Türk Sağlık Sektöründe Kayıt Dışı Ekonominin Nedenleri Üzerine Bir Araştırma

Abstract

Bu çalışma sağlık sektöründe kayıtdışı ekonominin ortaya çıkış nedenini incelemek amacıyla gerçekleştirilmiştir. Nitel araştırma olarak yürütülen bu çalışma kapsamında, sağlık sektöründe yer alan yöneticiler, denetçiler ve sektör temsilcileriyle görüşmeler yapılmıştır. Yapılan görüşmeler Yorumlayıcı Fenomenolojik Analiz yöntemiyle analiz edilmiştir. Çalışma sonucunda elde edilen bulgulara göre kayıt dışı ekonomi yalnızca tek bir faktörün etkisi ile ortaya çıkmadığı görülmüştür. Katılımcı ifadelerinden elde edilen sonuçalara göre gelir yetersizliği, denetim eksiksiliği, algılanan adalet eksikliği, hukuki belirsizlik ve sağlık sektörünün kendine has özellikleri kayıt dışı ekonominin nedenleri arasında gösterilen önemli nedenlerdendir. Ayrıca kültürel normlar, sosyal güven düzeyi, etik hassasiyetlerin aşınması ve gayriresmî ilişkilerin meşruiyet kazanması kayıt dışılığı besleyen önemli faktörler olarak ifade edilmiştir. Çalışma; ekonomik, kurumsal ve kültürel süreçlerin kayıt dışı ekonomik davranışlara olan etkisini çok boyutlu bir şekilde ele alarak literature katkı sağlamaktadır. Bulgulara göre, etik ilkelerin güçlendirilmesi, denetim mekanizmalarının güçlendirilmesi ve çalışanların çalışma koşullarının iyileştirilmesi süreci destekleyecek önemli politika önerilerindendir.

Keywords

• Kayıt dışı Ekonomi
• Nitel Araştırma
• Sağlık

A Study On The Causes Of Unrecorded Economy In Turkish Health Sector

Abstract

This study was conducted to examine the reasons for the emergence of the unrecorded economy in the healthcare sector. As part of this qualitative research, interviews were conducted with managers, auditors, and sector representatives in the healthcare industry. These interviews were analyzed using Interpretive Phenomenological Analysis. The findings indicate that the unrecorded economy is not caused by a single factor. According to the participants' statements, insufficient income, lack of oversight, perceived lack of justice, legal uncertainty, and the unique characteristics of the healthcare sector are significant factors contributing to the unrecorded economy. Furthermore, cultural norms, social trust levels, erosion of ethical sensitivities, and the legitimization of informal relationships are cited as important factors fueling informality. The study contributes to the literature by addressing the multi-dimensional impact of economic, institutional, and cultural processes on unrecorded economic behavior. According to the findings, strengthening ethical principles, solidifying oversight mechanisms, and improving working conditions for employees are significant policy recommendations to support this process.

Keywords

• Unrecorded Economy
• Qualitative Research
• Health

References

1. Adam, M. C., & Ginsburgh, V. (1985). The effects of irregular markets on macroeconomic policy. European Economic Review, 29, 15–33. https://doi.org/10.1016/0014-2921(85)90036-4
2. Akça, E. E., & Bal, H. (2018). Estimation of informal economy in Turkey through econometric approach. Hitit University Journal of Institute of Social Sciences, 11(1), 683–708. https://doi.org/10.17218/hititsosbil.359759
3. Akkaş, E. (2016). A qualitative study on cultural determinants of the profession of medicine in Turkey (Publication No. 453254) [Doctoral dissertation, Süleyman Demirel University Institute of Social Sciences]. YÖK National Thesis Center.
4. Altuğ, O. (1998). Dimensions of the informal economy. Erciyes University Journal of Economics and Business Administration, 15, 257–276. https://www.researchgate.net/publication/338912249_kayitdisi_ekonominin_boyutlari_1997
5. Barthelemy, P. (1988). The macroeconomic estimates of the hidden economy: A critical analysis. Review of Income and Wealth, 34(2), 183–208. https://doi.org/10.1111/j.1475-4991.1988.tb00567.x
6. Bordás, I. (1993). Piac és fekete piac az egészségügyben [Market and black market in health care]. Replika, 87–94.
7. Çolak, M. (2012). Legal regulation policy in the struggle with the unregistered economy (Publication No. 303759) [Doctoral dissertation, Istanbul University Institute of Social Sciences]. YÖK National Thesis Center.
8. Creswell, J. W. (2016). Research design: Qualitative, quantitative and mixed method approaches (S. B. Demir, Ed.). Eğiten Kitap.

