Research Article
BibTex RIS Cite

Türkiye’de Sağlık Enflasyonunun Belirleyicileri ve Bölgesel Etkileşimleri: Mekansal Panel Veri Analizi Bulguları

Year 2026, Volume: 11 Issue: 1 , 21 - 39 , 31.03.2026
https://doi.org/10.30784/epfad.1777387
https://izlik.org/JA56SE89LM

Abstract

Sağlık sektöründe meydana gelen mal ve hizmet fiyatlarındaki artış olarak tanımlanan sağlık enflasyonu, bireylerin sağlık hizmetlerine olan erişimini riske atmaktadır. Kamu bütçesi üzerinde baskı yaratan sağlık enflasyonu, Türkiye’de özellikle son yıllarda artış eğilimi göstermektedir. Bu doğrultuda çalışmanın temel amacı, 2011-2021 döneminde Türkiye’de Düzey-2 bölgelerindeki sağlık enflasyonunun belirleyicilerini, mekansal panel veri analizi yöntemiyle incelemektir. İlgili çalışma, literatürde yeterince ele alınmamış bir konu olan sağlık enflasyonunu araştırma konusu edinmesi ve mekansal veri analizi sürecinde uygun mekansal ağırlık matrisinin seçimine vurgu yapmasıyla diğer çalışmalardan ayrılmaktadır. Mekansal panel veri analizi neticesinde, queen komşuluk kriteri ile oluşturulan mekansal ağırlık matrisi kullanılarak tahmin edilen, sabit etkiler içeren mekansal gecikme modelinin uygun model olduğu tespit edilmiştir. Modele alınan açıklayıcı değişkenlerden genel enflasyon, üniversite mezun ve doğum oranları sağlık enflasyonunu artırmakta, sağlık alanındaki girişim sayısı, 100.000 kişi başına düşen hastane yatak sayısı ve genç nüfus oranı ise azaltmaktadır. Analizden elde edilen pozitif mekansal bağımlılık bulgusu ise sağlık enflasyonu konusunda Düzey-2 bölgelerindeki bölgesel etkileşimi vurgulamaktadır.

