SAĞLIK EKONOMİSİ PERSPEKTİFİNDEN FAYDA-MALİYET ANALİZLERİNDE SOSYAL İSKONTO ORANININ SEÇİMİNİN ANALİZİ

Year 2022, Issue: 53, 391 - 408, 28.10.2022

Nihal Kalaycı Oflaz

https://doi.org/10.30794/pausbed.1115230

Abstract

Sağlık ekonomisi, sağlık sektörüne ayrılan kaynaklardan daha etkin bir şekilde yararlanabilmek için incelemeler yapan bir bilim dalıdır. Bu çalışmanın amacı sağlık ekonomisinde ekonomik değerlendirme yöntemlerinden biri olarak kullanılan fayda maliyet analizini ve sağlık sektörüne ayrılan kaynakların verimli bir şekilde kullanılması için fayda maliyet analizlerinde kullanılan bir araç olan sosyal iskonto oranı kavramını değerlendirmektir. Bir derleme olan bu çalışmada sosyal iskonto oranına ilişkin yürütülen ulusal ve uluslararası, teorik ve ampirik çalışmalara yönelik bir literatür incelemesi gerçekleştirilerek sosyal iskonto oranının seçim yöntemleri ve sağlık projelerinde kullanılması gereken uygun sosyal iskonto oranın ne olması gerektiğini değerlendirmeye yönelik bir analiz gerçekleştirilmiştir. Analiz yürütülürken sosyal iskonto oranına ilişkin akademik literatüre, dünya genelinde sağlıkta ekonomik değerlendirmelerde uygulanan indirim oranlarına ve küresel olarak yol gösterici kılavuz ve yönergelere ilişkin bir inceleme gerçekleştirilmiştir. Bu bağlamda ekonomik bir bakış açısı çerçevesinde sağlık sektörü açısından sosyal iskonto oranı kavramsal olarak değerlendirilmeye çalışılmış, önerilen iskonto hadleri, iskonto haddinin seçimine etki eden faktörler ve oranının seçiminde yaşanan belirsizliğin nedenleri değerlendirilmiştir. Sonuç olarak politik tercihlerin yön verdiği sosyal iskonto oranı için kamusal kaynakların optimal kullanımının önemi ve kuşaklararasında bu kaynakların dağılımına olan etkileri nedeniyle toplumun geneline yayılan sonuçlar doğurduğu söylenebilir.

Keywords

Sağlık Ekonomisi, Maliyet - Fayda Analizi, Sosyal İskonto Oranı, Sağlık Ekonomisi, Maliyet - Fayda Analizi, Sosyal İskonto Oranı

ANALYSIS OF THE SELECTION OF THE SOCIAL DISCOUNT RATE IN COST-BENEFITS ANALYSIS FROM HEALTH ECONOMY PERSPECTIVE

Abstract

Health economics is a branch of science that examines in order to benefit more effectively from the resources allocated to the health sector. The aim of this study is to evaluate the concept of social discount rate, which is used as one of the economic evaluation methods in health economics and used in cost-benefit analysis, which is a tool for the efficient use of resources allocated to the health sector. In this study, which is a compilation, a literature review is carried out on national and international, theoretical and empirical studies on the social discount rate, and another analysis is carried out to evaluate the selection methods of the social discount rate and what the appropriate social discount rate should be used in health projects. While conducting the analysis, a review of the academic literature on the social discount rate, the discount rates applied in economic evaluations in health around the world, and globally guiding and instructions were performed. In this context, within the framework of an economic perspective, the social discount rate has been tried to be evaluated conceptually in terms of the health sector, the proposed discount rates and the factors affecting the selection of the discount rate and the reasons for the uncertainty in the selection of the rate have been evaluated. As a result, it can be said that the optimal use of public resources for the social discount rate, which is directed by political preferences, and its effects on the distribution of these resources between generations have consequences that spread throughout the society.

Keywords

Health Economics, Cost - Benefit Analysis, Social Discount Rate.