9. Dilnot, A., & Morris, C. N. (1981). What we know about the black economy? Fiscal Studies, 2(1), 8–73. https://www.jstor.org/stable/24434444
10. Feige, E. L. (1994). The underground economy and the currency enigma. Public Finance/Finances Publiques, 49(Supplement), 119–136. https://econwpa.ub.uni-muenchen.de/econ-wp/mac/papers/0502/0502004.pd
11. Feige, E. L. (1997). Revised estimates of the underground economy: Implications of US currency held abroad. MPRA Paper, 151–208. https://mpra.ub.uni-muenchen.de/13805/
12. Feige, E. L. (1989). The underground economies: Tax evasion and information distortion. Cambridge University Press.
13. Feldstein, M. (1970). The rising price of physician services. Review of Economics and Statistics, 52(2), 121–133. https://doi.org/10.2307/1926113
14. Folland, S., Goodman, A. C., & Stano, M. (2013). The economics of health and health care (7th ed.). Pearson Education.
15. Frey, B. S., & Weck, H. (1983). Estimating the shadow economy: A ‘naive’ approach. Oxford Economic Papers, 35(1), 23–44. https://www.jstor.org/stable/266292
16. Gaal, P., & McKee, M. (2004). Informal payment for health care and the theory of “INXIT.” International Journal of Health Planning and Management, 19(2), 163–178. https://doi.org/10.1002/hpm.751
17. Gutmann, P. M. (1977). The subterranean economy. CFA Institute, 33(6), 26–34. https://doi.org/10.2469/faj.v33.n6.26.
18. International Labour Organization. (2022). Impact of the Covid-19 pandemic on informality: Has informal employment increased or decreased? A review of country data (ISBN 978-92-2-037469-6). International Labour Office.
19. İşler, İ. (2020). Evaluation of individuals' attitudes towards taxes and donations within the scope of trust: A research on Pamukkale University students. Pamukkale University Journal of Social Sciences Institute, 40, 333–345. https://doi.org/10.30794/pausbed.692219
20. Izumida, N., Urushi, H., & Nakanishi, S. (1999). An empirical study of the physician-induced demand hypothesis: The cost function approach to medical expenditure of the elderly in Japan. Review of Population and Social Policy, 8, 11–25.
21. Kirchgässner, G. (1983). Size and development of the West German shadow economy, 1955–1980. Theoretical Economics, 139(2), 197–214. https://www.jstor.org/stable/40750590
22. Klitgaard, R., Maclean-Abaro, R., & Parris, H. L. (2000). Corrupt cities: A practical guide to cure and prevention. World Bank Institute. https://documents1.worldbank.org/curated/pt/709171468743399124/pdf/multi-page.pdf
23. Klovland, J. T. (2017). Tax evasion and the demand for currency in Norway and Sweden: Is there a hidden relationship? Journal of Economics, 86(4), 423–439. https://doi.org/10.2307/3439653
24. Kuş, E. (2012). Qualitative–quantitative research techniques: Research techniques in social sciences (4th ed.). Anı Publishing.
25. Kuti, E. (1984). Az orvosi hálapénzről—a következmények fényében [About medical gratitude payment—In light of its consequences]. Valóság, 111–114.
26. Lemieux, P. (2007). The underground economy: Causes, extent, approaches. Montreal Economic Institute Research Paper. https://www.iedm.org/files/cdr_nov07_en.pdf
27. Metin, A., & Erdem, R. (2020). Informal economy in the health sector. Süleyman Demirel University Visionary Journal, 11(28), 931–945. https://doi.org/10.21076/vizyoner.692385