References

  • Ankara, H.G. and Zeybek, D.Ö. (2021). Sağlıkta dönüşüm sonrası sağlık harcamaları ve sağlık enflasyonu: zaman serisi analizleri. Süleyman Demirel Üniversitesi Vizyoner Dergisi, 12(32), 1078-1093. https://doi.org/10.21076/vizyoner.808283
  • Anselin, L., Le Gallo, J. and Jayet, H. (2008). Spatial panel econometrics. In Matyas, L. and Sevestre, P. (Eds.), The econometrics of panel data, fundamentals and recent developments in theory and practice (pp. 624-660). Berlin: Springer.
  • Bac, T.C. (2025). Decoding the drivers of structural change: Novel insights from spatial panel data modeling. Montenegrin Journal of Economics, 21(1), 193-203. doi:10.14254/1800-5845/2025.21-1.15
  • Baltagi, B.H. (2005). Econometric analysis of panel data (3.ed.). England: John Wiley&Sons Ltd.
  • Baltagi, B.H., Song, S.H. and Koh, W. (2003). Testing panel data regression models with spatial error correlation. Journal of Econometrics, 117(1), 123-150. https://doi.org/10.1016/S0304-4076(03)00120-9
  • Baumol, W.J. (1993). Health care, education and the cost disease: A looming crisis for public choice. In C.K. Rowley, F. Schneider and R.D. Tollison (Eds.), The next twenty-five years of public choice. Dordrecht: Springer Netherlands.
  • Bayati, M., Sarikhani, Y., Rad, E.H., Heydari, S.T. and Lankarani, K.B. (2014). An analytical study on healthcare inflation rate and its most important components in Iran. Shiraz E-Medical Journal, 15(4), e23627. https://doi.org/10.17795/semj23627
  • Cutler, D.M. and Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (NBER Working Paper No. 12352). htpp://doi.org/10.3386/w12352
  • Cutler, D.M. and Sheiner, L. (1998). Demographics and medical care spending: Standard and non-standard effects (NBER Working Paper No. 6866). Retrieved from https://www.nber.org/papers/w6866
  • Çakır, N.Z. (2019). Sağlık harcamalarını etkileyen faktörlerin panel tobit modelleri ile analizi: Avrupa Birliği ülkeleri uygulaması (Unpublished master’s thesis). Marmara Üniversitesi, Sosyal Bilimler Enstitüsü, İstanbul.
  • Elhorst, J.P. (2012). Dynamic spatial panels: Models, methods, and inferences. Journal of Geographical Systems, 14(1), 5-28. htpp://doi.org/10.1007/s10109-011-0158-4.
  • Elhorst, J.P. (2014). Spatial econometrics: From cross-sectional data to spatial panels. Heidelberg: Springer.
  • Erasmus, M. and Fourie, H. (2014). Rising prices in the healthcare sector: Unpacking health inflation (Publication No. 36). Retrieved from: https://hasa.co.za/wp-content/uploads/2017/08/econex_researchnote_36-1-1.pdf
  • Feinstein, L., Sabates, R., Anderson, T. M., Sorhaindo, A. and Hammond, C. (2006). What are the effects of education on health. Paper presented at the Measuring the effects of education on health and civic engagement: Proceedings of the Copenhagen symposium. OECD, Paris. Retrieved from https://web.archive.org/web/20170809083650id_/http://www1.oecd.org/edu/innovation-education/37425753.pdf
  • Folland, S., Goodman, A.C., Stano, M. and Danagoulian, S. (2017). The economics of health and health care. London: Routledge.
  • Gaynor, M., Ho, K. and Town, R.J. (2015). The industrial organization of health-care markets. Journal of Economic Literature, 53(2), 235-284. http://dx.doi.org/10.1257/jel.53.2.235
  • Geary, R.C. (1954). The contiguity ratio and statistical mapping. The Incorporated Statistician, 5(3), 115-146. https://doi.org/10.2307/2986645
  • Getzen, T.E. and Kobernick, M.S. (2022). Health economics and financing (4.ed.). Hoboken, NJ: John Wiley & Sons.
  • Gujarati, D.N. and Porter, D. C. (2009). Basic econometrics (5.ed.). McGraw-Hill/Irwin.
  • Hausman, J.A. (1978). Specification tests in econometrics. Econometrica: Journal of the Econometric Society, 46(6), 1251-1271. https://doi.org/10.2307/1913827
  • Hsiao, C. (2003). Analysis of panel data (2.ed.). University of Southern California: Cambridge University Press.
  • Huddleston, J.R. (1976). Factors affecting the variation in cost inflation among hospitals which expand beds or facilities: An analysis of hospital regulation policy (Unpublished doctoral dissertation). Oklahoma State University, USA.
  • Kapoor, M., Kelejian, H.H. and Prucha, I.R. (2007). Panel data models with spatially correlated error components. Journal of Econometrics, 140(1), 97-130. https://doi.org/10.1016/j.jeconom.2006.09.004
  • Kim, H.J. and Chun, K.H. (1989). An analysis of determinants of medical cost inflation using both deterministic and stochastic models. Journal of Preventive Medicine and Public Health, 22(4), 542-554. Retrieved from https://www.koreamed.org/
  • LeSage, J. and Pace, R.K. (2009). Introduction to spatial econometrics. London: Chapman and Hall/CRC. Lu, L. (2023). Simultaneous spatial panel data models with common shocks. Journal of Business & Economic Statistics, 41(2), 608-623. https://doi.org/10.1080/07350015.2022.2046007
  • Millo, G. (2014). Maximum likelihood estimation of spatially and serially correlated panels with random effects. Computational Statistics & Data Analysis, 71, 914-933. https://doi.org/10.1016/j.csda.2013.07.024
  • Moran, P.A. (1948). The interpretation of statistical maps. Journal of the Royal Statistical Society: Series B (Methodological), 10(2), 243-251. Retrieved from http://www.jstor.org/
  • Movsisyan, A., Wendel, F., Bethel, A., Coenen, M., Krajewska, J., Littlecott, H., ... and Rehfuess, E. (2024). Inflation and health: A global scoping review. The Lancet Global Health, 12(6), e1038-e1048. https://doi.org/10.1016/S2214-109X(24)00133-5
  • Newhouse, J.P. (1992). Medical care costs: How much welfare loss? Journal of Economic Perspectives, 6(3), 3-21. Retrieved from https://pubs.aeaweb.org/doi/pdf/10.1257/jep.6.3.3
  • Özer, M., İnal, V. and Kırca, M. (2022). The relationship between the health services price index and the real effective exchange rate index in Turkey: A frequency domain causality analysis. EKOIST Journal of Econometrics and Statistics, 36, 21-41. https://doi: 10.26650/ekoist.2022.36.1108803
  • Poongavanam, S., Srinivasan, R., Arivazhagan, D. and Suresh, N.V. (2023). Medical inflation-issues and impact. Chettinad Health City Medical Journal, 12(2), 122-124. https://doi.org/10.24321/2278.2044.202340
  • Reichert, U.N. and Cebula, R.J. (1999). A note on health care inflation. Journal of Economics and Finance, 23(3), 193-198. https://doi:10.1007/BF02757704
  • Roemer, M.I. (1961). Bed supply and hospital utilization: A natural experiment. Hospitals, 35, 36-42. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14493273/
  • Salima, B.A., Julie, L.G. and Lionel, V. (2018). Spatial econometrics on panel data. In Loonis V. and de Bellefon M.P. (Eds.), Handbook of spatial analysis: Theory and practical application with R (pp. 179-203). Insee Méthodes, No 131.
  • Teimourizad, A., Hadian, M., Rezaei, S. and Rad, E.H. (2014). Health sector inflation rate and its determinants in Iran: A longitudinal study (1995–2008). Iranian Journal of Public Health, 43(11), 1537. Retrieved from https://pmc.ncbi.nlm.nih.gov/
  • TÜİK. (2025). Bölgesel istatistikler veri tabanı [Dataset]. Retrieved from https://biruni.tuik.gov.tr/bolgeselistatistik/degiskenlerUzerindenSorgula.do?durum=acKapa&menuNo=283&altMenuGoster=1&secilenDegiskenListesi=
  • Türkön, B.F., Mete, A.H. and Boz, C. (2024). The causality between the exchange rate and health price index: An econometric analysis. SDÜ Sağlık Yönetimi Dergisi, 6(2), 220-230. Retrieved from https://dergipark.org.tr/tr/pub/sdusyd/
  • Yılgör, M. (2019). Mekânsal ekonometri: Mekânsal yatay kesit ve mekânsal panel veri modelleri. İstanbul: DER Yayınları.