References

• Abdullah, M. M., Hughes, J., & Grafenauer, S. (2021). Healthcare cost savings associated with increased whole grain consumption among Australian adults. Nutrients, 13(6), 1855.
• Akalın, G. (1980). Yükseköğretim Karma Malına Maliyet-Fayda Analizinin Uygulanması, Ankara Üniversitesi Siyasal Bilgiler Fakültesi Yayınları, No:444.
• Aktan, C. C., & Sakal, M. (1999). Kamu Yatırım Projelerinde Karar Alma Ve Fayda Maliyet Analizi, Yeni Türkiye Dergisi, 103-119.
• Al Yaqoobi, A., & Ausloos, M. (2022). An Intergenerational Issue: The Equity Issues Due to Public–Private Partnerships; The Critical Aspect of the Social Discount Rate Choice for Future Generations. Journal of Risk and Financial Management, 15(2), 49.
• Arrow, K. J. (1995). Inter-generational equity and the rate of discount in long-term social investment. In Contemporary economic issues (89-102). Palgrave Macmillan, London.
• Arrow, K.J., Cropper, M., Gollier, C., Groom, B., Heal, G., Newell, R., Nordhaus, W., Pindyck, R., Pizer, W. 3, Portney, P., Sterner, T., Tol, R. S. J. & Weitzman, M. (2013). Determining Benefits and Costs for Future Generations, Science Magazine, V.341, 349-350.
• Attema, A.E., Brouwer, W.BF. & Claxton, K. (2018). Discounting in Economic Evaluations, PharmacoEconomics, 36:745–758.
• Azar, S. A. (2007). Measuring the US social discount rate, Applied Financial Economics Letters, 3(1), 63-66.
• Bağdatlı, M., & Akbıyıklı, R. (2015). Ulaştırma yapıları ekonomik analizlerinde iskonto oranı: bir durum çalışması. Sakarya University Journal of Science, 19(1), 67-74.
• Baumol, W. J. (1968). On the social rate of discount. The American Economic Review, 58(4), 788-802.
• Brent, R. J. (2006). Applied cost-benefit analysis. Edward Elgar Publishing.
• Broughel, J. (2020). The Social Discount Rate: A Primer for Policymakers, Mercatus Research Paper, https://ssrn.com/abstract=3639628.
• Burges, D.F. & Zerbe, R.O. (2011). Calculating the Social Opportunity Cost Discount Rate, Journal of Benefit-Cost Analysis, 2 (3).
• Campos, Serebrisky & Suarez-Aleman (2015), Time goes by:recent developments on the theory and practice of the discount rate, Inter-American Development Bank, Technical Note.
• Caplin, A., & Leahy, J. (2004). The social discount rate. Journal of political Economy, 112(6), 1257-1268.
• Chen, W., Wallhead, P., Hynes, S., Groeneveld, R., O'Connor, E., Gambi, C., ... & Smith, C. (2022). Ecosystem service benefits and costs of deep-sea ecosystem restoration. Journal of environmental management, 303, 114127.
• Chua, A. J., & Choong, W. W. (2016). A review of approaches to construct social discount rate. Sains Humanika, 8(4-3), 37-42.
• Claxton, K., Asaria, M., Chansa, C., Jamison, J., Lomas, J., Ochalek, J., & Paulden, M. (2019). Accounting for Timing when Assessing Health-Related Policies. Journal of Benefit-Cost Analysis, 10(S1), 73-105.
• Costanza, R., Kubiszewski, I., Stoeckl, N., & Kompas, T. (2021). Pluralistic discounting recognizing different capital contributions: An example estimating the net present value of global ecosystem services. Ecological Economics, 183, 106961.
• Culyer, A.J. (2005). The Dictionary of Health Economics, Edward Elgar, Cheltenham, UK.
• Daneshmand, A, Jahangard, E & Abdollah Milani, M (2018). A time preference measure of the social discount rate for Iran, Journal of Economic Structures,7:9.
• Darab, M. G., Keshavarz, K., Sadeghi, E., Shahmohamadi, J., & Kavosi, Z. (2021). The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Services Research, 21(1), 1-7.