28. Nekoeimoghadam, M., Esfandiari, A., Ramezani, F., & Amiresmaili, M. (2013). Informal payments in healthcare: A case study of Kerman Province in Iran. International Journal of Health Policy and Management, 1(2), 157–162. https://doi.org/10.15171/ijhpm.2013.28.
29. North, D. C. (1990). Institutions, institutional change and economic performance. Cambridge University Press. https://doi.org/10.1017/CBO9780511808678
30. Organisation for Economic Co-operation and Development. (2023). The COVID-19 pandemic and the future of telemedicine (OECD Health Policy Studies). OECD Publishing. https://doi.org/10.1787/ac8b0a27-en
31. Perry, G. E., Maloney, W. F., Arias, O. S., Fajnzylber, P., Mason, A. D., & Saavedra-Chanduvi, J. (2007). Informality: Exit and exclusion. The World Bank. https://openknowledge.worldbank.org/handle/10986/6733
32. Portes, A., Castells, M., & Benton, L. A. (1989). The informal economy: Studies in advanced and less developed countries. The Johns Hopkins University Press.
33. Savedoff, W. D., & Hussmann, K. (2006). Why are health systems prone to corruption? Global Corruption Report 2006, 3–24. https://images.transparencycdn.org/images/2006_GCR_HealthSector_EN.pdf
34. Sayım, F. (2009). Health services and the market structure of the health sector. In Health enterprises management guide (pp. 253–285). Seçkin Publishing.
35. Schneider, F. (1986). Estimating the size of the Danish shadow economy using the currency demand approach: An attempt. Journal of Economics, 88(4), 643–668. https://doi.org/10.2307/3440435
36. Seggie, N. F., & Bayyurt, Y. (2017). Qualitative research methods. In N. F. Seggie & Y. Bayyurt (Eds.), Qualitative research methods, techniques, analysis and approaches (pp. 11–23). Anı Publishing.
37. Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research. SAGE Publications.
38. Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 53–80). Sage. https://doi.org/10.1002/9780470776278.ch10
39. Sugözü, İ. H. (2010). Informal economy and Turkey. Nobel Publication Distribution.
40. Stepurko, T., Pavlova, M., Gryga, I., & Groot, W. (2015). Making Patients Pay: Informal Patient Payments in Central and Eastern European Countries. Frontiers in public health, 3, 192. https://doi.org/10.3389/fpubh.2015.00192.
41. Tanzi, V. (1980). The underground economy in the United States: Estimates and implications. Banca Nazionale Del Lavoro Quarterly Review, 13, 427–453.
42. Taylor, S. J., Bogdan, R., & Devault, M. (2016). Introduction to qualitative research methods: A guidebook and resource (4th ed.). John Wiley & Sons.
43. Tomini, S., Groot, W., & Pavlova, M. (2012). Paying informally in the Albanian health care sector: A two-tiered stochastic frontier model. The European Journal of Health Economics, 13(6), 777–788. https://doi.org/10.1007/s10198-011-0331-
44. Van Manen, M. (1977). Linking ways of knowing with ways of being practical. Curriculum Inquiry, 6(3), 205–228. https://doi.org/10.2307/1179579
45. Vian, T., & Crable, E. L. (2017). Corruption and the consequences for public health. https://www.researchgate.net/publication/323799029_Corruption_and_the_Consequences_for_Public_Health
46. Walton, H. J. (1967). The measurement of medical students' attitudes. Medical Education, 1(5), 330–340. https://doi.org/10.1111/j.1365-2923.1967.tb01727.