SAĞLIK HARCAMALARININ KARŞILAŞTIRMALI ANALİZİ: ABD, ALMANYA VE JAPONYA ÖRNEĞİ

Öz

Öz Amaç: Bu çalışma, Amerika Birleşik Devletleri (ABD), Almanya ve Japonya'nın sağlık harcamaları ve finansman modellerini karşılaştırarak, bu sistemlerin temel sağlık göstergeleri ve hizmetlere erişim ile ilişkili yapısal farklılıklarını değerlendirmektedir. Araştırma, harcama düzeyi ile sağlık sistemi performansı arasındaki ilişkiyi karşılaştırmalı olarak incelemekte ve farklı finansman yaklaşımlarının güçlü ve sınırlı yönlerini ortaya koymaktadır. Yöntem: OECD, Dünya Bankası ve Dünya Sağlık Örgütü (WHO) verileri kullanılarak betimsel istatistiksel ve karşılaştırmalı analiz yapılmıştır. Kişi başına sağlık harcaması, sağlık harcamalarının GSYİH içindeki payı, beklenen yaşam süresi, bebek ölüm oranı, sağlık sigortası kapsamı ve cepten yapılan harcama oranı gibi göstergeler incelenmiştir. Bulgular: ABD, kişi başına sağlık harcamasında en yüksek seviyeye sahip olmasına karşın, beklenen yaşam süresi ve bebek ölüm oranı gibi göstergelerde Almanya ve Japonya'nın gerisinde kalmıştır. Almanya ve Japonya ise daha düşük harcama ile daha iyi sağlık çıktıları sunmaktadır. ABD’de özel sigorta temelli sistem ve yüksek cepten ödeme oranı erişim eşitsizliklerine yol açmaktadır. Sonuç: Yalnızca harcama miktarının yüksekliği, daha iyi sağlık çıktıları sağlamamaktadır. Kamu finansmanına dayalı evrensel sigorta sistemleri, maliyet etkinliği ve kapsayıcılık açısından daha dengeli sonuçlar vermektedir. Politika yapıcılar için kaynakların yönetimi ve finansman mekanizmalarının sürdürülebilirliği, harcama seviyesinden daha kritik bir unsurdur.

Anahtar Kelimeler

• Sağlık Harcamaları
• Sağlık Finansmanı
• Evrensel Sağlık Sigortası
• ABD
• Almanya
• Japonya

COMPARATIVE ANALYSIS OF HEALTH EXPENDITURES: THE CASE OF THE UNITED STATES, GERMANY AND JAPAN

Abstract

Purpose: This study compares the healthcare expenditures and financing models of the United States (USA), Germany, and Japan to examine structural differences related to healthcare access and key health indicators. Rather than measuring causal impact, it provides a comparative assessment of how spending levels and financing structures relate to health system performance. Method: Descriptive statistical and comparative analyses were conducted using data from the OECD, World Bank, and World Health Organization (WHO). Key indicators include per capita healthcare expenditure, the share of healthcare spending in GDP, life expectancy, infant mortality rate, health insurance coverage, and out-of-pocket expenditure rates. Findings: The USA exhibits the highest per capita healthcare spending but lags behind Germany and Japan in outcomes such as life expectancy and infant mortality. Germany and Japan achieve better health outcomes with lower overall spending. The USA’s predominantly private insurance model and higher out-of-pocket payments contribute to inequities in healthcare access. Conclusion: High expenditure alone does not guarantee superior health outcomes. Publicly financed universal insurance systems demonstrate greater cost-effectiveness and equity. Policymakers should focus on the governance of resources and sustainability of financing mechanisms rather than solely on spending levels.

Keywords

• Healthcare Expenditures
• Healthcare Financing
• Universal Health Insurance
• USA
• Germany
• Japan