• Dhaliwal, I., Duflo, E., Glennerster, R., & Tulloch, C. (2013). Comparative cost-effectiveness analysis to inform policy in developing countries: a general framework with applications for education. Education policy in developing countries, 17, 285-338.
• Doğan, İ., Ünal, A. & Çankaya, M. (2019). Sağlık Hizmetlerinde Ekonomik Değerlendirme Yöntemleri. Fiscaoeconomia, 3(3), 152-168.
• Drèze, J., & Stern, N. (1987). The theory of cost-benefit analysis. In Handbook of public economics, Elsevier, Vol. 2, 909-989.
• Drupp, M.A., Freeman, M.C., Groom, B. & Nesje, F. (2015). Discounting Disentangled, http://piketty.pse.ens.fr/files/Druppetal2015.pdf.
• Du Preez, M. (2004). The discount rate for public sector conservation projects in South Africa. African development review, 16(3), 456-471.
• Edejer,T.T., Baltussen, R., Adam, T., Hutubessy, R., Acharya, A., Evans, D.B. & Murray, C.J.L. (Ed.) (2003). Making Choises in Health: WHO guide to cost-effectiveness analysis. WHO: Geneva.
• Evans, D. (2004). A Social Discount Rate for France, Applied Economics Letters, 11:13, 803-808.
• Evans, D. & Sezer, H. (2004). Social Discount Rates for Six Major Countries, Applied Economic Letters, 11:9, 557-560.
• Evans & Sezer (2005). Social Discount Rates for Member Countries of the European Union, Journal of Economic Studies, Vol.32, Issue:1, 47-59.
• Feldstein, M. (1964). The Social Time Preference Discount Rate in Cost Benefit Analysis. The Economic Journal, 74(294), 360-379.
• Florio, M. & Sirtori, E. (2013). The Social Cost of Capital: Recent Estimates for the EU Countries, Center for Endutrial Studies, Working Paper Series, Working Paper No. 03/2013.
• Groom, B., Drupp, M., Freeman, M. C., & Nesje, F. (2022). The future, now: A review of social discounting. Annual Review of Resource Economics, Accepted Version.
• Gürlük, S. (2016). Diagnostic of High Social Discount Rate in Developing Countries and Low Social Discount Rate in Developed Countries. Advances in Environmental Research, Nova Publishing House, USA.
• Gürlük, S. G. (2021). Biyoçeşitlilik Gölge Fiyatının Doğal Kaynak Yönetiminde Kullanımı Üzerine: Uludağ Milli Parkı Örneği. Tekirdağ Ziraat Fakültesi Dergisi, 18(2), 234-246.
• Halicioglu, F. & Karatas, C. (2011). A Social Discount Rate for Turkey, Munich Personal RePEc Archive, MPRA Paper No. 32925, http://mpra.ub.uni-muenchen.de/32925/.
• Harrison, M. (2010). Valuing the Future: the social discount rate in cost-benefit analysis, Visiting Researcher Paper, Productivity Commission, Canberra.
• Husereau, D., Drummond, M., Augustovski, F., De Bekker-Grob, E., Briggs, A., Carswell, C., . . . Staniszewska, S. (2022). Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: Updated reporting guidance for health economic evaluations. International Journal of Technology Assessment in Health Care, 38(1), E13.
• İpek, N. (2016). Yatırım Projelerinin Değerleme Çalışmalarında Kullanılabilecek İskonto Oranlarının Seçimi Ve Uygulama Sorunları, Dönem Projesi, Ankara Üniversitesi Fen Bilimleri Enstitüsü. Ankara.
• İşgüden, T. (1978). Kamu yatırım projelerinin değerlendirilmesinde fayda-maliyet analizi, Doktora Tezi, Marmara Universitesi.
• İşgüden, T. & Turanlı, R. (1992). Ansiklopedik Ekonomi Sözlüğü, Genişletilmiş 2. Baskı, Bilim ve Teknik Yayınevi, Eskişehir.
• Karayılmazlar, E. ve İşler, İ., (2019). Kamu Yatırım Projelerinde Fayda Maliyet Analizi, Pamukkale Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, sayı 35, 65-82.
• Kazlauskiene, V. (2015). Application of social discount rate for assessment of public investment projects, Procedia-Social and Behavioral Sciences, 213, 461-467.
