ARDL sonrasında sonuçların sağlamlığı, Tam Düzeltilmiş Sırasal En Küçük Kareler Regresyonu, Dinamik Sırasal En Küçük Kareler Regresyonu ve Kanonik Eşbütünleşme Regresyonu ile test edilmiştir.

References

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  • Akbulut, Y., Sarp, N., & Ugurluoglu, E. (2007). Reform of the health care system in Turkey: A review of universal health insurance. World Hospitals and Health Services, 43(1), 13.
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  • Li, F., Chang, T., Wang, M.C., & Zhou, J. (2022). The relationship between health expenditure, CO2 emissions, and economic growth in the BRICS countries—Based on the Fourier ARDL model. Environmental Science and Pollution Research, 29, 10908–10927.
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  • Lone, T.A., & Lone, P.A. (2022). Does fiscal deficit, public debt, economic growth and energy consumption affect health expenditure in India: An empirical evidence based ARDL bound testing approach. International Journal of Happiness and Development, 7(1), 1-14.
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  • Moreno-Serra, R., & Smith, P.C. (2012). Does progress towards universal health coverage improve population health? The Lancet, 380(9845), 917-923.
  • Mujtaba, G., & Ashfaq, S. (2022). The impact of environment degrading factors and remittances on health expenditure: An asymmetric ARDL and dynamic simulated ARDL approach. Environmental Science and Pollution Research, 29(6), 8560-8576.
  • Nkemgha, G. Z., Tékam, H. O., & Belek, A. (2021). Healthcare expenditure and life expectancy in Cameroon. Journal of Public Health, 29, 683-691.
  • Ojo-Olusoji, O., Nwosa-Philip, I., Alake-Olamide, J., & Adebanji-Funmilola, B. (2020). Health expenditure and life expectancy in Nigeria. Lead City Journal of the Social Sciences, 5(1), 66-71.
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  • Organisation for Economic Co-Operation and Development. (2017). What has driven life expectancy gains in recent decades? A cross-country analysis of OECD member states. https://www.oecd-ilibrary.org/docserver/health_glance-2017-5-en.pdf?expires=1691839617&id=id&accname=guest&checksum=83752DE5D87EAEB50A7A930AAC42972C
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  • Park, J. (1992). Canonical cointegrating regressions. Econometrica, 60, 119-143.
  • Pekten, A. (2006). Genel sağlik sigortasi sistemi ve getirdiği yenilikler. Sayıştay Dergisi, 61, 119-138.
  • Pesaran, M.H., Shin, Y., & Smith, R.J. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16(3), 289-326.
  • Phillips, P.C., & Hansen, B.E. (1990). Statistical inference in instrumental variables regression with I(1) processes. The Review of Economic Studies, 57(1), 99-125.
  • Radmehr, M., & Adebayo, T. S. (2022). Does health expenditure matter for life expectancy in mediterranean countries? Environmental Science and Pollution Research, 29(40), 60314-60326.
  • Reich, M.R., Harris, J., Ikegami, N., Maeda, A., Cashin, C., Araujo, E.C., … & Evans, T. G. (2016). Moving towards universal health coverage: Lessons from 11 country studies. The Lancet, 387(10020), 811-816.
  • Roffia, P., Bucciol, A., & Hashlamoun, S. (2023). Determinants of life expectancy at birth: A longitudinal study on OECD countries. International Journal of Health Economics and Management, 23(2), 189-212.
  • Sahin, D. (2016). Analysis of determinant factors of life expectancy at birth in Turkey: An ARDL bounds testing approach. IIB International Refereed Academic Social Sciences Journal, 7(21), 1.
  • Senturk, İ., & Ali, A. (2021). Socioeconomic determinants of gender-specific life expectancy in Turkey: A time series analysis. Sosyoekonomi, 29(49), 85-111.
  • Shah, M. H., Wang, N., Ullah, I., Akbar, A., Khan, K., & Bah, K. (2021). Does environment quality and public spending on environment promote life expectancy in China? Evidence from a nonlinear autoregressive distributed lag approach. The International Journal of Health Planning and Management, 36(2), 545-560.
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The Effect of Universal Health Coverage on Health Outcomes: The Case of Türkiye

