Do Preventive Healthcare Services Increase Labor Productivity? An Econometric Analysis Based on Bootstrap Panel Causality Test

Year 2025, Volume: 10 Issue: 1, 269 - 302, 28.03.2025

Neslihan Gence Şen Toprak , Binnaz Çoban

https://doi.org/10.30784/epfad.1591963

Abstract

The diversification, expansion, and widening impact of issues threatening individual and social health have highlighted the growing importance of preventive healthcare services. These services are often noted for their positive externalities on other sectors. This study uses Kónya’s (2006) bootstrap panel Granger causality test to examine whether preventive healthcare services boost labor productivity. Annual data from five European countries (Denmark, France, Luxembourg, the Netherlands, and Norway) from 1995 to 2019 are used for this purpose. The econometric analysis reveals a bidirectional Granger causality relationship between expenditures on preventive healthcare services and labor productivity in Denmark, France, and the Netherlands. In Norway and Luxembourg, the relationship is unidirectional, from expenditure on preventive healthcare services to labor productivity. Furthermore, the findings show that a one-unit increase in expenditure on preventive healthcare services leads to a rise in labor productivity in the range of approximately 0.78% to 0.96% at the 1% statistical significance level.

Keywords

Preventive Healthcare Services, Labor Productivity, Bootstrap Panel Granger Causality Test

Koruyucu Sağlık Hizmetleri İş Gücü Verimliliğini Artırır mı? Bootstrap Panel Granger Nedensellik Testine Dayalı Ekonometrik Bir Analiz

Abstract

Başta bireylerin, ardından da toplumun genel sağlığını ilgilendiren ve tehdit eden sorunların çeşitlenmesi, büyümesi ve etkilediği alanların genişlemesi koruyucu sağlık hizmetlerinin önemini daha da artırmıştır. Bunun yanında diğer sektörler üzerinde yarattığı pozitif dışsallıklarla, koruyucu sağlık hizmetleri adından sıklıkla söz ettirmektedir. Bu kapsamda araştırmalara konu olan koruyucu sağlık hizmetlerinin dışsallıklarından biri de iş gücü verimliliği üzerine olan etkileridir. Bu çalışmada Kónya’nın (2006) bootstrap panel Granger nedensellik testi kullanılarak koruyucu sağlık hizmetlerinin iş gücü verimliliğini artırıp artırmadığı analiz edilmektedir. Bunun için de örneklem olarak seçilmiş beş Avrupa ülkesinin (Danimarka, Fransa, Lüksemburg, Hollanda ve Norveç) 1995-2019 dönemine ilişkin yıllık veri seti kullanılmıştır. Yapılan ekonometrik analizde Danimarka, Fransa ve Hollanda’da koruyucu sağlık hizmetlerine yönelik harcamalar ile iş gücü verimliliği arasında çift yönlü bir Granger nedensellik ilişkisi tespit edilmiştir. Norveç ve Lüksemburg açısından bu ilişkinin koruyucu sağlık hizmetlerine yönelik harcamalardan iş gücü verimliliğine doğru tek yönlü olduğu sonucuna ulaşılmıştır. Bunun yanında ekonometrik bulgular koruyucu sağlık hizmetlerine yönelik harcamalardaki bir birimlik artışın, iş gücü verimliliğinde %1 istatistiksel anlamlılık düzeyinde yaklaşık %0,78 ile %0,96 arasında değişen bantta bir artışa neden olduğunu ortaya koymaktadır.