Determinants and Regional Interactions of Health Inflation: Evidence from Spatial Panel Data Analysis in Turkey

Year 2026, Volume: 11 Issue: 1 , 21 - 39 , 31.03.2026
https://doi.org/10.30784/epfad.1777387
https://izlik.org/JA56SE89LM

Abstract

Health inflation, which refers to the persistent rise in the costs of healthcare goods and services, constitutes a substantial barrier to access to medical care. By exerting pressure on the public budget, health inflation has shown an upward trend in Turkey, particularly in recent years. This study aims to examine the factors influencing health inflation in Turkey’s NUTS-2 regions over the period 2011–2021 through the application of spatial panel data analysis. The study differentiates itself from previous research by addressing health inflation, which has received limited attention in the literature, and by emphasizing the selection of an appropriate spatial weight matrix in the spatial data analysis process. The analysis identified the fixed-effects spatial lag model with a queen contiguity weight matrix as the appropriate model. Among the explanatory variables included in the model, general inflation, the proportion of university graduates, and birth rates were found to increase health inflation, whereas the number of enterprises in the health sector, the number of hospital beds per 100.000 population, and the share of the young population were found to reduce it. Finally, evidence of positive spatial dependence points to regional interaction in relation to health inflation among Turkey’s NUTS-2 regions.

