SAĞLIK STATÜSÜNDEKİ DEĞİŞİMLER KAMU HARCAMA BİLEŞENİNİ ETKİLER Mİ? GELİŞMİŞ ÜLKELER ÜZERİNE BİR UYGULAMA

Year 2023, Volume: 26 Issue: 3, 575 - 596, 26.09.2023

Şuheda Sağlam , Oğuz Kara

Abstract

Sağlık, doğumla birlikte kazanılan yaşama hakkının ayrılmaz bir parçasıdır. İktisadi açıdan sağlık, beşeri sermaye birikiminin ve emek arz zincirinin en önemli bileşenidir. Tüm ülkeler, sağlıklı bir toplum oluşturabilmek ve toplumun sağlık statüsünü artırabilmek için çaba sarf ederler. Birçok ülke sağlık sektörüne yönelik harcamalarını arttırmaktadır. Sağlığa yönelik harcama artışları bir yandan beşerî sermaye birikimi yoluyla ekonomik büyümeye katkı sağlarken diğer yandan kamu giderlerini artırıcı bir baskı oluşturmaktadır. Bu çalışmanın amacı, kamu ağırlıklı sağlık sistemi benimsemiş seçilmiş gelişmiş ülke örnekleminden hareketle sağlık statüsü göstergelerindeki değişimlerin kamu sağlık harcamalarının genel kamu harcamaları içerisindeki oranını hangi yönde ve ne ölçüde etkilediğini belirlemektir. 48 gelişmiş ülkenin 2005-2020 dönemi sağlık statüsü göstergelerindeki değişim ile sağlık harcamalarının kamu giderleri içerisindeki oransal payı panel veri analiz yöntemleri kullanılarak incelenmiştir. Analiz sonucunda kaba doğum oranındaki ve insani gelişmişlik endeksindeki artışlarının kamu sağlık harcamalarının diğer kamu giderleri içerisindeki oranını azalttığı belirlenmiştir. Kişi başına cepten sağlık harcamalarının ve yaşlı nüfusun toplam nüfus içindeki oranın artmasının kamu sağlık harcamalarının diğer kamu giderleri içerisindeki oranını artırdığı sonucuna ulaşılmıştır. Özel sağlık harcamaları oranı arttıkça kamu sağlık harcamalarının diğer kamu giderleri içerisindeki oranının azaldığı tespit edilmiştir.

Keywords

Sağlık statüsü, Kamu sağlık harcamalarının bileşeni, Sağlık ekonomisi, panel veri analizi

DO CHANGES IN HEALTH STATUS AFFECT THE COMPONENT OF PUBLIC EXPENDITURE? AN APPLICATION IN DEVELOPED COUNTRIES

Abstract

Health is an integral part of the right to life acquired at birth. From an economic point of view, health is the most critical component of human capital accumulation and the labor supply chain. All countries try to create a healthy society and increase the health status of the society, and many countries are increasing their spending on the health sector. Increases in health expenditures contribute to economic growth through human capital accumulation and create increasing pressure on public expenditures. This study aims to determine in which direction and to what extent the changes in health status indicators affect the ratio of public health expenditures to general public expenditures, based on the selected developed country sample that has adopted a public-dominated health system. The change in the health status indicators of 48 developed countries for 2005-2020 and the proportional share of health expenditures in public expenditures were examined using panel data analysis methods. As a result of the analysis, it was determined that the crude birth rate and the human development index increased the ratio of public health expenditures to other public expenditures. It has been concluded that the increase in per capita out-of-pocket health expenditures and the ratio of the elderly population to the total population increases the ratio of public health expenditures to other public expenditures. It has been determined that as the ratio of private health expenditures increases, the ratio of public health expenditures to other public expenditures decreases.

Keywords

Health status, component of public health expenditures, health economics, panel data analysis.