• Karasioğlu, F. ve Çam, A.V. (2008). Sağlık İşletmelerinde Maliyet Analizi: Karaman Devlet Hastanesinde Birim Muayene Maliyetlerinin Hesaplanması, Niğde Üniversitesi İİBF Dergisi, Haziran 2008, Cilt:1, Sayı:1, 15-24.
• Kirmanoglu, H. (2017). Kamu Ekonomisi, 6. Baskı, Beta, İstanbul.
• Koçkaya, G. ve Ökçün, S. (2020). Bütçe Etki Analizi ve Karar Analizleri, İçinde Çalışkan ve Oğuzhan (Ed.), Sağlık Teknolojisi Değerlendirmede Kavram ve Yöntemler, 1. Baskı, Gazi Kitabevi, Ankara.
• Kumru, S. (2020). Maliyet Yarar Analizi. İçinde Çalışkan ve Oğuzhan (Ed.), Sağlık Teknolojisi Değerlendirmede Kavram ve Yöntemler, 1. Baskı, Gazi Kitabevi, Ankara.
• Lipkan,V., Vasiutynska, L. & Diorditsa, I. (2018). Social Discount Rate: Assessment Methodology, Baltic Journal of Economic Studies, Vol. 4, No. 2, 2018, (114-118).
• Lopez, H. (2008). The Social Discount Rate: Estimates for Nine Latin American Countries, Policy Research Working Paper 4639, World Bank.
• Mahboub-Ahari, A, Pourreza A, Akbari Sari A, Rahimi Foroushani A, Heydari H. (2014). Stated Time Preferences for Health: A Systematic Review and Meta Analysis of Private and Social Discount Rates. Journal of Research in Health Sciences, 14(3): 181-186.
• Mahboub-Ahari A., Pourreza A., Akbari Sari A., Sheldon TA., Moeeni M. (2019). Private and social time preference for health outcomes: A general population survey in Iran. PLoS ONE, 14(2):e0211545.
• Haacker, M., Hallett, T.B., Atun, R. (2020). On discount rates for economic evaluations in global health, Health Policy and Planning, Volume 35, Issue 1, February 2020, Pages 107–114.
• McEwan, P. J. (2012). Cost-effectiveness analysis of education and health interventions in developing countries. Journal of Development Effectiveness, 4(2), 189-213.
• Meltzer, M. I. (2001). Introduction to health economics for physicians. The Lancet, 358(9286), 993-998.
• Mishan, E. J., & Quah, E. (2007). Cost–benefit analysis. Taylor & Francis e-Library, 5th Edition, London and Newyork.
• Moore, M.A, Boardman, A.E, Vining, A.R., Weimer, D.L. & Greenberg, D.H. (2004). “Just give me a number!” Practical values for the social discount rate, Journal of Policy Analysis and Management, Vol. 23(4), 789-812.
• Moore, M. A., Boardman, A. E., & Vining, A. R. (2020). Social Discount Rates for Seventeen Latin American Countries: Theory and Parameter Estimation. Public Finance Review, 48(1), 43-71.
• Mozayani, A. H., Sahabi, B., & Asadi, M. (2021). Estimating Social Discount Rate Trend in Iran. Iranian Economic Review, 25(2), 191-203.
• Oğuz, F., & Benli, E. (2018). Hayatımız Kaç Para Eder?. Ankara Barosu Dergisi. 2018 (1), 25-52.
• Parfit, D. (1981). An attack on the social discount rate, QQ – Report from the Center for Philosophy & Public Policy, University of Maryland, 1, 8–11.
• Poulos C. & Whittington D. (2000). Time Preferences for Life-Saving Programs: Evidence from Six Less Developed Countries. Environmental Science & Technology. 34(8):1445–55.
• Pearce, D. & Ulph, D. (1995). A Social Discount Rate for the United Kingdom, CSERGE Working Paper GEC 95-01.
• Percoco, M. (2008). A Social Discount Rate for Italy, Applied Economics Letters, 15:1, 73-77.
• Parsonage, M., & Neuburger, H. (1992). Discounting and health benefits. Health Economics, 1(1), 71–76.
• Ramsey, F.P. (1928). A Mathematical Theory of Saving. Economic Journal, 38, 543-559.
• Rambaud, S.C. & Torrecillas, M.J.M (2006). Social Discount Rate: A Revision, Anales de Estudios Economicos y Empresariales, Vol. XVI, 2006, 75-98.