Keywords

Koruyucu Sağlık Hizmetleri, İş gücü Verimliliği, Bootstrap Panel Granger Nedensellik Analizi

References

• Atkinson, A. (2015). Can we reduce income inequality in OECD countries? Empirica, 42(2), 211-223. https://doi.org/10.1007/s10663-015-9288-0
• Baltagi, B.H. (2005). Econometric analysis of panel data (3rd Ed.). New York: John Wiley & Sons Inc.
• Barro, R. (1991). Economic growth in a cross-section of countries. Quarterly Journal of Economics, 106(2), 407-443. https://doi.org/10.2307/2937943
• Breusch, T.S. and Pagan, A.R. (1980). The lagrange multiplier test and its application to model specification in econometric. Review of Economic Studies, 47, 239-253. https://doi.org/10.2307/2297111
• Burton, W., Chen, C-Y., Conti, D., Schultz, A. and Edington, D. (2006). The association between health risk change and presenteeism change. Journal of Occupational and Environmental Medicine, 48, 252-263. https://doi.org/10.1097/01.jom.0000201563.18108.af
• Burton, W., Chen, C-Y., Conti, D.J., Schultz, A.B., Pransky, G. and Edington, D.W. (2005). The association of health risks with on-the-job productivity. Journal of Occupational and Environmental Medicine, 47(8), 769-777. https://doi.org/10.1097/01.jom.0000169088.03301.e4
• Cedefop. (2010). Skill mismatch in Europe. Retrieved from https://www.cedefop.europa.eu/files/9023_en.pdf
• Choudhry, M.T. (2009). Determinants of labor productivity: An empirical investigation of productivity divergence. Retrieved from https://archivo.alde.es/encuentros.alde.es/anteriores/xiieea/trabajos/pdf/104.pdf
• Constantinescu, C., Mattoo, A. and Ruta, M. (2019). Does vertical specialisation increase productivity? The World Economy, 42(8), 2385-2402. https://doi.org/10.1111/twec.12801
• Corvers, F. (1997). The impact of human capital on labour productivity in manufacturing sectors of the European Union. Applied Economics, 29(8), 975–987. https://doi.org/ 10.1080/000368497326372
• Demir, C. (2019). Dışa açılma ve kamu harcamaları: OECD ülkeleri için panel veri analizi. Kırklareli Üniversitesi Sosyal Bilimler Dergisi, 3(2), 80-96. Erişim adresi: https://dergipark.org.tr/tr/pub/kusbder
• Edington, D. and Burton, W. (2003). Health and productivity. In R. McCunney and R. McCunney (Eds.), A practical approach to occupational and environmental medicine (pp. 40-152). Philadelphia, PA: Lippincott Williams and Wilkins.
• European Commission. (2021). Education and training – monitor 2021. Retrieved from https://op.europa.eu/en/publication-detail/-/publication/8599033b-57d9-11ec-91ac-01aa75ed71a1
• European Union. (2016a). Luxembourg: Mismatch priority occupations. Retrieved from https://www.cedefop.europa.eu/en/data-insights/luxembourg-mismatch-priority-occupations
• European Union. (2016b). France: Mismatch priority occupations. Retrieved from https://www.cedefop.europa.eu/en/data-insights/france-mismatch-priority-occupations#group-details
• European Union. (2019). Manual on sources and methods for the compilation of COFOG statistics. Retrieved from https://ec.europa.eu/eurostat/web/products-manuals-and- guidelines/-/ks-gq-19-010
• Eurostat. (2023). Employment by educational attainment level – quarterly data. Retrieved from https://doi.org/10.2908/LFSI_EDUC_Q
• Feenstra, R.C., Inklaar, R. and Timmer, M.P. (2015). The next generation of the Penn world table. American Economic Review, 105(10), 3150-3182. https://doi.org/10.2908/LFSI_EDUC_Q
• Freeman, R. (1976). The overeducated American. New York: Academic Press.   Gera, S., Gu, W. and Lee, F.C. (1999). Information technology and labour productivity growth: An empirical analysis for Canada and the United States. The Canadian Journal of Economics/Revue Canadienne d'Economique, 32(2), 384-407. Retrieved from https://publications.gc.ca/