References

• Acharya, S., Ghimire, S., Jeffers, E. M., & Shrestha, N. (2019). Health care utilization and health care expenditure of Nepali older adults. Frontiers in public health, 7, 24.
• Adebisi, Y. A., Umah, J. O., Olaoye, O. C., Alaran, A. J., Sina-Odunsi, A. B., & Lucero-Prisno III, D. E. (2020). Assessment of health budgetary allocation and expenditure toward achieving universal health coverage in Nigeria. International Journal of Health and Life Sciences, 6(2).
• Asiskovitch, S. (2010). Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men. Social Science & Medicine, 70(6), 886-895.
• Aslan, B. (2020). OECD ülkelerinde güvenceli esneklik uygulamaları: Karşılaştırmalı panel veri analizi, Doktora Tezi, Gazi Üniversitesi, Sosyal Bilimler Üniversitesi, Ekonometri Anabilim Dalı, Ankara.
• Atabey, S. (2012). Ulusal sağlık sistemleri ve 1980 sonrasında Türkiye’de sağlıkta dönüşüm politikalarının incelenmesi ve değerlendirilmesi, Doktora Tezi, Gazi Üniversitesi Sosyal Bilimler Enstitüsü, Maliye Anabilim Dalı, Ankara
• Atems, B. (2019). Public health expenditures, taxation, and growth. Health Economics, 28(9), 1146-1150.
• Atella, V., Piano Mortari, A., Kopinska, J., Belotti, F., Lapi, F., Cricelli, C., & Fontana, L. (2019). Trends in age‐related disease burden and healthcare utilization. Aging cell, 18(1), e12861.
• Atilgan, E., Kilic, D., & Ertugrul, H. M. (2017). The dynamic relationship between health expenditure and economic growth: is the health-led growth hypothesis valid for Turkey?. The European Journal of Health Economics, 18, 567-574.
• Bartolo, A. D. (1999). Human capital estimation through structural equation models with some categorical variables. In International Workshop on Correlated Data: Estimating Function Approach, Trieste.
• Barkat, K., Sbia, R., & Maouchi, Y. (2019). Empirical evidence on the long and short run determinants of health expenditure in the Arab world. The Quarterly Review of Economics and Finance, 73, 78-87.
• Bayram, Y. (2011) 1980 sonrası sağlık harcamalarının bütçedeki gelişimi ve değerlendirilmesi, Yüksek Lisans Tezi, Gazi Üniversitesi Sosyal Bilimler Enstitüsü, Maliye Anabilim Dalı, Ankara.
• Behera, D. K., & Dash, U. (2018). The impact of macroeconomic policies on the growth of public health expenditure: An empirical assessment from the Indian states. Cogent Economics & Finance, 6(1), 1435443.
• Behera, D. K., & Dash, U. (2019). Impact of macro-fiscal determinants on health financing: empirical evidence from low-and middle-income countries. Global health research and policy, 4(1), 1-13.
• Breusch, T. S., & Pagan, A. R. (1980). The Lagrange multiplier test and its applications to model specification in econometrics. The review of economic studies, 47(1), 239-253.
• Chaabouni, S., & Abednnadher, C. (2014). The determinants of health expenditures in Tunisia: An ARDL bounds testing approach. International Journal of Information Systems in the Service Sector (IJISSS), 6(4), 60-72.
• Chang, K., & Ying, Y. H. (2006). Economic growth, human capital investment, and health expenditure: a study of OECD countries. Hitotsubashi Journal of Economics, 1-16.
• Chatterjee, C., Nayak, N. C., Mahakud, J., & Chatterjee, S. C. (2019). Factors affecting the choice of health care utilisation between private and public services among the elderly population in India. The International journal of health planning and management, 34(1), e736-e751.
• Chen, A., & Goldman, D. (2016). Health care spending: historical trends and new directions. Annual Review of Economics, 8, 291-319.
• Di Matteo, L. (2010). The sustainability of public health expenditures: evidence from the Canadian federation. The European Journal of Health Economics, 11(6), 569-584.
