SAĞLIK SİGORTASI SİSTEMİNE DEVLET MÜDAHALESİNİN SEVİYESİNİN ÖLÇÜMÜ: ÜLKELER ARASI KARŞILAŞTIRMALI ANALİZ

Abstract

Ekonomik kalkınmanın önemli amacı, günümüzde sosyal güvenceyi sağlamaktır. Sosyal güvencenin ana bileşenlerinden biri, nüfusun sağlık durumunun iyileştirilmesidir. Dünya deneyimi, sağlık sigortasının (özellikle zorunlu) nüfusun sağlık durumunun iyileştirilmesinde önemli bir rolünün olduğunu göstermektedir. Böylece, yüksek oranda sağlık sigortasına sahip ülkelerde, nüfusun sağlığı daha güvenilir bir şekilde korunur, tedavi ve önleme kapsamını genişletme fırsatı oluşur. Sağlık sigortası da dahil olmak üzere sağlık sisteminin gelişimi, devletin bu alana müdahale oranına bağlıdır. Araştırmalar, hükümetin sağlık sistemine ne kadar çok müdahale ederse, nüfusun sağlık durumunun o kadar iyi olduğunu gösteriyor. Ekonomik kalkınmanın önemli hedefi, modern zamanlarda sosyal korumayı güçlendirmektir. Sosyal korumanın ana bileşenlerinden biri, nüfusun sağlık hizmetlerinin sağlanmasıdır. Dünya deneyimi, sağlık sigortasının (özellikle zorunlu) nüfusun sağlık hizmetlerinin korunmasında önemli bir rol oynadığını göstermektedir. Böylece, yüksek düzeyde sağlık sigortasına sahip ülkelerde, nüfusun sağlığı daha güvenilir bir şekilde korunur ve tedavi ve önleme kapsamını genişletme fırsatı doğar. Sağlık sigortası da dahil olmak üzere sağlık sisteminin gelişimi, bu alandaki devlet müdahalesinin düzeyine bağlıdır. Araştırmalar gösteriyor ki, hükümet sağlık sistemine ne kadar çok müdahale ederse, halk için o kadar iyi sağlık hizmeti veriliyor. Şimdiye kadar sağlık sigortası sistemine devlet müdahalesinin gerekliliği çeşitli bilim adamlarının araştırma konusu olmuş ancak müdahalenin düzeyini ölçmek için herhangi bir araştırma yapılmamıştır. Sağlık sigortası sistemine devlet müdahalesinin düzeyini ölçmek mümkün müdür? Yazarlar, sağlık sigortası sistemindeki devlet müdahalesinin düzeyini ölçmeye izin veren bir metodoloji oluşturmaya çalıştılar. Bu metodolojiye Sağlık Sigortası Sistemine Müdahale Endeksi (IIHIS) denir. Yazarlar, IIHIS'i hesaplayarak, Sağlık Sigortası Sistemindeki devlet müdahale düzeyini belirlemektedir. Sağlık Sigortası Sistemine devlet müdahalesinin seviyesinin ölçülmesi, uygulanan reformların sosyal sonuçlarının değerlendirilmesine olanak tanır. İİHİS, zorunlu sağlık sigortası kapsamı, özel sağlık sigortası kapsamı, sağlık sigortası tarifeleri ve ilaçlarda Katma Değer Vergisi (KDV) olmak üzere 4 gösterge üzerinden hesaplanmıştır. İlk aşamada 31 ülke için IIHIS hesaplanmıştır. 31 ülke arasında gelişmiş, gelişmekte olan ve sosyalizm sonrası ülkeler var. IIHIS'e göre en dirigist (solcu) ülkeler Slovenya ve İsrail. İHİS'e göre en liberal (haklı) ülkeler Azerbaycan, ABD. Yazarlar, sağlık sigortası sistemine devlet müdahalesinin seviyesini ölçmek ve Azerbaycan'ın sağlık sigortası sisteminin konumunu belirlemek istiyor. Yazarlar korelasyon, analitik-istatistiksel ve ülkeler arası analizler gerçekleştirdiler. Sağlık sigortası sistemine devlet müdahalesinin düzeyi 31 ülkede ölçülmüştür.

