A Spatial Analysis for the Determinants of Health Status: The Case of Turkey NUTS-3

Öz

Turkey’s health outcomes are far behind the average of OECD countries and there are significant differences between its regions as well, for this reason it is important to identify the determinants of the health status. In this study, considering the externalities in the health care, the possible determinants of health status have been analysed by using Spatial Panel Data method for 2008-2014 and at the level of 81 provinces. According to the Fixed Effects Spatial Lag Panel model estimations, there are positive spillover between provinces on health status. Also the findings reveal that the level of income and proportion of the population covered social security scheme are most important determinants of health status, and also education level, urbanization rate and ease of access to healthcare facilities are among the findings that improve health. On the other hand there are no statistical evidences that the investment incentives for health and technology level of provinces have a positive effect on health status. All these results indicate that reducing of development disparities between regions, expansion of the population covered under social security scheme and facilitating access to health services are important policies for the point of eliminating the differences in health status. The effectiveness of investment incentives for health care should also be closely monitored in Turkey.

Anahtar Kelimeler

• Health Transformation Program,Health Status,Health Inequality,Spatial Panel Data Analysis

Sağlık Düzeyinin Belirleyicilerine Yönelik Mekânsal Bir Analiz: Türkiye İBBS-3 Örneği

Öz

Türkiye’nin sağlık çıktıları açısından gerek OECD ülkeleri ortalamasının oldukça gerisinde kalması; gerekse de bölgesel düzeyde belirgin farklılıklar göstermesi, sağlık düzeyinin muhtemel belirleyicilerinin tespitini gerektirmektedir. Bu doğrultuda çalışmada, 2008-2014 döneminde ve 81 il düzeyinde, sağlık hizmetlerinin dışsallık özelliği de dikkate alınarak sağlık düzeyinin olası belirleyicileri Mekânsal Panel Veri yöntemiyle analiz edilmiştir. Tahmin edilen Mekânsal Gecikmeli Sabit Etkiler Panel Modeli’nin bulguları, iller arasında sağlık düzeyi açısından pozitif yönlü yayılma etkisinin varlığını kanıtlamaktadır. Ayrıca, sağlık düzeyinin en önemli belirleyicilerinin gelir düzeyi ve sosyal sağlık güvencesi olduğu; bununla birlikte, eğitim düzeyi, kentleşme oranı ve sağlık hizmetlerine erişim kolaylığı gibi unsurların da sağlık düzeyi üzerinde iyileşme sağladığı elde edilen bulgular arasındadır. Fakat illerin teknoloji düzeyleri ve sağlık sektörüne yönelik düzenlenen teşvikler ile sağlık düzeyi arasında istatistiksel açıdan anlamlı herhangi bir bulguya ulaşılamamıştır. Elde edilen sonuçlar, sağlık düzeyindeki farklılıkların giderilmesi noktasında, iller arasındaki gelişmişlik farklılıklarının azaltılması, sosyal güvence kapsamındaki nüfusun genişletilmesi ve sağlık hizmetlerine erişimin kolaylaştırılması gibi politikalara ihtiyaç duyulduğunu gösterdiği gibi sağlık sektörüne yönelik teşvik politikalarının etkinliğinin de sorgulanmasını gerektirmektedir.

Anahtar Kelimeler

• Sağlıkta Dönüşüm Programı,Sağlık Düzeyi,Sağlıkta Eşitsizlik,Mekânsal Panel Veri Analizi

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