• Dhoro, N. L., Chidoko, C., Sakuhuni, R. C., & Gwaindepi, C. (2011). Economic determinants of public health care expenditure in Zimbabwe. International Journal of Economic Research, 2(6), 13-25.
• Fayissa, B., & Traian, A. (2013). Estimation of a health production function: Evidence from East-European countries. The American Economist, 58(2), 134-148.
• Feng, J., Wang, Z., & Yu, Y. (2020). Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China. Social Science & Medicine, 258, 113081.
• Fogel, R. W. (2004). Health, nutrition, and economic growth. Economic development and cultural change, 52(3), 643-658.
• Goodacre, S., Collins, C., & Slattery, C. (2013). Cambridge VCE Health and Human Development Units 3 and 4 Pack. Cambridge University Press.
• Harper, S. (2014). Economic and social implications of aging societies. Science, 346(6209), 587-591. Hayran, O. (2012). Sağlık Yönetimi Yazıları. Ankara: SAGE Yayınları.
• Himmelstein, D. U., Campbell, T., & Woolhandler, S. (2020). Health care administrative costs in the United States and Canada, 2017. Annals of internal medicine, 172(2), 134-142.
• Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of health economics, 11(2), 173-181.
• Hsiao, W. C. (2003). What is a health system? Why should we care. Harvard School of Public Health. working paper.
• Hokayem, C., & Ziliak, J. P. (2014). Health, human capital, and life cycle labor supply. American Economic Review, 104(5), 127-131.
• İslam S. M. Z. (2012) Bangladeş sağlık sisteminin ekonomik sürdürülebilirliğinin incelenmesi ve uluslararası karşılaştırılması, Doktora Tezi, İstanbul Üniversitesi Sosyal Bilimler Enstitüsü İktisat Anabilim Dalı, İstanbul.
• İyidoğan, P. V., Balikçioğlu, E., & Yilmaz, H. H. (2017). The tax effects of health expenditures on aging economies: Empirical evidence on selected OECD countries. Romanian Journal of Economic Forecasting, 20(1), 116-127.
• Kanavos, P., & Yfantopoulos, J. (2019). Cost containment and health expenditure in the EU: a macroeconomic perspective. In Health Care and Cost Containment in the European Union (pp. 155-196). Routledge.
• Kaya, A. (2011). Türkiye ile bazı OECD ülkelerinde sağlık sistemleri ve karşılaştırması, Doktora Tezi, Marmara Üniversitesi, Bankacılık ve Sigortacılık Enstitüsü, Sigortacılık Anabilim Dalı, İstanbul.
• Leow, M. (2015). A pilot randomized, controlled trial of the effectiveness of a psychoeducational intervention on family caregivers of patients with advanced cancer. Cancer. In Oncology Nursing Forum, 42(2), E63-E72.
• Li, L., Du, T., & Hu, Y. (2020). The effect of population aging on healthcare expenditure from a healthcare demand perspective among different age groups: evidence from Beijing City in the People's Republic of China. Risk Management and Healthcare Policy, 1403-1412.
• Linden, M., & Ray, D. (2017). Life expectancy effects of public and private health expenditures in OECD countries 1970–2012: Panel time series approach. Economic Analysis and Policy, 56, 101-113.
• Lkhagvaa, U. (2019). OECD ülkelerinin sağlık sistemlerinin karşılaştırılması (Master's thesis, Ondokuz Mayıs Üniversitesi, Sağlık Bilimleri Enstitüsü).
• Lukášová, T. (2018). Semashko health financing model–economic and health consequences in Czechia. Ecoforum, 7(1), 0-0.
• Lopreite, M., & Zhu, Z. (2020). The effects of ageing population on health expenditure and economic growth in China: A Bayesian-VAR approach. Social science & medicine, 265, 113513.
• Magazzino, C., & Mele, M. (2012). The determinants of health expenditure in Italian regions. Magazzino, C., Mele, M.,(2012), The Determinants of Health Expenditure in Italian Regions, International Journal of Economics and Finance, 4(3), 61-72.
• Mihalache, I. C., & Apetroi, F. C. (2020). Services in Romania, from the Semashko model to the Bismarck model. Review of Economic and Business Studies, 13(1), 137-147.
