Türkiye'de Ekonomik Faktörlerin Kamu Sağlık Harcamaları Üzerine Etkileri: 2002-2022 Yılları Arası Dönemin Temel Bileşenler Analizi ile Değerlendirilmesi

Abstract

Bu çalışma, 2002-2022 yılları arasında Türkiye'de kamu sağlık harcamalarını etkileyen ekonomik faktörleri analiz etmektedir. Temel amaç, kamu sağlık harcamalarının Gayri Safi Yurt İçi Hasıla (GSYİH) içindeki payının azalmasının ekonomik nedenlerini belirlemektir. Temel bileşenler analizi (PCA) kullanılarak kişi başına GSYİH, işsizlik oranı, işgücüne katılım oranı, tüketici fiyat endeksi, vergi geliri ve döviz kuru gibi makroekonomik değişkenler incelenmiştir. Sonuçlar kişi başına düşen GSYİH, döviz kuru ve vergi gelirinin kamu sağlık harcamalarını önemli ölçüde etkilediğini ve ekonomik büyüme ile sağlık harcamaları arasında doğrudan bir ilişki olduğunu göstermektedir. İşsizlik oranı kamu sağlık harcamalarını doğrudan etkilemezken, işgücüne katılım oranındaki artış harcamaları azaltabilmektedir. Bu çalışma, Türkiye'de sürdürülebilir sağlık finansmanı için makroekonomik istikrarın ve etkili ekonomi politikalarının önemini vurgulamaktadır. Uzun vadeli verileri kullanarak, ekonomik faktörlerin sağlık harcamalarını nasıl etkilediğine dair kapsamlı bir analiz sunmakta ve literatürdeki diğer çalışmalardan ayrılmaktadır. Bulgular, sağlıklı bir ekonominin sağlık hizmetlerine yapılan kamu yatırımlarının artmasına yol açtığını vurgulamaktadır.

Keywords

• Temel Bileşenler Analizi
• Sağlık Harcamaları
• Ekonomik Faktörler

The Impact of Economic Factors on Public Health Expenditure in Türkiye: Principal Component Analysis Evaluation for the Period 2002-2022

Abstract

This study analyzes the economic factors affecting public health expenditure in Türkiye from 2002 to 2022. The main objective is to identify the economic reasons for the decreasing share of public health expenditure in Gross Domestic Product (GDP). It examines macroeconomic variables such as GDP per capita, unemployment rate, labor force participation rate, consumer price index, tax revenue, and exchange rate using principal component analysis (PCA). The results show that GDP per capita, exchange rate, and tax revenue significantly impact public health expenditure, indicating a direct relationship between economic growth and health spending. The unemployment rate does not directly affect public health expenditure, while an increase in labor force participation rate can reduce it. This study underscores the importance of macroeconomic stability and effective economic policies for sustainable health financing in Türkiye. By using long-term data, it provides a comprehensive analysis of how economic factors impact health expenditure, distinguishing it from other studies in the literature. The findings emphasize that a healthy economy leads to increased public investment in health services.

Keywords

• Principal Component Analysis
• Health Expenditure
• Economic Factors

References

1. Aboubacar, B. and Xu, D. (2017). The impact of health expenditure on the economic growth in sub-Saharan Africa. Theoretical Economics Letters, 7(3), 615–622. https://doi.org/10.4236/tel.[phone]
2. Akdağ, R. (2011). Sağlıkta dönüşüm programı değerlendirme raporu (2003-2010). Ankara: TC Sağlık Bakanlığı Yayınları.
3. Altınöz, B. and Aslan, A. (2019). Eğitim ve sağlık faktörleri bağlamında beşeri sermayenin ekonomik büyümeye katkısı: N-11 ülkeleri için bir uygulama. In A. Umut (Ed.), 3. International economic research and financial markets congress proceeding book (pp. 183-194). Paper presented at the International Economics Research and Financial Markets Congress, Gaziantep, Türkiye.
4. Anderson, G.F., Hurst, J., Hussey, P.S. and Jee-Hughes, M. (2000). Health spending and outcomes: Trends in OECD Countries, 1960–1998. Health Affairs, 19(3), 150–157. https://doi.org/10.1377/hlthaff.19.3.150
5. Ataklı-Yavuz, R. and Yılmaztürk, R. G. (2023). Sağlık harcamalarının ekonomik etkileri: Türkiye örneği. Yönetim ve Ekonomi Araştırmaları Dergisi, 21(3), 163-175. https://doi.org/10.11611/yead.1344037
6. Atilgan, E., Kiliç, D. and Ertuğrul, H. M. (2017). The dynamic relationship between health expenditure and economic growth: Is the health-led growth hypothesis valid for Türkiye? The European Journal of Health Economics, 18(5), 567–574. https://doi.org/10.1007/s10198-016-0810-5
7. Bieszk-Stolorz, B. and Dmytrów, K. (2023). The well-being-related living conditions of elderly people in the European Union - Selected aspects. Sustainability, 15(24), 16823. https://doi.org/10.3390/su152416823
8. Boyacioğlu, E.Z. and Terzi̇oğlu, M.K. (2022). Do health spending and economic growth matter in development? Evidence from Türkiye. Ekonomi Politika ve Finans Araştırmaları Dergisi, 7(Özel Sayı), 19-32. https://doi.org/10.30784/epfad.1147618

