Demografik Faktörlerdeki Değişiklikler Kamu Sağlık Harcamalarını Etkiliyor Mu? Türkiye Örneği

Year 2024, , 145 - 160, 27.06.2024

Sacit Sarı

https://doi.org/10.33399/biibfad.1412196

Abstract

Bu çalışmanın temel amacı, 1980-2021 dönemi arası kamu sağlık harcamalarının belirleyicilerini yıllık verilerle demografik faktörler özelinde Türkiye ekonomisi için analiz etmektir. Bu kapsamda zaman serisi yöntemleri kullanılmıştır. Değişkenlerin durağanlığı geleneksel birim kök testleriyle ve serilerde yapısal kırılmayı içselleştiren birim kök testiyle sınanmıştır. Düzeyde durağan olmayan değişkenler arasındaki uzun dönemli ilişkilerin varlığı ARDL sınır testi yöntemiyle araştırılmıştır. Analiz sonucuna göre, kamu sağlık harcamaları ile GSYH, yaşlı bağımlı nüfus oranı, şehirleşme ve nüfus değişkenleri arasında uzun dönemli bir ilişki bulunmaktadır. GSYH düzeyindeki artışlar kamu sağlık harcamalarını azaltırken, demografik değişkenlerdeki artışlar kamu sağlık harcamalarını artırmaktadır. Beklenen yaşam süresinin artması, değişen demografik yapı, kentleşme ve tıbbi teknolojideki ilerlemeler sağlık harcamalarını önemli ölçüde artırmıştır. Sürdürülebilir ve verimli bir kamu sağlık harcaması için politika yapıcıların özel sektörün sağlık piyasasındaki payını artıracak politikalar geliştirmesi gerekmektedir.

Keywords

Kamu sağlık harcamaları, Demografik Eğilimler, ARDL sınır testi

Do Changes in Demographic Factors Affect Public Health Expenditures? The Case of Turkiye

Abstract

The main objective of this study is to analyze the effect of demographic factors on public health expenditures in the Turkish economy for the period between 1980 and 2021. Time series methods are employed in this analysis. The stationarity of the variables is tested with the conventional unit root test, while Zivot-Andrews unit root test is employed to identify potential structural breaks in the data. The existence of long-run relationships between non-stationary variables is investigated using the ARDL bounds test method. According to the analysis results, a persistent and statistically significant association exists between public health expenditures and GDP, contingent upon variables such as the old dependent population ratio, urbanization, and population. While increases in national product decrease public health expenditures, increases in demographic variables cause an overall rise in total public health expenditures. Increasing life expectancy, changing demographic structure, urbanization, and advances in medical technology have significantly increased health expenditures. Policymakers must establish strategies to boost the representation of the private sector in the health market if public health spending is to be sustainable and efficient.