• Mohan, R., & Mirmirani, S. (2007). An assessment of OECD health care system using panel data analysis. MPRA Paper No. 6122
• Moscone, F., & Tosetti, E. (2010). Health expenditure and income in the United States. Health economics, 19(12), 1385-1403.
• Murthy, V. N., & Okunade, A. A. (2016). Determinants of US health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration. Economic Modelling, 59, 67-73.
• Pazarlıoğlu, M. V., & Gürler, Ö. K. (2007). Telekomünikasyon yatırımları ve ekonomik büyüme: panel veri yaklaşımı. Finans Politik ve Ekonomik Yorumlar, 44(508), 35-43.
• Pesaran, M. H. (2004). General diagnostic tests for cross section dependence in panels. Working Papers No.1233, 255–60
• Pesaran, M. H. (2007). A simple panel unit root test in the presence of cross‐section dependence. Journal of applied econometrics, 22(2), 265-312.
• Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: promise and potential. Health information science and systems, 2, 1-10.
• Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: insights from the United States data. Frontiers in public health, 8, 156.
• Sargutan, A. E. (2005). Sağlık sektörü ve sağlık sistemlerinin yapısı. Hacettepe Sağlık İdaresi Dergisi, 8(3), 400-428.
• Sayılı, U., Sayman, Ö. A., VEHİD, S., Köksal, S. S., & Erginöz, E. (2017). Türkiye ve OECD ülkelerinin sağlık göstergeleri ve sağlık harcamalarının karşılaştırılması. Online Türk Sağlık Bilimleri Dergisi, 2(3), 1-12.
• Sheiman, I., Shishkin, S., & Shevsky, V. (2018). The evolving Semashko model of primary health care: the case of the Russian Federation. Risk management and healthcare policy, 209-220.
• Sisko, A. M., Keehan, S. P., Poisal, J. A., Cuckler, G. A., Smith, S. D., Madison, A. J., ... & Hardesty, J. C. (2019). National health expenditure projections, 2018–27: economic and demographic trends drive spending and enrollment growth. Health affairs, 38(3), 491-501.
• Smith, S., Newhouse, J. P., & Freeland, M. S. (2009). Income, insurance, and technology: why does health spending outpace economic growth?. Health affairs, 28(5), 1276-1284.
• Sonğur, C. (2016). Sağlık göstergelerine göre ekonomik kalkınma ve iş birliği örgütü ülkelerinin kümeleme analizi. SGD-Sosyal Güvenlik Dergisi, 6(1), 197-224.
• Tulchinsky, T. H., & Varavikova, E. A. (2014). The new public health. Academic Press.
• Turna, Y., & Özcan, A., (2021) The relationship between foreign exchange rate, interest rate and inflation in Turkey: ARDL approach. Journal of Ekonomi, 3(1), 19-23.
• Ulutürk, S. (2015). Sağlık ekonomisi, sağlık statüsü, sağlığın ölçülmesinde kullanılan ölçütler ve önemi: türkiye örneği. Finans Politik ve Ekonomik Yorumlar, (603), 47-63.
• Ünsal, A. (2016). Avrupa birliği ülkeleri ve Türkiye’nin sağlık sistemleri ve sağlık göstergelerinin karşılaştırmalı analizi, Yüksek Lisans Rezi, Bilecik Şeyh Edebali Üniversitesi, Sosyal Bilimler Enstitüsü, Bilecik.
• 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.
• Yetim, B., İlgün, G., Çilhoroz, Y., Demirci, Ş., & 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.
• Yang, X. (2020). Health expenditure, human capital, and economic growth: an empirical study of developing countries. International journal of health economics and management, 20(2), 163-176.
• Younsi, M., Chakroun, M., & Nafla, A. (2016). Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low‐, middle‐and high‐income countries. The International journal of health planning and management, 31(4), 580-601.
• Zeng, Y., Li, J., Yuan, Z., & Fang, Y. (2019). The effect of China’s new cooperative medical scheme on health expenditures among the rural elderly. International journal for equity in health, 18, 1-10.