References

  • Ankara, H.G. and Zeybek, D.Ö. (2021). Sağlıkta dönüşüm sonrası sağlık harcamaları ve sağlık enflasyonu: zaman serisi analizleri. Süleyman Demirel Üniversitesi Vizyoner Dergisi, 12(32), 1078-1093. https://doi.org/10.21076/vizyoner.808283
  • Anselin, L., Le Gallo, J. and Jayet, H. (2008). Spatial panel econometrics. In Matyas, L. and Sevestre, P. (Eds.), The econometrics of panel data, fundamentals and recent developments in theory and practice (pp. 624-660). Berlin: Springer.
  • Bac, T.C. (2025). Decoding the drivers of structural change: Novel insights from spatial panel data modeling. Montenegrin Journal of Economics, 21(1), 193-203. doi:10.14254/1800-5845/2025.21-1.15
  • Baltagi, B.H. (2005). Econometric analysis of panel data (3.ed.). England: John Wiley&Sons Ltd.
  • Baltagi, B.H., Song, S.H. and Koh, W. (2003). Testing panel data regression models with spatial error correlation. Journal of Econometrics, 117(1), 123-150. https://doi.org/10.1016/S0304-4076(03)00120-9
  • Baumol, W.J. (1993). Health care, education and the cost disease: A looming crisis for public choice. In C.K. Rowley, F. Schneider and R.D. Tollison (Eds.), The next twenty-five years of public choice. Dordrecht: Springer Netherlands.
  • Bayati, M., Sarikhani, Y., Rad, E.H., Heydari, S.T. and Lankarani, K.B. (2014). An analytical study on healthcare inflation rate and its most important components in Iran. Shiraz E-Medical Journal, 15(4), e23627. https://doi.org/10.17795/semj23627
  • Cutler, D.M. and Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (NBER Working Paper No. 12352). htpp://doi.org/10.3386/w12352
  • Cutler, D.M. and Sheiner, L. (1998). Demographics and medical care spending: Standard and non-standard effects (NBER Working Paper No. 6866). Retrieved from https://www.nber.org/papers/w6866
  • Çakır, N.Z. (2019). Sağlık harcamalarını etkileyen faktörlerin panel tobit modelleri ile analizi: Avrupa Birliği ülkeleri uygulaması (Unpublished master’s thesis). Marmara Üniversitesi, Sosyal Bilimler Enstitüsü, İstanbul.
  • Elhorst, J.P. (2012). Dynamic spatial panels: Models, methods, and inferences. Journal of Geographical Systems, 14(1), 5-28. htpp://doi.org/10.1007/s10109-011-0158-4.
  • Elhorst, J.P. (2014). Spatial econometrics: From cross-sectional data to spatial panels. Heidelberg: Springer.
  • Erasmus, M. and Fourie, H. (2014). Rising prices in the healthcare sector: Unpacking health inflation (Publication No. 36). Retrieved from: https://hasa.co.za/wp-content/uploads/2017/08/econex_researchnote_36-1-1.pdf
  • Feinstein, L., Sabates, R., Anderson, T. M., Sorhaindo, A. and Hammond, C. (2006). What are the effects of education on health. Paper presented at the Measuring the effects of education on health and civic engagement: Proceedings of the Copenhagen symposium. OECD, Paris. Retrieved from https://web.archive.org/web/20170809083650id_/http://www1.oecd.org/edu/innovation-education/37425753.pdf
  • Folland, S., Goodman, A.C., Stano, M. and Danagoulian, S. (2017). The economics of health and health care. London: Routledge.
  • Gaynor, M., Ho, K. and Town, R.J. (2015). The industrial organization of health-care markets. Journal of Economic Literature, 53(2), 235-284. http://dx.doi.org/10.1257/jel.53.2.235
  • Geary, R.C. (1954). The contiguity ratio and statistical mapping. The Incorporated Statistician, 5(3), 115-146. https://doi.org/10.2307/2986645
  • Getzen, T.E. and Kobernick, M.S. (2022). Health economics and financing (4.ed.). Hoboken, NJ: John Wiley & Sons.
  • Gujarati, D.N. and Porter, D. C. (2009). Basic econometrics (5.ed.). McGraw-Hill/Irwin.
  • Hausman, J.A. (1978). Specification tests in econometrics. Econometrica: Journal of the Econometric Society, 46(6), 1251-1271. https://doi.org/10.2307/1913827
  • Hsiao, C. (2003). Analysis of panel data (2.ed.). University of Southern California: Cambridge University Press.
  • Huddleston, J.R. (1976). Factors affecting the variation in cost inflation among hospitals which expand beds or facilities: An analysis of hospital regulation policy (Unpublished doctoral dissertation). Oklahoma State University, USA.