• Giuliano, R., Mahy, B., Rycx, F. and Vermeylen, G. (2024). Overeducation, overskilling and job satisfaction in Europe: The moderating role of employment contracts (IZA Discussion Paper No. 16913). Retrieved from https://www.iza.org/publications/dp/16913/overeducation-overskilling-and-job-satisfaction-in-europe-the-moderating-role-of-employment-contracts
• Gul, S., Khan, A.G. and Ajmair, M. (2022). Relationship between human capital and labour productivity. Pakistan Social Sciences Review, 6(2), 663-677. https://doi.org/10.35484/pssr.2022(6-II)56
• Goetzel, R. and Ozminkowski, R. (2008). The health and cost benefits of work site health-promotion programs. Annual Review of Public Health, 29, 303-323. https://doi.org/10.1146/annurev.publhealth.29.020907.090930.
• Harris, R.G. (1999). Determinants of Canadian productivity growth: Issues and prospects. Paper Presented at CSLS-Industry Canada Conference on Canada in the 21st Century: A Time for Vision. Ottawa, Ontario. Retrieved from https://www.csls.ca/events/sept1999/harre.pdf
• Hartog, J., Odink, J. and Smits, J. (1999). Private returns to education in the Netherlands: A review of the literatüre. In R. Asplund and P.T. Pereira (Eds), Returns to human capital in Europe (pp. 209-226). Helsinki: ETLA.
• Hernæs, E., Kornstad, T., Markussen, S. and Røed, K. (2023). Ageing and labor productivity. Labour Economics, 82, 102347. https://doi.org/10.1016/j.labeco.2023.102347
• Hsiao, C. (2003). Analysis of panel data. United Kingdom: Cambridge University Press.
• Index of Economic Freedom. (2024). Norway – Economic Freedom Country Profile. Retrieved from https://www.heritage.org/index/pages/country-pages/norway
• Index of Economic Freedom. (2024). Luxembourg – Economic Freedom Country Profile. Retrieved from https://www.heritage.org/index/pages/country-pages/luxembourg
• Investment in Luxembourg. (2024). Luxembourg. Retrieved from https://commission.europa.eu/system/files/2015-12/luxembourg-country-file_en.pdf
• Kacou, K.Y., Kassouri, Y., Evrard, T.H. and Altuntaş, M. (2022). Trade openness, export structure, and labor productivity in developing countries: Evidence from panel VAR approach. Structural Change and Economic Dynamics, 60, 194-205. https://doi.org/10.1016/j.strueco.2021.11.015
• Kang, H., Kim, S., Malloy, K., McMurry, T.L., Balkrishnan, R., Anderson, R., ... Lobo, J.M. (2021). Evaluating efficiency of counties in providing diabetes preventive care using data envelopment analysis. Health Services and Outcomes Research Methodology, 21(3), 324–338. https://doi.org/10.1007/s10742-020-00237-1
• Kar, M., Nazlıoğlu, Ş. and Ağır, H. (2011). Financial development and economic growth nexus in the MENA countries: Bootstrap panel granger causality analysis. Economic Modelling, 28(1-2), 685-693. https://doi.org/10.1016/j.econmod.2010.05.015
• Kónya, L. (2006). Exports and growth: Granger causality analysis on OECD countries with a panel data approach. Economic Modelling, 23(6), 978-992. https://doi.org/10.1016/j.econmod.2006.04.008
• Koyuncu, C. and Unver, M. (2019). The association between health expenditure and productivity in Asian countries. In D.K. Dimitrov, D. Nikoloski and R. Yilmaz (Eds.), Proceedings (pp. 187-192). Papers presented at XII. International Balkan and Near Eastern Congress Series on Economics, Business and Management in University of Agribusiness and Rural Development, Plovdiv- Bulgaria.
• KPMG. (2024). Luxembourg. Retrieved from https://kpmg.com/xx/en/home/insights/2020/10/why-luxembourg-remains-attractive-for-investment.html
• Lee, J.W. and Lee, H. (2016). Human capital in the long run. Journal of Development Economics, 122, 147-169. https://doi.org/10.1016/j.jdeveco.2016.05.006
