ULUSAL SAĞLIK SİSTEMLERİNDE TOPLAM FAKTÖR VERİMLİLİĞİ DEĞİŞİMİ: OECD ÜLKELERİ ÜZERİNDE BİR ÇALIŞMA

Öz

Ulusal sağlık sistemlerinin etkinliğini kıyaslama yoluyla ortaya koyarken çeşitli parametrik ve parametrik olmayan yöntemlerden yararlanılabilir. Parametrik olmayan yöntemler arasında Veri Zarflama Analizinin (VZA) ve VZA temelli analizlerin kullanım sıklığı bakımından diğerlerinin önünde olduğu söylenebilir. Bu çalışma, Organisation for Economic Co-operation and Development (OECD) üyesi ülkelerin ulusal sağlık sistemlerinin zamana dayalı etkinliğinde yaşanan değişimi ve çeşitli ekonomik faktörler ile davranışsal risk faktörlerinin bu değişime etkisini, VZA temelli bir analiz olan Malmquist Toplam Faktör Verimliliği (MTFV) ve istatistiksel fark testleri ile ortaya koymayı amaçlamaktadır. Elde edilen sonuçlara göre, ekonomik ve davranışsal risk faktörlerine ilişkin göstergeler MTFV ve alt bileşenlerine ait skorları istatistiksel olarak anlamlı şekilde değiştirmektedir (p<0,05). Olumsuz ekonomik şartların ve davranışsal risk faktörlerinin toplumların sağlık statüsünde sebep olduğu gerilemeleri önleyici politikalar oluşturulması önerilmektedir.

Anahtar Kelimeler

• Ulusal Sağlık Sistemleri
• Performans
• Etkinlik
• Malmquist Toplam Faktör Verimliliği

TOTAL FACTOR PRODUCTIVITY CHANGE IN NATIONAL HEALTHCARE SYSTEMS: A STUDY ON OECD COUNTRIES

Abstract

Various parametric and non-parametric methods can be used to demonstrate the efficiecny of national healthcare systems through comparison. Among the non-parametric methods, it can be stated that Data Envelopment Analysis (DEA) and DEA-based analysis are ahead of the others in terms of frequency of use. This study aims to demonstrate the change in the time-based efficiency of the national healthcare systems of the Organization for Economic Co-operation and Development (OECD) member countries and the effect of various economic factors and behavioral risk factors on this change via Malmquist Total Factor Productivity (MTFP), a DEA-based analysis, and hypothesis tests. According to the results, indicators related to economic and behavioral risk factors statistically significantly change the scores of MTFP and its sub-components (p <0.05). It is recommended to create policies to prevent the decline in the health status of societies caused by adverse economic conditions and behavioral risk factors.

Kaynakça

1. Adang, E. M., & Borm, G. F. (2007). Is There an Association Between Economic Performance and Public Satisfaction in Health Care? The European Journal of Health Economics, 8(3), 279-285
2. Ahangar, A., Ahmadi, A. M., Mozayani, A. H., Dizaji, S. F., & Safarani, S. (2019). Transition of Health Financing, Cost Risk-Sharing and Risk-Pooling Models in the Health Sector: A Systematic Review (1990 - 2019). Iran Red Crescent Med J., 21(12), e63215.
3. Alpar, R. (2014). Uygulamalı İstatistik ve Geçerlik-Güvenirlik. 3. Baskı, Ankara: Detay Yayınları.
4. Cabanda, E., Ariff, M., & Viverita, R. (2004). A Multı-Crıterıa Approach to Technologıcal Progress, Effıcıency Change, and Productıvıty Growth in Global Telecommunıcatıons.
5. Emrouznejad, A., & Podinovski, V. (Eds.) Data Envelopment Analysis and Performance Measurement İçinde, UK: Warwick Print.
6. Caves, D. W., Christensen, L. R., & Diewert, W. E. (1982a). Multilateral Comparisons of Output, Input and Productivity Using Superlative Index Numbers. Economic Journal, 92, 73-86.
7. Caves, D. W., Christensen, L. R., & Diewert, W. E. (1982b). The Economic theory of Index Numbers and the Measurement of Input, Output and Productivity. Econometrica, 50, 1393-1414.
8. Cylus, J., Papanicolas I., & Smith, P. C. (2017). Using Data Envelopment Analysis to Address the Challenges of Comparing Health System Efficiency. Global Policy, 8(Supplement 2), 60-68.

