OECD Ülkelerinde Sağlık Sistemleri ve Sağlık Harcamaları İlişkisi: Ekonometrik bir Yaklaşım

Abstract

Bu çalışmada OECD ülkelerinde sağlık harcamalarını belirleyen etkenler ve sağlık sistemlerinin bu etkenler üzerinde etkili olup olmadığı anlaşılmaya çalışılmıştır. Bu doğrultuda 27 OECD ülkesinin 1995-2020 yılları arasındaki yıllık verileri ile panel kointegrasyon ekonometrik modeli oluşturulmuştur. Bunun yanında bu çalışmada; sağlık sistemlerinin, sağlık harcamalarının belirleyicileri üzerindeki etkilerinin anlaşılması amaçlandığı için sağlık sistemleri ayrı ayrı modellenmiştir. Bu nedenle birinci modelde 27 OECD ülkesinin verileri incelenmiştir. İkinci modelde ise Beveridge sağlık sistemini benimseyen 14 ülkenin verileri, üçüncü modelde Bismarck sağlık sistemini benimseyen 13 ülkenin verileri modellenmiştir. Analizlerden doğru sonuçlar alabilmek için çalışmada kullanılan serilere ve kurulan modellere panel kointegrasyon analizinin gerektirdiği testler uygulanmıştır. Bu doğrultuda öncelikle serilere homojenlik ve yatay kesit bağımlılık testleri yapılmış ve bu testler sonucunda serilerin heterojen oldukları ve yatay kesit bağımlılığına sahip oldukları saptanmıştır. Buradan hareketlere serilere heterojenliği esas alan ikinci nesil panel birim kök testleri uygulanmıştır. Birim kök testleri sonucunda serilerin aynı derecede durağan olduklarının anlaşılması üzerine modeller oluşturulmuş ve bu sefer modellere yönelik homojenlik ve yatay kesit bağımlılık testleri yapılmış ve 3 modelin de heterojen olduğu ve yatay kesit bağımlılığına sahip oldukları ortaya konmuştur. Sonraki aşamada ise modellere kointegrasyon testleri yapılmıştır. Çalışmanın son aşamasında da CUP-FM kointegrasyon tahmincisinin sonuçları değerlendirilmiştir. Bu tahmin sonucunda ise sağlık sistemlerinin sağlık harcamalarını belirleyen etkenler üzerinde etkili olduğu ortaya konmuştur.

Keywords

• Sağlık Harcamaları
• Sağlık Sistemleri
• Beveridge
• Bismarck
• OECD

The Relationship Between Health Systems and Health Expenditures In OECD Countries: An Econometric Approach

Abstract

This study aims to understand the determinants of health expenditures in OECD countries and whether health systems have an impact on these determinants. In this direction, it is constructed a panel cointegration econometric model with the annual data of 27 OECD countries between 1995-2020 years. In addition, since this study aims to understand the effects of health systems on the determinants of health expenditures, health systems are modeled separately. For this reason, in the first model it was examined the data of 27 OECD countries. In the second model, it is modeled the data of 14 countries that have adopted the Beveridge health and in the third model, it modeled the data of 13 countries that have adopted the Bismarck health system. In order to obtain accurate results from the analyses, it was conducted the tests to the that required by panel cointegration analysis. In this direction, first of all, homogeneity and cross-section dependence tests were performed to the series. According to result of these tests, it was determined that the series are heterogeneous and they have cross-section dependence. Therefore, second generation panel unit root tests based on heterogeneity were applied to the series. The unit root tests revealed that the series were stationary at the same degree. So afte that models were constructed. Then homogeneity and cross-section dependence tests were conducted for the models and it was revealed that all three models were heterogeneous and have cross-section dependence. In the next stage, the models were tested for cointegration. Finally in the last stage, it was evaluated the results of the CUP-FM cointegration estimator. As a result of this estimation, it is revealed that health systems have an impact on the determinants of health expenditures.