• Loeppke, R. and Hymel, P. (2008). Health and productivity enhancement. In R.Jr. Moser (Ed.), Effective management of health and safety programs: A practical guide (pp. 225-243). MA: OEM Press.
• Loeppke, R., Hymel, P., Lofland, J., Pizzi, L.T., Konicki, D.L., Anstadt, G., … Scharf, T. (2003). Health-related workplace productivity measurement: General and migraine-specific recommendations from the ACOEM expert panel. Journal of Occupational and Environmental Medicine, 45, 349-359. https://doi.org/10.1097/01.jom.0000063619.37065.e2
• Loeppke, R., Nicholson, S., Taitel, M., Sweeney, M., Haufle, V. and Kessler R.C. (2008). The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions and productivity. Population Health Management, 11(6), 287-296. https://doi.org/10.1089/pop.2008.0006
• Loeppke, R., Taitel, M., Richling, D., Parry, T., Kessler, R.C., Hymel, P. and Konicki, D. (2007). Health and productivity as a business strategy. Journal of Occupational and Environmental Medicine, 49(7), 712-721. https://doi.org/10.1097/JOM.0b013e318133a4be
• Lucas, R.E. (1988). On the mechanics of economic development. Journal of Monetary Economics, 22, 3-42. https://doi.org/10.1016/0304-3932(88)90168-7
• Mallick, J. (2013). Globalisation and labor productivity in OECD regions. Retrieved from https://dk.upce.cz/server/api/core/bitstreams/59654b38-95e5-4d00-8c16-b82b8d6fb928/content
• Máté, D. (2015). Impact of human capital on productivity growth in different labour-skilled branches. Acta Oeconomica, 65(1), 51-67. https://www.jstor.org/stable/24857543
• Máté, D., Darabos, É. and Dajnoki, K. (2016). The impact of human capital on labour productivity regarding 2020 targets: Case study. Network Intelligence Studies, 4(7), 61-67. Retrieved from https://seaopenresearch.eu/
• Menyah, K., Nazlioglu, S. and Wolde-Rufael, Y. (2014). Financial development, trade openness and economic growth in African countries: New insights from a panel causality approach. Economic Modelling, 37, 386-394. https://doi.org/10.1016/j.econmod.2013.11.044
• Nielsen, C.P. (2011). Immigrant over-education: Evidence from Denmark. Journal of Population Economics, 24(2), 499-520. Retrieved from https://www.jstor.org/stable/41488315
• OECD. (2000). A system of health accounts: Version 1.0. Retrieved from https://www.oecd.org/els/health-systems/1841456.pdf
• OECD. (2011). A system of health accounts 2011 revised edition. http://dx.doi.org/10.1787/9789264270985-en
• OECD. (2023a). Health at a glance 2023. Country note: The Netherlands. Retrieved from https://www.oecd.org/netherlands/health-at-a-glance-Netherlands-EN.pdf
• OECD. (2023b). European observatory on health systems and policies, France: Country health profile 2023, state of health in the eu. Retrieved from https://eurohealthobservatory.who.int/publications/m/france-country-health-profile-2023
• OECD. (2023c). Country health profiles 2023. Retrieved from https://www.oecd.org/health/country-health-profiles-eu.htm
• OECD. (2024). OECD better life index, Norway. Retrieved from https://www.oecdbetterlifeindex.org/countries/norway/
• Osathanunkul, R., Dumrong, P., Yamaka, W. and Maneejuk, P. (2023). The nonlinear impacts of aging labor and government health expenditures on productivity in ASEAN+3 economies. Economic Analysis and Policy, 80, 450-470. https://doi.org/10.1016/j.eap.2023.08.021
• Osim, R.O., Uzoigwe, M.C., Okpechi, E.O., Abane, P. and Igbineweka, P.O. (2024). Public health expenditure, government effectiveness and labour productivity in West Africa. Nurture, 18(1), 55-72. https://doi.org/10.55951/nurture.v18i1.543
• Pangean. (2020). The Norway: The perfect economy. Retrieved from https://thepangean.com/The-Perfect-Economy
• Pesaran, M.H. (2004). General diagnostic tests for cross section dependence in panels (IZA Discussion Paper No. 1240). Retrieved from https://docs.iza.org/dp1240.pdf