Keywords

Public health expenditure, Demographic Trends, ARDL bounds test

References

• Abbas, F., & Hiemenz, U. (2011). Determinants of public health expenditures in Pakistan. ZEF-Discussion Papers on Development Policy, (158).
• Abdullah, H., Azam, M., & Zakariya, S. K. (2016). The impact of environmental quality on public health expenditure in Malaysia. Asia Pacific Journal of Advanced Business and Social Studies (APJABSS), 2(2), 365-379.
• Baltagi, B. H., & Moscone, F. (2010). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic modelling, 27(4), 804-811.
• Becker, G. S. (2009). Human capital: A theoretical and empirical analysis, with special reference to education. University of Chicago press.
• Bloom, D. E., Canning, D., & Sevilla, J. (2004). The effect of health on economic growth: a production function approach. World development, 32(1), 1-13.
• 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.
• Byaro, M., Kinyondo, A., Michello, C., & Musonda, P. (2018). Determinants of public health expenditure growth in Tanzania: An application of Bayesian model. African Journal of Economic Review, 6(1), 1-13.
• Card, D. (1999). The causal effect of education on earnings. Handbook of labor economics, 3, 1801-1863.
• Christiansen, T., Bech, M., Lauridsen, J., & Nielsen, P. (2006). Demographic Changes and Aggregate Health-Care Expenditure in Europe. ENEPRI Research Reports No. 32, 22.
• Dhoro, N. L., Chidoko, C., Sakuhuni, R. C., & Gwaindepi, C. (2011). Economic determinants of public health care expenditure in Zimbabwe. International Journal of Economics and Research, 2(6), 13-25.
• 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(1), 23-42.
• Di Matteo, L., & Di Matteo, R. (1998). Evidence on the determinants of Canadian provincial government health expenditures: 1965–1991. Journal of health economics, 17(2), 211-228.
• Ecevit, E., Cetin, M., & Yucel, A. G. (2018). Turki cumhuriyetlerinde saglik harcamalarinin belirleyicileri: Bir panel veri analizi. Akademik Araştırmalar ve Çalışmalar Dergisi (AKAD), 10(19), 318-334.
• Esener, S.C. & Karadag, Y.(2020). Kamu maliyesi gozunden gelişmekte olan ulkelerde kamu sağlık harcamalarının belirleyicileri uzerine bir ampirik bir analiz. Selcuk Zirvesi, 2.Uluslararası Sosyal Bilimler Kongresi Türkiye.
• Goktaş, P., Pekmezci, A., &Bozkurt, K.(2019). Ekonometrik Serilerde Uzun Dönem Esbutunlesme ve Kısa Donem Nedensellik. Gazi Kitabevi: Ankara.
• Grossman, M. (1972). On the concept of health capital and the demand for health. In Determinants of health: an economic perspective (pp. 6-41). Columbia University Press.
• Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of health economics, 11(2), 173-181.
• Imoughele, L. E. and Ismaila, M. (2013). Effect of public education expenditure on economic growth in Nigeria (1980-2010): Interdisciplinary journal of contemporary research in business, 4(11).
• Ke, X. U., Saksena, P., & Holly, A. (2011). The determinants of health expenditure: a country-level panel data analysis. Geneva: World Health Organization, 26(1-28).
• Khan, H. N., Razali, R. B., & Shafie, A. B. (2016). Modeling determinants of health expenditures in Malaysia: evidence from time series analysis. Frontiers in pharmacology, 7, 69.
• Lawal, A. I., Nwanji, T. I., Asaleye, A., & Ahmed, V. (2016). Economic growth, financial development and trade openness in Nigeria: An application of the ARDL bound testing approach. Cogent Economics & Finance, 4(1), 1258810.
• Mert, M., & Cağlar, A. E. (2019). Eviews ve Gauss Uygulamalı Zaman Serileri Analizi. Detay Yayıncılık: Ankara.
• Miladinov, G. (2020). Socioeconomic development and life expectancy relationship: evidence from the EU accession candidate countries. Genus, 76(1), 2.
• Narayan, P. K. (2005). The saving and investment nexus for China: evidence from cointegration tests. Applied economics, 37(17), 1979-1990.
• Newhouse, J. P. (1977). Medical care expenditure: A cross national. Journal of Human Resources, 12, 115-125.
• OECD (2024), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 15 March 2024).
• Pesaran, M. H. (2015). Time series and panel data econometrics. Oxford University Press.
• 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.
• Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: insights from the United States data. Frontiers in public health, 8, 156.
• Rahman, T. (2008). Determinants of public health expenditure: some evidence from Indian states. Applied Economics Letters, 15(11), 853-857.
• Shiu, Y. M., & Chiu, M. C. (2008). Re-estimating the demographic impact on health care expenditure: evidence from Taiwan. The Geneva Papers on Risk and Insurance-Issues and Practice, 33, 728-743.
• Stock, J. H., & Watson, M. W. (2020). Introduction to econometrics 4th ed. Pearson.
• Tıras, H. H. & Turkmen, S. (2020). Sağlık Harcamalarının Belirleyicilerine Yonelik Bir Araştırma; AB ve Turkiye Ornegi. Bingol Universitesi Iktisadi ve Idari Bilimler Fakultesi Dergisi, 4 (1), 107-139.
• Tosun, C. (2018). Turkiye’de sağlık harcamalarının belirleyicileri. (Unpuplished doctoral dissertation). Hacettepe University.
• Turkiye Statistical Institute (2022). Health Expenditure Statistics 2021. Retrieved February 10, 2023, from https://data.tuik.gov.tr/Bulten/Index?p=Health-Expenditure-Statistics-2021-45728&dil=2
• World Bank (2023). World development indicators 2023. The World Bank. Retrieved March 08, 2023, from https://datacatalog.worldbank.org
• Yap, K., & Selvaratnam, D. (2018). Empirical analysis of factors influencing the public health expenditure in Malaysia. Journal Of Emerging Economies And Islamic Research, 6(3), 1-14.
• Yetim, B., Ilgun, G., Cilhoroz, Y., Demirci, S., & Konca, M. (2020). The socioeconomic determinants of health expenditure in OECD: An examination on panel data. International Journal of Healthcare Management, 14(4), 1265-1269.
• Yun, W. S. (2021). Impact of Demographical Structural Change on Public Health Care Expenditure in Malaysia. Applied Economics, 28(2), 21-42.
• Zivot, E., & Andrews, D. W. K. (1992). Further evidence on the great crash, the oil-price shock, and the unit-root hypothesis. Journal of business & economic statistics, 10(3), 251-270.