9. Chao, Y. and Wu, C.-J. (2017). Principal component-based weighted indices and a framework to evaluate indices: Results from the Medical Expenditure Panel Survey 1996 to 2011. PLoS ONE, 12(8), e0183997. https://doi.org/ 10.1371/journal.pone.0183997
10. Coşkun Yılmaz, S. (2023). The effect of health and education expenditures on the employment: Empirical evidence from Türkiye. Journal of Economics and Research, 4(2). https://doi.org/10.53280/jer.1357586
11. Dorlach, T. and Yeğen, O. (2023). Universal health coverage with private options: The politics of Türkiye’s 2008 health reform. Studies in Comparative International Development, 58(3), 430–456. https://doi.org/10.1007/s12116-023-09402-2
12. Erdogan, S. and Erdogan, E.S. (2023). Analyzing the asymmetric effect of disaggregated health expenditures on economic growth. Quality & Quantity, 57(3), 2673–2686. https://doi.org/10.1007/s11135-022-01487-6
13. Erus, B. and Hatipoğlu, O. (2017). Health policy and redistribution: Türkiye's health transformation program in perspective. Health Policy and Planning, 32(8), 1120-1127. https://doi.org/10.1093/heapol/czx062
14. Esen, E. and Çelik Keçili, M. (2022). Economic growth and health expenditure analysis for Türkiye: Evidence from time series. Journal of the Knowledge Economy, 13, 1786–1800. https://doi.org/10.1007/s13132-021-00789-8.
15. Euronews. (2022). Sağlık harcamalarının milli gelire oranı. Retrieved from https://tr.euronews.com/saglik/2022/04/05/sagl-k-harcamalar-n-n-milli-gelire-oran-oecd-ve-ab-de-sagl-ga-en-az-pay-ay-ran-ulke-turkiy /(18/3/2024)
16. Focacci, C.N. (2023). Old versus young: How much do countries spend on social benefits? Deterministic modeling for government expenditure. Quality & Quantity, 57, 363-377. https://doi.org/10.1007/s11135-022-01371-3
17. Gerdtham, U.-G., Søgaard, J., Andersson, F. and Jönsson, B. (1992). An econometric analysis of health care expenditure: A cross-section study of the OECD countries. Journal of Health Economics, 11(1), 63–84. https://doi.org/10.1016/0167-6296(92)90025-V
18. Gerdtham, U.G. and Jönsson, B. (2000). International comparisons of health expenditure: Theory, data and econometric analysis. In A.J. Culyer and J.P. Newhouse (Eds.), Handbook of health economics (pp. 11-53), https://doi.org/10.1016/S1574-0064(00)80160-2
19. Getzen, T.E. and Poullier, J.P. (1992). International health spending forecasts: Concepts and evaluation. Social Science & Medicine, 34(9), 1057-1068. https://doi.org/10.1016/0277-9536(92)90106-M
20. Guo, J., Jing, Y., Nguyen, K., Fan, H., Li, X. and Kelton, C. (2008). Principal components analysis of drug expenditure and utilisation trends for major therapeutic classes in US Medicaid programmes. Journal of Medical Economics, 11(4), 671-694. https://doi.org/10.3111/13696990802596095
21. Human Rights Watch. (2023). Governments should step up public health care spending. Retrieved from https://www.hrw.org/news/2023/09/21/governments-should-step-public-health-care-spending
22. Jakovljevic, M., Sugahara, T., Timofeyev, Y. and Rancic, N. (2020). Predictors of (in)efficiencies of healthcare expenditure among the leading Asian economies – Comparison of OECD and non-OECD nations. Risk Management and Healthcare Policy, 13, 2261–2280. https://doi.org/10.2147/RMHP.S266386
23. Kara, A. (2013). A low quality–high cost–low satisfaction trap in public health care: A model and an efficiency-quality-welfare improving stochastic resolution. Quality & Quantity, 47(4), 2081–2093. https://doi.org/10.1007/s11135-011-9643-6