• Pesaran, M.H., Ullah, A. and Yamagata, T. (2008). A bias-adjusted LM test of error cross section independence. The Econometrics Journal, 1(11), 105-127. Retrieved from https://www.jstor.org/stable/23116064
• Pesaran, M.H. and Yamagata, T. (2008). Testing slope homogeneity in large panels. Journal of Econometrics, 1(142), 50-93. https://doi.org/10.1016/j.jeconom.2007.05.010
• Pindyck, R.S. and Rubinfeld, ‎L. (1998). Econometric models and economic forecasts (4th Ed.). New York: McGraw-Hill.
• Portrait of the Luxembourg Economy. (2024). Portrait of the Luxembourg economy. Retrieved from https://luxembourg.public.lu/en/invest/competitiveness/portrait-luxembourg-economy.html
• Raghupathi, V. and Raghupathi, W. (2020). Healthcare expenditure and economic performance: Insights from the United States data. Frontiers in Public Health, 8, 156. https://doi.org/10.3389/fpubh.2020.00156
• Romer, P. (1986). Increasing returns and long-run growth. Journal of Political Economy, 94(10), 1002-1037. Retrieved from https://www.jstor.org/stable/
• Sachs, J.D. and Warner A.M. (1995). Natural resource abundance and economic growth (NBER Working Paper No. 5398). https://doi.org/10.3386/w5398
• Schultz, T.P. (2003). Human capital, schooling and health. Economics & Human Biology, 1(2), 207-221. https://doi.org/10.1016/S1570-677X(03)00035-2
• Street, T.D. and Lacey, S.J. (2019). Accounting for employee health: The productivity cost of leading health risks. Health Promotion Journal of Australia, 30(2), 228-237. https://doi.org/10.1002/hpja.200
• Şen, H., Kaya, A. and Alpaslan, B. (2018). Education, health, and economic growth nexus: A bootstrap panel Granger causality analysis for developing countries. Sosyoekonomi, 26(36), 125-144. https://doi.org/10.17233/sosyoekonomi.2018.02.07
• Ünsal, M.E. (2020). Ekonomik büyümenin kaynağı olarak iş gücü verimliliği, sermaye verimliliği ve toplam faktör verimliliği: Gelişmiş ve gelişmekte olan ülkelerden yeni kanıtlar. Verimlilik Dergisi, 3, 7-23. Retrieved from https://dergipark.org.tr/tr/pub/verimlilik/
• Van Lottum, J. and Van Zanden, J.L. (2014). Labour productivity and human capital in the European maritime sector of the eighteenth century. Explorations in Economic History, 53, 83-100. https://doi.org/10.1016/j.eeh.2014.04.001
• Wang, F., Wang, J.-D. and Huang, Y.-X. (2016). Health expenditures spent for prevention, economic performance, and social welfare. Health Economics Review, 6(1). https://doi.org/10.1186/s13561-016-0119-1
• Waters, H. and Graf, M. (2018) The costs of chronic disease in the U.S (Milken Institute, August 2018). Retrieved from https://milkeninstitute.org/sites/default/files/reports-pdf/ChronicDiseases-HighRes-FINAL_0_1.pdf
• WHO. (1978). International classification of procedures in medicine, Volume 2. Retrieved from https://iris.who.int/bitstream/handle/10665/40527/9241541253_eng.pdf;jsessionid=0FBD9F3AEC794AF23B618413025A72EC?sequence=2
• WHO. (2021a). Global expenditure on health: Public spending on the rise? Retrieved from https://files.aho.afro.who.int/afahobckpcontainer/production/files/2_Global_expenditure_on_health_Public_spending_on_the_rise.pdf
• WHO. (2021b). Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond. Retrieved from https://iris.who.int/bitstream/handle/10665/346515/WHO-UHL-PHC-SP-2021.01-eng.pdf?sequence=1
• WHO. (2022). Implications of the COVID-19 pandemic for patient safety: A rapid review. Retrieved from https://iris.who.int/bitstream/handle/10665/361283/9789240055094-eng.pdf?sequence=1
• WHO. (2023). Global spending on health coping with the pandemic. Retrieved from https://iris.who.int/bitstream/handle/10665/375855/9789240086746-eng.pdf?sequence=1