Sağlık Harcamaları ile Maliye Politikasının Bileşenleri Arasındaki İlişki: Latin Amerika ve Karayipler Bağlamında VECM Yaklaşımı

Yıl 2023, Cilt: 8 Sayı: 1, 67 - 91, 30.06.2023

Sadık Aden Dırır

https://doi.org/10.25229/beta.1250104

Öz

Kapasite verimsizlikleri, ekonomik büyüme, yaşlanan nüfusa doğru demografik kayma ve insan gücü ile üretim maliyeti arasındaki dengesizliğin bir sonucu olarak çok sayıda ülke, özellikle Latin Amerika'daki ülkeler artan sağlık harcamaları yaşıyor. Bu nedenle, artan harcamalar karşısında bir ülkenin sağlık sektörü için yeterli parayı toplaması önemli bir yüktür. Bu makale, özellikle Latin Amerika ve Karayipler'de son 21 yılda sağlık harcamaları ile maliye politikası bileşenleri arasında var olan ilişkiyi analiz etmektedir. Çalışmaya devam etmek için maliye politikası bileşenlerini iki ana modele ayırdık. Birinci model büyük ölçekli bileşenleri kapsarken, ikinci model küçük ölçekli bileşenleri içermektedir. Buna bağlı olarak, uzun vadeli ve faktörler arasındaki nedensel ilişkiyi yakalamak için bir VECM ve granger nedensellik yaklaşımı uyguladık. Bulgular, kısa dönemde ticaret, vergi geliri ve faiz oranının sağlık harcamaları üzerinde etkili olduğunu ortaya koydu. Uzun dönemde ise özel sektöre sunulan yurtiçi krediler dışındaki tüm maliye politikaları sağlık sektörüne ayrılan fonlar üzerinde etkili olmuştur. Son olarak Covid, 19 pandemisi ve diğer uluslararası savaşlar göz önüne alındığında ülkeler belirli bir alana fon tahsis etmekte tereddüt edebilirler. Bunun ışığında çalışma, ülkelerin sağlık sektörü ile ilgili olarak aldıkları mali önlemlerin kapsamını ortaya koyarak bu endişeleri gidermeye yardımcı olmaktadır.

Anahtar Kelimeler

Maliye Politikası, Sağlık Sektörü, Devlet Harcamaları, Latin Amerika Ülkeleri, VECM

The Association between Health Expenditure and the Components of Fiscal Policy: VECM Approach in the Context of Latin America and the Caribbean

Öz

Growing healthcare expenses are being experienced by numerous nations, particularly nations in Latin America, as a result of capacity inefficiencies, economic growth, demographic shift to the aging population, and an imbalance between the cost of manpower and output. Therefore, it is a significant burden for a nation to collect enough money for the health sector in view of escalating expenditures. Hereby, this paper analyzes the association that exists between health expenditure and the components of fiscal policy particularly in Latin America and the Caribbean during the last 21 years. To proceed with the study, we subdivided the fiscal policy components into two major models. The first model encompasses large-scale components whereas the second model consists of small-scale components. Correspondingly, we performed a VECM and granger causality approach to capture the long run as well the causal relationship between the factors. The findings revealed that in the short run trade, tax revenue, and interest rate have an influence on health expenditure. While in the long run, all the fiscal policies except domestic credit offered to the private sector presented an influence on the funds allocated to the health sector. Finally, considering the Covid, 19 pandemic, and other international wars, countries may be hesitant to allocate funds to a particular area. In light of this, the study helps ease these worries by outlining the scope of fiscal measures adopted by countries in relation to the health sector.