Year 2024, Volume: 8 Issue: 2, 490 - 502, 31.05.2024
https://doi.org/10.29023/alanyaakademik.1342126

Abstract

This study aimed to examine the effect of Universal Health Coverage practice on life expectancy at birth (as years) in Türkiye. An autoregressive distributed lag bounds testing (ARDL) model was used. The independent variables were the number of physicians (per 1,000 people), the ratio of health expenditures to the gross domestic product, and the Universal Health Coverage practice in the study model. Life expectancy at birth was selected as the dependent variable. The ratio of health expenditures to the gross domestic product (p=0.001) and Universal Health Coverage practice (p=0.011) were found to have statistically significant and positive effects on life expectancy at birth in the long run. Universal Health Coverage practice was also found to have a statistically significant and positive effect on life expectancy at birth in the short run (p=0.001). After ARDL, the robustness of results was tested with Fully Modified Ordinary Least Squares, Dynamic Ordinary Least Squares, and Canonical Cointegrating Regressions.

References

  • Agartan, T.I. (2021). Politics of success stories in the path towards universal health coverage: The case of Turkey. Development Policy Review, 39(2), 283-302.
  • Akbulut, Y., Sarp, N., & Ugurluoglu, E. (2007). Reform of the health care system in Turkey: A review of universal health insurance. World Hospitals and Health Services, 43(1), 13.
  • Ali, A., & Audi, M. (2016). The impact of income inequality, environmental degradation and globalization on life expectancy in Pakistan: An empirical analysis. https://mpra.ub.uni-muenchen.de/71112/1/MPRA_paper_71112.pdf
  • Anand, V., Nizamani, M.Q., & Nizamani, F.Q. (2019). Macroeconomic determinants of inclusive growth in Pakistan: An ARDL approach. Global Economics Review, 4(2), 105-118.
  • Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I., … & Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382(9886), 65-99.
  • Azam, M., Uddin, I., & Saqib, N. (2023). The determinants of life expectancy and environmental degradation in Pakistan: evidence from ARDL bounds test approach. Environmental Science and Pollution Research, 30(1), 2233-2246.
  • Baris, E., Mollahaliloglu, S., & Aydın, S. (2011). Healthcare in Turkey: from laggard to leader. BMJ, 342. Boerma, T., Eozenou, P., Evans, D., Evans, T., Kieny, M. P., & Wagstaff, A. (2014). Monitoring progress towards universal health coverage at country and global levels. Plos Medicine, 11(9), e1001731.
  • Bump, J., Sparkes, S., Tatar, M., & Celik, Y. (2014). Turkey on the way of universal health coverage through the health transformation program (2003-13). https://openknowledge.worldbank.org/server/api/core/bitstreams/e198136c-6722-5aca-90ad-ee187019a30d/content
  • Das, S., & Debanth, A. (2023). Impact of CO2 emission on life expectancy in India: An autoregressive distributive lag (ARDL) bound test approach. Future Business Journal, 9(1), 5.
  • Engle, R.F., & Granger, C.W. (1987). Co-Integration and error correction: Representation, estimation, and testing. Econometrica: Journal of the Econometric Society, 55(2), 251-276.
  • Erlangga, D., Suhrcke, M., Ali, S., & Bloor, K. (2019). The impact of public health ınsurance on health care utilisation, financial protection and health status in low-and middle-ıncome countries: A systematic review. PloS One, 14(8), e0219731.
  • Gilligan, A.M., & Skrepnek, G.H. (2015). Determinants of life expectancy in the eastern mediterranean region. Health Policy and Planning, 30(5), 624-637.
  • Heijink, R., Koolman, X., & Westert G.P. (2013). Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries. European Journal of Health Economics, 14, 527-538.
  • Horton, R., & Das, P. (2015). Universal health coverage: Not why, what, or when—but how? The Lancet, 385(9974), 1156-1157.
  • Hossain, S., Sıddıka, M.A., Koly, I. J., & Akter, K. (2020). Exploring the ımpact of environmental degradation on life expectancy in Bangladesh: An ARDL bounds test approach. International Journal of Science and Business, 4(12), 69-79.