Keywords

• Health Expenditures
• Health Systems
• Beveridge
• Bismarck
• OECD

References

1. Amiri, A., and Ventelou, B. (2012).Granger causality between total expenditure on health and GDP in OECD: Evidence from the Toda–Yamamoto approach. Economics Letters, 116(3), s. 541-544.
2. Baltagi, B., and Moscone, F. (2010). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling, 27(4), s. 804-811.
3. Blomqvist, A., and Carter, R. (1997). Is health care really a luxury? Journal of Health Economics, 16(2), p. 207–229.
4. Busse, R., Blümel, M., Knieps, F., and Bärnighausen, T. (2017). Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet(390), p. 882-897. recieved from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31280-1.pdf
5. Clemente, J., Marcuello, C., Montañés, A., and Pueyo , F. (2004). On the international stability of health care expenditure functions: are government and private functions similar? J Health Econ, 23(3), p. 589–613.
6. Di Matteo, L. (2005). The macro determinants of health expenditure in theUnited States and Canada: assessing the impactof income, age distribution and time. Health Policy(7), p. 23-42.
7. Dreger , C., and Reimers , H.-E. (2005). Health Care Expenditures in OECD Countries: A Panel Unit Root and Cointegration Analysis. Discussion Paper(No. 1469).
8. Feng, Y., Watt, T., Charlesworth, A., Marsden, G., Roberts, A., and Sussex, J. (2017). What Determines the Health Care Expenditure of High Income Countries? Applied Economics and Finance, 6. doi:https://doi.org/10.11114/aef.v4i6.2586