24. Kurt, S. (2015). Government health expenditures and economic growth: A Feder-Ram approach for the case of Türkiye. International Journal of Economics and Financial Issues, 5(2), 441–447. Retrieved from https://dergipark.org.tr/en/pub/ijefi/
25. Liu, Y.-H., Chang, W.-S. and Chen, W.-Y. (2019). Health progress and economic growth in the United States: The mixed frequency VAR analyses. Quality & Quantity, 53, 1895-1911. https://doi.org/10.1007/s11135-019-00847-z
26. Lorenzoni, L., Belloni, A. and Sassi, F. (2014). Health-care expenditure and health policy in the USA versus other high-spending OECD countries. The Lancet, 384(9937), 83–92. https://doi.org/10.1016/S0140-6736(14)60571-7
27. Munsur, A.M., Atia, A., Koffi, A.K. and Kawahara, K. (2009). Household out-of-pocket expenditures on health care in Bangladesh according to principal component analysis (PCA). Bioscience Trends, 3(1), 25-31. https://doi.org/10.5582/bst.3.25
28. Ministry of Family, Labor and Social Services. (2020). OECD ve AB ülkelerinde sağlık ve geri ödeme sistemleri. Ankara: Sosyal Güvenlik Kurumu.
29. Nghiem, S.H. and Connelly, L.B. (2017). Convergence and determinants of health expenditures in OECD countries. Health Economics Review, 7(1), 29. https://doi.org/10.1186/s13561-017-0164-4
30. OECD. (2024). Health expenditure and financing [Dataset]. Retrieved from https://stats.oecd.org/index.aspx?DataSetCode=SHA
31. Okunade, A.A. and Suraratdecha, C. (2000). Health care expenditure inertia in the OECD countries: A heterogeneous analysis. Health Care Management Science, 3(1), 31–42. https://doi.org/10.1023/a:1019020802989
32. Özen, A. and Köse, C.B. (2022). Türkiye’de kamu harcaması bileşenlerinin ekonomik büyümeye etkisi. Ekonomi Politika ve Finans Araştırmaları Dergisi, 7(1), 32-52. https://doi.org/10.30784/epfad.1006124
33. Panopoulou, E. and Pantelidis, T. (2011). Convergence in per capita health expenditures and health outcomes in the OECD countries. Applied Economics, 44(30), 3909–3920. https://doi.org/10.1080/00036846.2011.583222
34. Peker Say, N. and Yücel, M. (2006). Energy consumption and CO2 emissions in Türkiye: Empirical analysis and future projection based on an economic growth. Energy Policy, 34(18), 3870–3876. https://doi.org/10.1016/j.enpol.2005.08.024
35. Pekkurnaz, D. (2015). Convergence of health expenditure in OECD countries: Evidence from a nonlinear asymmetric heterogeneous panel unit root test. Journal of Reviews on Global Economics, 4, 76–86. https://doi.org/10.6000/1929-7092.2015.04.07
36. Piabuo, S.M. and Tieguhong, J.C. (2017). Health expenditure and economic growth - A review of the literature and an analysis between the economic community for central African states (CEMAC) and selected African countries. Health Economics Review, 7(1), 23. https://doi.org/10.1186/s13561-017-0159-1
37. Reimers, C.W. and Powell, L.M. (2001). Health care spending in OECD countries: A convergence analysis. Journal of Health Economics, 20(6), 1271-1282. https://doi.org/10.1016/S0167-6296(01)00110-2
38. Roberts, M.J., Hsiao, W., Berman, P. and Reich, M.R. (2008). Getting health reform right: A guide to improving performance and equity. Oxford: Oxford University Press.
39. Sayan, S. and Yıldırım, J. (2012). Inequities in health care financing in Türkiye: Redistributive effect of health care payments by households. The European Journal of Health Economics, 13(3), 351-364. https://doi.org/10.1007/s10198-011-0306-2
40. Söyük, S. (2023). The impact of public health expenditure and gross domestic product per capita on the risk of catastrophic health expenditures for OECD countries. Frontiers in Public Health, 11, 1122424. https://doi.org/10.3389/fpubh.2023.1122424