9. Färe, R., Grosskopf, S., & Lovell, C. A. K. (1985) The Measurement of Efficiency of Production. Boston: Kluwer Academic Publishers.
10. Färe, R., Grosskopf, S., & Lovell, C. A. K. (1994) Production Frontiers. Cambridge: Cambridge University Press.
11. Hakkinen, U., & Joumard, I. (2007). Cross-Country Analysıs of Efficiency ın OECD Health Care Sectors: Options for Research. France: Working Paper, OECD Publishings.
12. Ibrahim, M. D., Daneshvar, S., Hocaoğlu, M. B., & Oluseye, O. W. G. (2019). An Estimation of the Efficiency and Productivity of Healthcare Systems in Sub‑Saharan Africa: Health‑Centred Millennium Development Goal‑Based Evidence. Social Indicators Research, 143(1), 371-389.
13. Kirigia, J. M., Asbu, E. Z., Greene, W., & Emrouznejad, A. (2007). Technical Efficiency, Efficiency Change, Technical Progress and Productivity Growth in the National Health Systems of Continental African Countries. Eastern Africa Social Science Research Review, 23(2), 19-40.
14. Kočıšová, K., & Sopko, J. (2020). The Effıcıency of Publıc Health And Medıcal Care Systems in EU Countrıes: Dynamıc Network Data Envelopment Analysıs. Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis, 68(2), 383–394.
15. Li, H., Dong, S., & Liu, T. (2014). Relative Efficiency and Productivity: A Preliminary Exploration of Public Hospitals in Beijing, China. BMC Health Services Research, 14(1), 158. Malmquist, S. (1953). Index numbers and indifference surfaces. Trabajos de estadística, 4(2), 209-242.
16. Masri, M. D., & Asbu, E. Z. (2018). Productivity Change of National Health Systems in the WHO Eastern Mediterranean Region: Application of DEA-Based MTFV Productivity Index. Global Health Research and Policy, 3(1), 22.
17. Mohamadi, E., Manesh, A. O., Takian, A., et al. (2020). Technical Efficiency in Health Production: A Comparasion Between Iran and Other Upper Middle-Income Countries. Health Policy And Technology, Doi.org/10.16/j.hlpt.2020.06.007.
18. O’Neill, L., Raune, M., Heidenberge, K., & Krau, M. (2008). A Cross-National Comparison and Taxonomy of DEA-Based Hospital Efficiency Studies. Socio-Economic Planning Sciences, 42, 158–189.
19. OECD (2019a). Health Data. http://www.oecd.org/els/health-systems/health-data.html Erişim Tarihi: (15.02.2021).
20. OECD (2019b). Economy Data. https://data.oecd.org/economy.htm Erişim Tarihi: (15.02.2021).
21. Ozcan, Y. A. (2014). Health Care Benchmarkıng and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA). Second Edition, USA: Springer.
22. Ozcan, Y. A., & Khushalani, J. (2017). Assessing Efficiency of Public Health and Medical Care Provision in OECD Countries After a Decade of Reform. Central European Journal of Operations Research, 25(2), 325-343.
23. Prada, G., Grimes, K., & Sklokin, L. (2014). Defining Health and Healthcare Sustainability. Canada: The Conference Board of Canada.
24. Ray, S. C. (2004). Data Envelopment Analysis: Theory and Techniques for Economics and Operations Research. Cambridge: Cambridge University Press.
25. Spinks, J., & Hollingsworth, B. (2009). Cross-country Comparisons of Technical Efficiency of Health Production: A Demonstration of Pitfalls. Applied Economics, 41(4), 417-427.
26. WHO (2010). The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva: World Health Organization Publishings.
27. World Bank (2019) Health Data. https://data.worldbank.org/topic/health (Erişim Tarihi: 01.02.2021).