Keywords

• müdahale
• Devlet
• sağlık sigortası
• sağlık sigortası sistemine müdahale endeksi

MEASUREMENT OF THE LEVEL OF GOVERNMENT INTERVENTION IN THE HEALTH INSURANCE SYSTEM: CROSS-COUNTRY COMPARATIVE ANALYSIS

Abstract

The important goal of economic development is to strengthen social protection in modern times. One of the main components of social protection is the provision of health care of the population. World experience shows that health insurance (especially compulsory) plays an important role in the protection of the health care of the population. Thus, in countries with a high level of health insurance, the health of the population is more reliably protected, and there is an opportunity to expand the scope of treatment and prevention. The development of the health system, including health insurance, depends on the level of government intervention in this field. The research shows that the more government interferes in the health system, the better health care for the population. So far, the need for government intervention in the health insurance system has been the subject of research by various scientists, but no research has been conducted to measure the level of intervention. Is it possible to measure the level of government intervention in the health insurance system? The authors have tried to create a methodology that allows for measuring the level of government intervention in the health insurance system. This methodology is called the Index of Intervention of Health Insurance System (IIHIS). By calculating IIHIS, the authors determine the government intervention level in Health Insurance System. Measurement of the level of government intervention in the Health Insurance System allows for evaluating the social consequences of the implemented reforms. IIHIS has been calculated on the basis of 4 indicators – Coverage of compulsory health insurance, Coverage of private health insurance, Health insurance tariffs, and Value-Added Tax (VAT) on medications. At the initial stage, IIHIS has been calculated for 31 countries. Among 31 countries, there are developed, emerging, and post-socialist countries. According to IIHIS, the most dirigist (leftness) countries are Slovenia, and Israel. According to the IIHIS, the most liberal (rightness) countries are Azerbaijan, USA. The authors want to measure the level of government intervention in the health insurance system and to determine the position of Azerbaijan health insurance system. The authors have performed correlation, analytical-statistical, and cross-country analyses. The level of government intervention in the health insurance system has been measured in 31 countries.

Keywords

• health insurance intervention index
• Government
• intervention
• health insurance
• health insurance intervention index
• Devlet
• müdahale
• sağlık sigortası
• sağlık sigortası sistemine müdahale endeksi.
• sağlık sigortası sistemine müdahale endeksi

References

1. Abdullayeva, R., Muradov, A., Kuliyeva, A., Mahmudov, S. (2020). The state regulation of the health care system: Cross-country comparative analysis, 57-67. Retrieved from https://www.researchgate.net/profile/Leyla-Mehdiyeva-3/publication/347488425_Book_of_Proceedings_esdBaku2020_Vol3_Online/links/5fddd63192851c13fe9d3721/Book-of-Proceedings-esdBaku2020-Vol3-Online.pdf#page=68
2. Allen, P. (2009). Restructuring the NHS again: Supply side reform in recent English healthcare policy. I. Lapsley (ed.), Financial Accountability and Management. London: Wiley. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-0408.2009.00483.x
3. ANAS, Institute of Economics. (2016). Index of leftness (rightness) of economy. Retrieved from http://economics.com.az/en/index.php/2016.html
4. Auerbach, L., Donner, A., Peters, D., Townson, H. and Yalnizyan, A. (2003). Funding Hospital Infrastructure: Why P3s don’t work, and what will. Ottawa: Canadian Centre for Policy Alternatives. Retrieved from http://www.ontariohealthcoalition.ca/wp-content/uploads/FULL-REPORT-November-2003.pdf
5. Bahadori, M., Ravangard, R., Alimohammadzadeh, K. and Hosseini, S.M. (2015). Plan and road map for health reform in Iran. R. Horton (ed.), BMJ. London: BMJ printing group. Retrieved from https://www.bmj.com/content/351/bmj.h4407
6. Baku Research Institute. (2022). Application of the compulsory health insurance: visible and invisible aspects of the process. Retrieved from https://snip.ly/5hs6fa
7. Balabanova, D. & Coker, R. (2008). Russia and Former USSR, Health Systems of. In International Encyclopedia of Public Health, 627-637. doi: https://doi.org/10.1016/B978-012373960-5.00316-6
8. Brown, M.M., Brown, G.C., Sharma, S. and Landy, J. (2003). Healthcare economic analyses and value-based medicine. J. Gittinger (ed.), Survey of Ophthalmology. Plymouth: Elsevier. Retrieved from https://www.surveyophthalmol.com/article/S0039-6257(02)00457-5/fulltext