  • Hughes, P., & Kaya, M.G. (2022). Determinants of health care expenditure in the United States: An ARDL approach focusing on insurance coverage. Ekonomski Pregled, 73(4), 643-660.
  • Hwang, S.W., Chambers, C., Chiu, S., Katic, M., Kıss, A., Redelmeier, D.A., & Levinson, W. (2013). A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. American Journal of Public Health, 103(S2), 294-S301.
  • Jaba, E., Balan, C.B., & Robu, I.B. (2014). The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis. Procedia Economics and Finance, 15, 108-114.
  • Johansen, S. (1988). Statistical analysis of cointegration vectors. Journal of Economic Dynamics and Control, 12(2-3), 231-254.
  • Khandelwal, V. (2015). Impact of energy consumption, GDP & fiscal deficit on public health expenditure in India: An ARDL bounds testing approach. Energy Procedia, 75, 2658-2664.
  • Kim, T.K., & Lane, S.R. (2013). Government health expenditure and public health outcomes: A comparative study among 17 countries and implications for US health care reform. American International Journal of Contemporary Research, 3(9), 8-13.
  • Konca, M., & Yıldırım, H.H. (2021). How can Turkey create fiscal space for its health care system? A qualitative approach. International Journal of Healthcare Management, 14(4), 940-947.
  • Kruk, M.E., Gage, A.D., Joseph, N.T., Danaei, G., García-Saisó, S., & Salomon, J.A. (2018). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392 (10160), 2203-2212.
  • Kutlu, G., & Örün, E. (2023). The effect of carbon dioxide emission, GDP per capita and urban population on health expenditure in OECD countries: A panel ARDL approach. International Journal of Environmental Health Research, 33(12), 1233-1242.
  • Li, F., Chang, T., Wang, M.C., & Zhou, J. (2022). The relationship between health expenditure, CO2 emissions, and economic growth in the BRICS countries—Based on the Fourier ARDL model. Environmental Science and Pollution Research, 29, 10908–10927.
  • Linden, M., & Ray, D. (2017). Life expectancy effects of public and private health expenditures in OECD countries 1970–2012: Panel time series approach. Economic Analysis and Policy, 56, 101-113.
  • Lone, T.A., & Lone, P.A. (2022). Does fiscal deficit, public debt, economic growth and energy consumption affect health expenditure in India: An empirical evidence based ARDL bound testing approach. International Journal of Happiness and Development, 7(1), 1-14.
  • Mondal, M.N.I., Baki, A.N.M.A., Hoque, M.N., Khan, H.T., & Khan, M.N. (2019). Exploring the determinants of global life expectancy in an ecological perspective. Turkish Journal of Public Health, 17(3), 314-325.
  • Moreno-Serra, R., & Smith, P.C. (2012). Does progress towards universal health coverage improve population health? The Lancet, 380(9845), 917-923.
  • Mujtaba, G., & Ashfaq, S. (2022). The impact of environment degrading factors and remittances on health expenditure: An asymmetric ARDL and dynamic simulated ARDL approach. Environmental Science and Pollution Research, 29(6), 8560-8576.
  • Nkemgha, G. Z., Tékam, H. O., & Belek, A. (2021). Healthcare expenditure and life expectancy in Cameroon. Journal of Public Health, 29, 683-691.
  • Ojo-Olusoji, O., Nwosa-Philip, I., Alake-Olamide, J., & Adebanji-Funmilola, B. (2020). Health expenditure and life expectancy in Nigeria. Lead City Journal of the Social Sciences, 5(1), 66-71.
  • Organisation for Economic Co-Operation and Development. (2009). OECD reviews of health systems: Turkey 2008. OECD Publishing.
  • Organisation for Economic Co-Operation and Development. (2017). What has driven life expectancy gains in recent decades? A cross-country analysis of OECD member states. https://www.oecd-ilibrary.org/docserver/health_glance-2017-5-en.pdf?expires=1691839617&id=id&accname=guest&checksum=83752DE5D87EAEB50A7A930AAC42972C
  • Organisation for Economic Co-Operation and Development. (2022). https://www.oecd.org/health/