9. Food and Health Bureau. (2022, January 1). January 10, 2022 recieved from https://www.fhb.gov.hk/statistics/download/dha/en/c_definition_0405.pdf
10. Harrison, A. (1997). Hospitals in England: impact of the 1990 National Health Service reforms. Med Care.(10). doi:10.1097/00005650-199710001-00007
11. HCA. (2022). High Level Overview of Major International Models. March 23, 2022 recieved from https://www.hca.wa.gov/assets/program/major-final-frameworks-international-models.pdf
12. Hendry, D., and Juselius, K. (2000). Explaining cointegration analysis: Part 1. The Energy Journal, 21(1).
13. Herwartz, H., and Theilen, B. (2003). The determinants of health care expenditure: testing pooling restrictions in small samples. Health Economics, 12(2), p. 113-124.
14. Hosoya, K. (2014). Determinants of health expenditures: Stylized facts and a new signal. Modern Economy, 5(13), p. 1171.
15. Hörl, W., de Alvaro, F., and Williams, P. (1999). Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: access to ESRD treatments. Nephrol Dial Transplant.(14), p. 10-15. doi:10.1093/ndt/14.suppl_6.10
16. Hyejin, L., Oh, D.-Y., and Meng , M. (2019). Stationarity and cointegration of health care expenditure and GDP: evidence from tests with smooth structural shifts. Empirical Economics(57), p. 631–652.
17. Isik, M., Isik, F., and Kiyak, M. (2005). Analyzing Financal Structure of Turkish Healthcare System In Comparison With U.S., German, British, French and Cuban Healthcare
18. Karim, S., Eikemo, T., and Bambra, C. (2010). Welfare state regimes and population health: Integrating the East Asian welfare states. Health Policy(94), p. 45-53.
19. Kleiman, E. (1974). The determinants of national outlay on health. In The economics of health and medical care, p. 66-88.
20. Kutzin, J. (2011). Bismarck vs. Beveridge: is there increasing convergence between health financing systems? First annual meeting of SBO network on health expenditure. Paris: OECD.
21. Lameire, N., Joffe, P., and Wiedemann, M. (1994). Healthcare systems--an international review: an overview. Nephrol Dial Transplant.(6), p. 3-9. doi:10.1093/ndt/14.suppl_6.3.
22. Mehrara, M., Musai, M., and Amiri, H. (2010). The Relationship between Health Expenditure and GDP in OECD Countries Using PSTR. European Journal of Economics, Finance and Administrative Sciences(24), p. 50-58.
23. Meuriot, V. (2015). The concept of cointegration: the decisive meeting between Hendry and Granger (1975). Cahiers d'économie Politique(68), p. 91-118.
24. Musgrove, P. (2000). Health insurance: the influence of the Beveridge Report. Bulletin of the World Health Organization(6), p. 845-846.
25. Newhouse, J. P. (1977). Medical-care expenditure: a cross-national survey. Journal of Human Resources, 12(1), p. 115-125. doi:https://doi.org/10.2307/145602
26. OECD. (2020). Health Spending. January 10, 2022 recieved from https://data.oecd.org/healthres/health-spending.htm
27. OECD. (2021). Health spending (indicator). doi:10.1787/8643de7e-en
28. Okunade, A., Karakuş, M., and Okeke, C. (2004). Determinants of Health Expenditure Growth of the OECD Countries: Jackknife Resampling Plan Estimates. Health Care Management Science(7), p. 173-183.
29. Or, Z., Cases, C., Lisac, M., Vrangbaek, K., Winblad, U., and Bevan, G. (2010). Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems. Health Economics, Policy and Law(5), p. 269–293. doi:10.1017/S1744133110000034
30. Pesaran, M., and Yamagata, T. (2008). Testing slope homogeneity in large panels. Journal of econometrics, 142(1), p. 50-93.
31. Phi, G. (2017). Determinants of Health Expenditures in OECD Countries. Bryant University. https://digitalcommons.bryant.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1025&context=honors_economics
32. Poullier, J.-P., Hernandez, P., Kawabata, K., and Savedoff, W. (2002). Patterns of Global Health Expenditures: Results for 191 Countries. Discussion Paper(No. 51).
33. Saltman, R., Bankauskaite, V., and Vrangbaek, K. (2007). Decentralization in Health Care: Strategies and outcomes. New York: Open University Press. Recieved from https://www.euro.who.int/en/publications/abstracts/decentralization-in-health-care.-strategies-and-outcomes-2007
34. Shain, M., and Roemer, M. (1959). Hospital costs relate to the supply of beds. Modern Hospital(92), p. 71–73. School of Public Health: recieved from https://web.archive.org/web/20120304021055/http://www.ph.ucla.edu/pr/miroemer.html
35. Tchoe, B., and Nam, S. (2010). Aging risk and health care expenditure in Korea. International journal of environmental research and public health, 7(8), p. 3235-3254.
36. Tulchinsky, T. (2018). Bismarck and the Long Road to Universal Health Coverage. Case Studies in Public Health, p. 131–179. doi:10.1016/B978-0-12-804571-8.00031-7
37. Vera. (2019, 17 July). Global Healthcare: 4 Major National Models And How They Work. April 18, 2022 recieved from https://www.verawholehealth.com/blog/global-healthcare-4-major-national-models-and-how-they-work
38. Westerlund, J. (2007). Estimating Cointegrated Panels with Common Factors and the Forward Rate Unbiasedness Hypothesis. Journal of Financial Econometrics, 5(3), p. 491–522.
39. Westerlund, J. (2008). Panel cointegration tests of the Fisher effect. Journal of Applied Econometrics(23), p. 193–233.
40. World Bank. (2021). Out-of-pocket expenditure (% of current health expenditure). World Health Organization Global Health Expenditure database: resived from https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?end=2019&locations=TR-CA-US-DE&most_recent_value_desc=false&start=2019
41. World Bank. (2022). Out-of-pocket expenditure (% of current health expenditure). World Health Organization Global Health Expenditure database: recieved from https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?end=2019&locations=TR-CA-US-DE&most_recent_value_desc=false&start=2019 World Health Organization. (2022). Health Expenditure. January 10, 2022 recieved from https://www.who.int/data/nutrition/nlis/info/health-expenditure