41. Sparkes, S.P., Bump, J.B., Özçelik, E.A., Kutzin, J. and Reich, M.R. (2019). Political economy analysis for health financing reform. Health Systems and Reform, 5(3), 183–194. https://doi.org/10.1080/23288604.2019.1633874
42. Sülkü, S.N. and Caner, A. (2011). Health care expenditures and gross domestic product: The Turkish case. The European Journal of Health Economics, 12(1), 29–38. https://doi.org/10.1007/s10198-010-0221-y
43. Şenol, O., Gökkaya, D. and Çirakli, Ü. (2021). The effects of economic variables on health expenditure per capita and life expectancy at birth: Panel data analysis for middle top income countries. Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 8(3), 1499–1515. https://doi.org/10.30798/makuiibf.909994
44. Topcu, E. and Atasayar, Y. (2020). Sağlık harcamaları, sermaye birikimi ve ekonomik büyüme arasındaki nedensel ilişki: Gelişmiş ve gelişmekte olan ülkeler üzerine bir inceleme. Ekonomi Politika ve Finans Araştırmaları Dergisi, 5(2), 276-291. https://doi.org/10.30784/epfad.734004
45. TURKSTAT. (2023). Public health expenditures. Retrieved from https://data.tuik.gov.tr/Bulten/Index?p=49676&dil=2#
46. Vankar, P. (2024). U.S. national health expenditure as percent of GDP from 1960 to 2022 [Dataset]. Retrieved from https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/#:~:text=In%202022%2C%20U.S.%20national%20health,GDP%20share%20among%20developed%20countries
47. Wang, F. (2015). More health expenditure, better economic performance? Empirical evidence from OECD countries. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 52, 0046958015602666. https://doi.org/10.1177/0046958015602666
48. Wanzala, M., Were, V., Oloo, J. and Nguka, G. (2019). Assessing capacity and performance of health systems using principal component analysis: Results from cross sectional survey in Kakamega County, Western Kenya. Journal of Health, Medicine and Nursing, 59, 33-40. https://doi.org/10.7176/JHMN/59-05
49. Wendt, C., Frisina, L. and Rothgang, H. (2010). Healthcare system types: A conceptual framework for comparison. Social Policy & Administration, 43(1), 70-90. https://doi.org/10.1111/j.1467-9515.2008.00647.x
50. World Bank Open Data. (2023). Open data [Dataset]. Retrieved from https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=TR
51. WHO (1946). Constitution of the World Health Organization (WHO). Retrieved from https://www.globalhealthrights.org/instrument/constitution-of-the-world-health-organization-who/
52. Yavuz, N.C., Yilanci, V. and Ozturk, Z.A. (2013). Is health care a luxury or a necessity or both? Evidence from Türkiye. The European Journal of Health Economics, 14(1), 5–10. https://doi.org/10.1007/s10198-011-0339-6
53. Yetim, B., İlgün, G., Çilhoroz, Y., Demirci, Ş. and Konca, M. (2021). The socioeconomic determinants of health expenditure in OECD: An examination on panel data. International Journal of Healthcare Management, 14(4), 1265–1269. https://doi.org/10.1080/20479700.2020.1756112
54. Yip, W. and Hsiao, W. (2008). The Chinese health system at a crossroads. Health Affairs, 27(2), 460-468. https://doi.org/10.1377/hlthaff.27.2.460
55. Zhang, X. and Wan, X. (2023). Research and prediction of health expenditure factors in China based on machine learning methods. In K. Li, Q. Li, P. Fournier-Viger., W-Ch. Hong., X. Liang., L. Wang and X. Xu (Eds.), Atlantis highlights in computer sciences (pp. 737-744). https://doi.org/10.2991/978-94-6463-040-4_112