9. Carrin, G. & James, C. (2005). Social health insurance: key factors affecting the transition towards universal coverage. Geneva: International Social Security Review (WHO). Retrieved from https://doi.org/10.1111/j.1468-246X.2005.00209.x
10. Cremer, H. & Pestieau, P. (2003). Social Insurance Competition between Bismarck and Beveridge. N.B. Snow (ed.), Journal of Urban Economics. London: Elsevier. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0094119003000421
11. EFPIA. (2018). VAT rates applicable to medicines. Retrieved from https://www.efpia.eu/publications/data-center/the-pharma-industry-in-figures-economy/vat-rates/
12. ExpatFocus. (2022). How does the state health insurance system work? Retrieved from: https://www.expatfocus.com/latvia/health/health-insurance-latvia
13. Farell, D., Henke, P. and Mango, P. (2007). Universal principles for healthcare reform. London: The Mckinsey Quarterly. Retrieved from http://fcollege.nankai.edu.cn/_upload/article/e5/f8/711920d14fcbb0fb77708edbe1cc/6e32fbeb-a907-4250-bfba-7627aff71b34.pdf
14. Fattore, G. & Tediosi F. (2013). The Importance of values in shaping how health systems governance and management can support universal health coverage. M. Drummond (ed.), Value in health. Barcelona: Elsevier. Retrieved from https://www.sciencedirect.com/science/article/pii/S1098301512041599
15. Gil1, M.A. & García, J.M.B. (2016). The healthcare system in Spain: from decentralization to economic current crisis. Sociology and Anthropology. San Jose: Horizon Research Publishing. Retrieved from http://www.hrpub.org/download/20160430/SA2-19604973.pdf
16. Gov.UK. (2022). National Insurance rates and categories. Retrieved from: https://www.gov.uk/national-insurance-rates-letters
17. Grittner, A.M. (2013). Results-based financing amanda melina grittner evidence from performance-based financing in the health sector. Retrieved from https://www.oecd.org/dac/peer-reviews/Results-based-financing.pdf
18. Hoof, F.V., Kok, I. and Joost, V. (2007). Liberalisation of healthcare in the Netherlands: The case of mental healthcare. N. Talley (ed.), Euro health. London: London School of Economics and Political Science. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0006/80439/Eurohealth_14_4.pdf
19. ISSA (a). (2019). Social Security Programs Throughout the World: Asia and the Pacific, 2018. Retrieved from: https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/asia/ssptw18asia.pdf
20. ISSA (b). (2019). Social Security Programs Throughout the World: The Americas, 2019. Retrieved from: https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/americas/ssptw19americas.pdf
21. ISSA (c). (2019). Social Security Programs Throughout the World: Europe, 2018. Retrieved from: https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/europe/ssptw18europe.pdf
22. Lakeh, M.M. & Moghaddam, A.V. (2015). Health sector evolution plan in iran; equity and sustainability concerns. A.K. Mahani (ed.), International Journal of Health Policy and Management. Kerman: Kerman University of Medical Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594102/
23. Mahmudov, S.M. (2018). Measuring government intervention in the health insurance system. ANAS News, Economic series, 4, 89-99.
24. Medicare Wages. (2021). Julia Kagan. Retrieved from: https://www.investopedia.com/terms/m/medicarewages.asp
25. Memia, F. (2015). The benefits of mandatory health insurance. The institutional approach in Albania. Tirana: European Journal of Social Sciences Education and Research 2(1), 55-61. Retrieved from https://revistia.com/files/articles/ejser_v2_i1_15/Fjoralba.pdf