• Rezapour, A., Hosseinijebeli, S. S., & Faradonbeh, S. B. (2021). Economic evaluation of E-health interventions compared with alternative treatments in older persons’ care: A systematic review. Journal of Education and Health Promotion, 10, 134.
• Romero-Castro, N., López-Cabarcos, M. Á., & Piñeiro-Chousa, J. (2022). Uncovering complexity in the economic assessment of derogations from the European industrial emissions directive. Journal of Innovation & Knowledge, 7(1), 100159.
• Sartori, D., Catalano, G., Genco, M., Pancotti, C., Sirtori, E., Vignetti, S., & Bo, C. (2014). Guide to cost-benefit analysis of investment projects. Economic appraisal tool for cohesion policy 2014-2020.
• Schad, M. & John, J. (2012). Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis. European Journal Health Economics, 13:127-144.
• Sheluntsova, M. (2009). Evaluation of a social discount rate for the Russian Federation, The International Conference on Administration and Business, Faculty of Administration and Business, University of Bucharest, Romania, ICEA – FAA Bucharest, 14-15th November 2009.
• Song, J. (2017), Revisiting Social Discount Rates for Public Investment. KDI Journal of Economic Policy, Vol. 39(2), 75-98.
• Smith, D., & Gravelle, H. (2001). The Practice Of Discounting In Economic Evaluations Of Healthcare Interventions. International Journal of Technology Assessment in Health Care, 17(2), 236-243.
• Şataf, C. (2014). Fayda-Maliyet Analizinde Uygulamada Karşılaşılan Güçlükler: Fayda Ve Maliyetin Belirlenebilme Sorunu, Süleyman Demirel Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 19 (1), 107-123.
• Tatar, M. (2009). Teorik Çerçevesiyle Sağlık ekonomisi ve Türkiye’ye İlişkin Genel Bir Değerlendirme. Sağlık Ekonomisi Dergisi, (1).
• Tran, B. T., Choi, K. S., Nguyen, T. X., Sohn, D. K., Kim, S. Y., Suh, J. K., ... & Oh, J. K. (2021). The direct and indirect costs of colorectal cancer in Vietnam: an economic analysis from a social perspective. International journal of environmental research and public health, 18(1), 12.
• Treasury, H.M. (2022). The green book: Central government guidance on appraisal and evaluation. HM Treasury, London.
• Uzunkaya, Z. C., & Uzunkaya, M. (2012). Türkiye icin ekonomik indirgeme oranı tahmini. Kalkınma Bakanlığı.
• Ülke Keski̇n, A. , Demi̇r, Ş. (2018). Amasya Değirmendere Barajında Sulama Alanı ve Baraj Yüksekliği Arasında Ekonomik Analiz. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen ve Mühendislik Dergisi, 20 (60), 755-764.
• Yılmaz, F. & Aslan, Ö. (2019). Sağlık Hizmetlerinde Ekonomik Değerlendirme Teknikleri Üzerine Bir İnceleme. Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 6(2), 253-272.
• Yiğit, A. (2020). Sağlık Teknolojisi Değerlendirme, İçinde Çalışkan ve Oğuzhan (Ed.), Sağlık Teknolojisi Değerlendirmede Kavram ve Yöntemler, 1. Baskı, Gazi Kitabevi, Ankara.
• Yiğit, V. & Erdem, R. (2014). Sağlık Hizmetlerinde Maliyet Etkililik Analizi. Suleyman Demirel University Journal of Faculty of Economics & Administrative Sciences, 19(2).
• Zhuang, J., Liang, Z., Lin, T. & De Guzman, F. (2007). Theory and Practice in the Choice of Social Discount Rate for Cost-Benefit Analysis: A Survey, ERD Working Paper Series No.94, Asian Development Bank.
• Warusawitharana, M. (2014). The Social Discount Rate in Developing Countries, FEDS Notes. Washington: Board of Governors of the Federal Reserve System, October 09, 2014.
• World Health Organization. (2019). WHO guide for standardization of economic evaluations of immunization programmes (No. WHO/IVB/19.10). World Health Organization.