  • Organisation for Economic Co-Operation and Development. (2023) Life expectancy at birth (indicator). 10.1787/27e0fc9d-en
  • Özalp, N.Y. (2015). Yasa, kanun hükmünde kararname ve mahkeme kararlari işiğinda tam gün sorunsalı. Ankara Hacı Bayram Veli Üniversitesi Hukuk Fakültesi Dergisi, 19(2), 259-290.
  • Park, J. (1992). Canonical cointegrating regressions. Econometrica, 60, 119-143.
  • Pekten, A. (2006). Genel sağlik sigortasi sistemi ve getirdiği yenilikler. Sayıştay Dergisi, 61, 119-138.
  • Pesaran, M.H., Shin, Y., & Smith, R.J. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16(3), 289-326.
  • Phillips, P.C., & Hansen, B.E. (1990). Statistical inference in instrumental variables regression with I(1) processes. The Review of Economic Studies, 57(1), 99-125.
  • Radmehr, M., & Adebayo, T. S. (2022). Does health expenditure matter for life expectancy in mediterranean countries? Environmental Science and Pollution Research, 29(40), 60314-60326.
  • Reich, M.R., Harris, J., Ikegami, N., Maeda, A., Cashin, C., Araujo, E.C., … & Evans, T. G. (2016). Moving towards universal health coverage: Lessons from 11 country studies. The Lancet, 387(10020), 811-816.
  • Roffia, P., Bucciol, A., & Hashlamoun, S. (2023). Determinants of life expectancy at birth: A longitudinal study on OECD countries. International Journal of Health Economics and Management, 23(2), 189-212.
  • Sahin, D. (2016). Analysis of determinant factors of life expectancy at birth in Turkey: An ARDL bounds testing approach. IIB International Refereed Academic Social Sciences Journal, 7(21), 1.
  • Senturk, İ., & Ali, A. (2021). Socioeconomic determinants of gender-specific life expectancy in Turkey: A time series analysis. Sosyoekonomi, 29(49), 85-111.
  • Shah, M. H., Wang, N., Ullah, I., Akbar, A., Khan, K., & Bah, K. (2021). Does environment quality and public spending on environment promote life expectancy in China? Evidence from a nonlinear autoregressive distributed lag approach. The International Journal of Health Planning and Management, 36(2), 545-560.
  • Shou-Hsia, C., & Tung-Liang, C. (1997). The effect of universal health insurance on health care utilization in Taiwan: Results from a natural experiment. Jama, 278(2), 89-93.
  • STATISTA. (2022). https://www.statista.com/topics/4782/health-care-in-turkey/#topicHeader__wrapper Stock, J. H., & Watson, M. W. (1993). A simple estimator of cointegration vectors in higher order integrated systems. Econometrica, 61, 783-820.
  • Tang, T.C. (2003). Japanese aggregate import demand function: Reassessment from ‘bound’ testing approach. Japan and the World Economy, 15(4), 419–436.
  • Tao, W., Zeng, Z., Dang, H., Lu, B., Chuong, L., Yue, D., ... & Kominski, G. F. (2020). Towards universal health coverage: Lessons from 10 years of healthcare reform in China. BMJ Global Health, 5(3), e002086.
  • Tatar, M., Mollahaliloglu, S., Sahin, B., Aydin, S., Maresso, A., & Hernandez-Quevedo (2011). Turkey: Health system review. Health in Transition, 13(6), 1-186.
  • The Ministry of Health. (2003) Transformation in health. The Ministry of Health Publishing.
  • The Turkish Government Gazette. (1992). Regulation on government charge of the treatment expenses of citizens without power of payment and green card. https://www.resmigazete.gov.tr/arsiv/21273.pdf
  • The Turkish Government Gazette. (2004). The law of family physician. https://www.resmigazete.gov.tr/eskiler/2004/12/20041209.htm#1
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There are 67 citations in total.

Details

Primary Language English
Subjects Econometric and Statistical Methods
Journal Section Makaleler
Authors

Murat Konca 0000-0002-6830-8090

Publication Date May 31, 2024
Acceptance Date January 20, 2024
Published in Issue Year 2024 Volume: 8 Issue: 2

Cite

APA Konca, M. (2024). The Effect of Universal Health Coverage on Health Outcomes: The Case of Türkiye. Alanya Akademik Bakış, 8(2), 490-502. https://doi.org/10.29023/alanyaakademik.1342126