References

1. Anderson, G. F., Hussey, P., & Petrosyan, V. (2019). It’s still the prices, stupid: why the US spends so much on health care, and a tribute to Uwe Reinhardt. Health Affairs, 38(1), 87-95. https://doi.org/10.1377/hlthaff.2018.05144
2. Blumenthal, D., Abrams, M., & Nuzum, R. (2020). The Affordable Care Act at 10 years: What’s worked and what’s next? Health Affairs, 39(3), 403-411. https://doi.org/10.1377/hlthaff.2020.00279
3. Busse, R., & Blümel, M. (2014). Germany: Health system review. Health Systems in Transition, 16(2), 1-296.
4. Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). SAGE Publications.
5. Dünya Bankası. (2021). World Bank Open Data. Erişim adresi: https://data.worldbank.org/
6. Ekonomik Kalkınma ve İşbirliği Örgütü (OECD). (2021). OECD Health Statistics 2021. Erişim adresi: https://www.oecd.org/els/health-systems/health-data.htm
7. Field, A. (2024). Discovering statistics using IBM SPSS statistics (6th ed.). SAGE Publications. Ikegami, N., & Anderson, G. F. (2012). In Japan, all-payer rate setting under tight government control has proved to be an effective approach to containing costs. Health Affairs, 31(5), 1049-1056. https://doi.org/10.1377/hlthaff.2011.1037
8. International Monetary Fund (IMF). (2023). IMF data portal. https://www.imf.org/en/Data Kwon, S., Lee, T.-J., & Kim, C.-Y. (2020). Republic of Korea: Health System Review. Health Systems in Transition (HiT) profile. https://iris.who.int/bitstream/handle/10665/208215/9789290617105_eng.pdf;jsessionid=34CB8318F9900330

9. Mackenbach, J. P., Kulhánová, I., Artnik, B., Bopp, M., Borrell, C., Costa, G., & Hoffmann, R. (2019). Changes in mortality inequalities over two decades: Register based study of European countries. BMJ, 362, k2726. https://doi.org/10.1136/bmj.k2726
10. Mossialos, E., Wenzl, M., Osborn, R., & Anderson, C. (2016). International profiles of health care systems, 2015. The Commonwealth Fund.
11. Murray, C. J., & Frenk, J. (2021). A framework for assessing the performance of health systems. Bulletin of the World Health Organization, 89(7), 567-576.
12. Neuman, W. L. (2014). Social research methods: Qualitative and quantitative approaches (7th ed.). Pearson Education Limited.
13. Organization for Economic Cooperation and Development (OECD). (2019). Health at a glance 2019: OECD indicators. OECD Publishing. https://doi.org/10.1787/4dd50c09-en
14. Organization for Economic Cooperation and Development (OECD). (2020). Health spending indicators. https://www.oecd.org/health/health-data/
15. Organization for Economic Cooperation and Development (OECD). (2023). Health at a Glance 2023: OECD indicators. OECD Publishing.
16. Organization for Economic Cooperation and Development (OECD). (2023). Health at a glance 2023: OECD indicators. OECD Publishing. https://www.oecd.org/en/publications/health-at-a-glance-2019_4dd50c09-en.html
17. Ragin, C. C. (2014). The comparative method: Moving beyond qualitative and quantitative strategies. Univ of California Press.
18. Reinhardt, U. (2019). Priced Out: The Economic and Ethical Costs of American Health Care. Princeton: Princeton University Press. https://doi.org/10.1515/9780691192611
19. Reinhardt, U. E. (2019). Priced out: The economic and ethical costs of American health care. Princeton University Press.
20. Schneider, E. C., Shah, A., Doty, M. M., Tikkanen, R., Fields, K., & Williams, R. D. (2022). Mirror, mirror 2022: The US health care system in a global context. The Commonwealth Fund.
21. Smith, P. C., & Witter, S. (2020). Risk pooling in health care financing: The implications for health system efficiency and equity. World Health Organization.
22. Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International health care system profiles. The Commonwealth Fund. https://www.commonwealthfund.org/sites/default/files/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020.pdf
23. Uluslararası Para Fonu (IMF). (2021). IMF Data Portal. Erişim adresi: https://www.imf.org/en/Data
24. Wagstaff, A., Flores, G., Hsu, J., Smitz, M. F., Chepynoga, K., Buisman, L. R., & Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries: A retrospective observational study. The Lancet Global Health, 6(2), e169-e179. https://doi.org/10.1016/S2214-109X(17)30429-1
25. World Bank. (2023). World development indicators: Health systems performance. The World Bank. https://data.worldbank.org/
26. World Bank. (2023). World Development Indicators: Health systems performance. The World Bank.
27. World Health Organization (WHO). (2021). Global spending on health: Weathering the storm. Geneva: WHO.
28. World Health Organization (WHO). (2022). World health statistics 2022. WHO. https://www.who.int/news/item/20-05-2022-world-health-statistics-2022
29. World Health Organization (WHO). (2023). Global health expenditure database. World Health Organization. https://apps.who.int/nha/database
30. World Health Organization (WHO). (2023). Global spending on health: Weathering the storm. Geneva: WHO.
31. World Health Organization. (2010). Health systems financing: The path to universal coverage. World Health Organization. https://iris.who.int/handle/10665/44371
32. Xu, K., Evans, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., & Evans, T. (2003). Protecting households from catastrophic health expenditures. Health Affairs, 26(4), 972-983. https://doi.org/10.1377/hlthaff.26.4.972