26. Mueller, M. & D. Morgan (2017). New insights into health financing: first results of the international data collection under the system of health accounts 2011 framework. Health policy, 121(7), 764–769.
27. Muzaffarli, N. (2014). The social dimension of the economy is in the right and left systems. Retrived from http://economics.com.az/images/fotos/sag-solluq/N.Muzaffarli_Iqtisadiyyatin_Salliqi(Sollugu).pdf
28. Nguyen, K.T., Khuat, O.T.H., Ma, S., Pham, D.C., Khuat, G.T.H. and Ruger, J.P. (2012). Impact of health insurance on health care treatment and cost in Vietnam: a health capability approach to financial protection. AmJ Public Health, 102(8),1450–1461. Retrieved from doi: 10.2105/AJPH.2011.300618
29. OECD (2017). Financing of health care. in Health at a Glance 2017: OECD Indicators, Paris: OECD Publishing, Retrieved from https://doi.org/10.1787/health_glance-2017-46-en
30. OECD (a). (2020). Social Protection. Retrieved from https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PROT
31. OECD (b). (2020). Social Protection: Total public and primary private health insurance. Retrieved from https://stats.oecd.org/index.aspx?queryid=30137
32. Ozen, E. (2021). Otomatik Katilim Algisi, Finansal Bilgi ve Finansal Davranişin Bireysel Emeklilik Sistemi Talebine Etkisi (The Effect of Auto-Enrollment Perception Financial Knowledge and Financial Behavior on the Demand for the Individual Pension System), Journal of Research in Economics, Politics & Finance, 6(3), 912-927. DOI: 10.30784/epfad.1019921
33. PapayaGlobal (a). (2022). CountryPedia. Retrieved from: https://www.papayaglobal.com/countrypedia/
34. PapayaGlobal (b). (2022). Canada – Quebec Payroll and Benefits Guide. Retrieved from: https://www.papayaglobal.com/countrypedia/country/canada-quebec/
35. Schieber, G., Baeza, C., Kress, D. and Maier, M. (2006). Financing health systems in the 21st century. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11772/ Si, Y., Zhou, Z., Su, M., Ma, M., Xu, Y and Heitner, J. (2017). Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China. E. Shadmi (ed.), International Journal for Equity in Health. Israel: Wiley. Retrieved from https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0506-6
36. Spanish Employee Benefits. (2022). What are the Employee Benefits in Spain? Retrieved from: https://www.bradfordjacobs.com/countries/spain-employee-benefits/
37. SSCRA. (2020). Health, Social Protection, Sport. Retrieved from https://www.stat.gov.az/source/healthcare/en/001_1_1en.xls
38. Sturmberg, J.P., O’Halloran, D.M. and Martin, C.M. (2010). People at the centre of complex adaptive health systems reform. N. Talley (ed.), The Medical Journal of Australia. Sydney: MJA. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20955127
39. The World Bank. (2020). Life expectancy at birth, total (years) – Azerbaijan. Retrieved from https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=AZ
40. Tulchinsky, T.H. & Varavikova, E.A. (2014). Expanding the concept of public health. Retrieved from doi: 10.1016/B978-0-12-415766-8.00002-1
41. UNIICEF. (2020). Child health. Retrieved from https://data.unicef.org/country/aze/
42. WHO. (2003). Social Health Insurance. Retrieved from https://snip.ly/exzjab
43. Zhai, S. Yuan, S. and Dong, Q. (2021). The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China. Retrieved from https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01379-5