  • Kapoor, M., Kelejian, H.H. and Prucha, I.R. (2007). Panel data models with spatially correlated error components. Journal of Econometrics, 140(1), 97-130. https://doi.org/10.1016/j.jeconom.2006.09.004
  • Kim, H.J. and Chun, K.H. (1989). An analysis of determinants of medical cost inflation using both deterministic and stochastic models. Journal of Preventive Medicine and Public Health, 22(4), 542-554. Retrieved from https://www.koreamed.org/
  • LeSage, J. and Pace, R.K. (2009). Introduction to spatial econometrics. London: Chapman and Hall/CRC. Lu, L. (2023). Simultaneous spatial panel data models with common shocks. Journal of Business & Economic Statistics, 41(2), 608-623. https://doi.org/10.1080/07350015.2022.2046007
  • Millo, G. (2014). Maximum likelihood estimation of spatially and serially correlated panels with random effects. Computational Statistics & Data Analysis, 71, 914-933. https://doi.org/10.1016/j.csda.2013.07.024
  • Moran, P.A. (1948). The interpretation of statistical maps. Journal of the Royal Statistical Society: Series B (Methodological), 10(2), 243-251. Retrieved from http://www.jstor.org/
  • Movsisyan, A., Wendel, F., Bethel, A., Coenen, M., Krajewska, J., Littlecott, H., ... and Rehfuess, E. (2024). Inflation and health: A global scoping review. The Lancet Global Health, 12(6), e1038-e1048. https://doi.org/10.1016/S2214-109X(24)00133-5
  • Newhouse, J.P. (1992). Medical care costs: How much welfare loss? Journal of Economic Perspectives, 6(3), 3-21. Retrieved from https://pubs.aeaweb.org/doi/pdf/10.1257/jep.6.3.3
  • Özer, M., İnal, V. and Kırca, M. (2022). The relationship between the health services price index and the real effective exchange rate index in Turkey: A frequency domain causality analysis. EKOIST Journal of Econometrics and Statistics, 36, 21-41. https://doi: 10.26650/ekoist.2022.36.1108803
  • Poongavanam, S., Srinivasan, R., Arivazhagan, D. and Suresh, N.V. (2023). Medical inflation-issues and impact. Chettinad Health City Medical Journal, 12(2), 122-124. https://doi.org/10.24321/2278.2044.202340
  • Reichert, U.N. and Cebula, R.J. (1999). A note on health care inflation. Journal of Economics and Finance, 23(3), 193-198. https://doi:10.1007/BF02757704
  • Roemer, M.I. (1961). Bed supply and hospital utilization: A natural experiment. Hospitals, 35, 36-42. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14493273/
  • Salima, B.A., Julie, L.G. and Lionel, V. (2018). Spatial econometrics on panel data. In Loonis V. and de Bellefon M.P. (Eds.), Handbook of spatial analysis: Theory and practical application with R (pp. 179-203). Insee Méthodes, No 131.
  • Teimourizad, A., Hadian, M., Rezaei, S. and Rad, E.H. (2014). Health sector inflation rate and its determinants in Iran: A longitudinal study (1995–2008). Iranian Journal of Public Health, 43(11), 1537. Retrieved from https://pmc.ncbi.nlm.nih.gov/
  • TÜİK. (2025). Bölgesel istatistikler veri tabanı [Dataset]. Retrieved from https://biruni.tuik.gov.tr/bolgeselistatistik/degiskenlerUzerindenSorgula.do?durum=acKapa&menuNo=283&altMenuGoster=1&secilenDegiskenListesi=
  • Türkön, B.F., Mete, A.H. and Boz, C. (2024). The causality between the exchange rate and health price index: An econometric analysis. SDÜ Sağlık Yönetimi Dergisi, 6(2), 220-230. Retrieved from https://dergipark.org.tr/tr/pub/sdusyd/
  • Yılgör, M. (2019). Mekânsal ekonometri: Mekânsal yatay kesit ve mekânsal panel veri modelleri. İstanbul: DER Yayınları.
There are 38 citations in total.

Details

Primary Language English
Subjects Econometric and Statistical Methods, Econometrics (Other)
Journal Section Research Article
Authors

Nazife Zeynep Çakır 0000-0002-3207-4528

Submission Date September 3, 2025
Acceptance Date January 28, 2026
Publication Date March 31, 2026
DOI https://doi.org/10.30784/epfad.1777387
IZ https://izlik.org/JA56SE89LM
Published in Issue Year 2026 Volume: 11 Issue: 1

Cite

APA Çakır, N. Z. (2026). Determinants and Regional Interactions of Health Inflation: Evidence from Spatial Panel Data Analysis in Turkey. Ekonomi Politika Ve Finans Araştırmaları Dergisi, 11(1), 21-39. https://doi.org/10.30784/epfad.1777387