Anahtar Kelimeler

Fiscal Policy, Healthcare sector, Government expenditure, Latin America, VECM

Kaynakça

• Abdelwahed, L. (2020). More oil, more or less taxes? new evidence on the impact of resource revenue on domestic tax revenue. Resources Policy, 68, 101747. https://doi.org/10.1016/j.resourpol.2020.101747
• Alberola, E., Arslan, Y., Cheng, G., & Moessner, R. (2021). Fiscal response to the COVID‐19 crisis in advanced and emerging market economies. Pacific Economic Review, 26(4), 459-468. https://doi.org/10.1111/1468-0106.12370
• Alloza, M., Andrés, J., Burriel, P., Kataryniuk, I., Pérez, J. J., & Croissier, J. L. V. (2021). The Reform of the European Union's Fiscal Governance Framework in a New Macroeconomic Environment (No. 2121). Banco de España.
• Bakkeli, N. Z. (2016). Income inequality and health in China: a panel data analysis. Social Science & Medicine, 157, 39-47. https://doi.org/10.1016/j.socscimed.2016.03.041
• Baltagi, B. H., & Moscone, F. (2010). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic modeling, 27(4), 804-811. https://doi.org/10.1016/j.econmod.2009.12.001
• Barroy, H., Cylus, J., Patcharanarumol, W., Novignon, J., Evetovits, T., & Gupta, S. (2021). Do efficiency gains really translate into more budget for health? An assessment framework and country applications. Health policy and planning, 36(8), 1307-1315. https://doi.org/10.1093/heapol/czab040
• Bashar, O. H., Bhattacharya, P. S., & Wohar, M. E. (2017). The cyclicality of fiscal policy: New evidence from unobserved components approach. Journal of Macroeconomics, 53, 222-234. https://doi.org/10.1016/j.jmacro.2017.07.010
• Benmelech, E., & Tzur-Ilan, N. (2020). The determinants of fiscal and monetary policies during the COVID-19 crisis (No. w27461). National Bureau of Economic Research. DOI 10.3386/w27461
• Blundell, R., Britton, J., Dias, M. C., & French, E. (2021). The impact of health on labor supply near retirement. Journal of Human Resources, 1217-9240R4. doi:10.3368/jhr.58.3.1217-9240R4
• Botta, A., Caverzasi, E., & Russo, A. (2020). Fighting the COVID-19 crisis: Debt monétisation and EU recovery bonds. Intereconomics, 55(4), 239-244. https://doi.org/10.1007/s10272-020-0907-z
• Bui, D., Dräger, L., Hayo, B., & Nghiem, G. (2022). The effects of fiscal policy on households during the COVID-19 pandemic: Evidence from Thailand and Vietnam. World Development, 153, 105828. https://doi.org/10.1016/j.worlddev.2022.105828
• Combes, J. L., Minea, A., & Sow, M. (2017). Is fiscal policy always counter-(pro-) cyclical? The role of public debt and fiscal rules. Economic Modelling, 65, 138-146. https://doi.org/10.1016/j.econmod.2017.05.017
• Cuadro Sáez, L., López Vicente, F., Párraga Rodríguez, S., & Viani, F. (2020). Fiscal policy measures in response to the health crisis in the main euro area economies, the United States and the United Kingdom. Documentos Ocasionales/Banco de España, 2019.
• Elgin, C., Basbug, G., & Yalaman, A. (2020). Economic policy responses to a pandemic: Developing the COVID-19 economic stimulus index. Covid Economics, 1(3), 40-53.
• Faria-e-Castro, M. (2020). Fiscal policy and COVID-19: insights from a quantitative model. Available at SSRN 3587665. https://dx.doi.org/10.20955/es.2020.8
• Flaxman, S., Mishra, S., Gandy, A., Unwin, H. J. T., Mellan, T. A., Coupland, H., ... & Bhatt, S. (2020). Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature, 584(7820), 257-261. https://doi.org/10.1371/journal.pone.0252827
• Gaspar, V., Lam, W. R., & Raissi, M. (2020). Fiscal policies to contain the damage from COVID-19. Washington: International Monetary Fund. IMF PFM BLOG.
• Goel, R. K., Mazhar, U., Nelson, M. A., & Ram, R. (2017). Different forms of decentralization and their impact on government performance: Micro-level evidence from 113 countries. Economic Modelling, 62, 171-183. https://doi.org/10.1016/j.econmod.2016.12.010
• Granger, C. W. (1969). Investigating causal relations by econometric models and cross-spectral methods. Econometrica: journal of the Econometric Society, 424-438. https://doi.org/10.2307/1912791
• Gunarsa, S., Makin, T., & Rohde, N. (2020). Public debt in developing Asia: a help or hindrance to growth?. Applied Economics Letters, 27(17), 1400-1403. https://doi.org/10.1080/13504851.2019.1683147
• Gujarati, D., & Porter, D. C. (2010). Functional forms of regression models. Essentials of Econometrics, 132-177.
• Hall, S. G., Swamy, P. A. V. B., & Tavlas, G. S. (2012). Generalized cointegration: a new concept with an application to health expenditure and health outcomes. Empirical Economics, 42(2), 603-618. https://doi.org/10.1007/s00181-011-0483-y
• Ho, A. T. K., & Im, T. (2015). Challenges in building an effective and competitive government in developing countries: An institutional logics perspective. The American Review of Public Administration, 45(3), 263-280. https://doi.org/10.1177/0275074013501856
• Izquierdo, A., Pessino, C., & Vuletin, G. (Eds.). (2018). Better spending for better lives: how Latin America and the Caribbean can do more with less (Vol. 10). Inter-American Development Bank.
• Jayawardana, S., Cylus, J., & Mossialos, E. (2019). It’s not ageing, stupid: why population ageing won’t bankrupt health systems. European Heart Journal-Quality of Care and Clinical Outcomes, 5(3), 195-201. https://doi.org/10.1093/ehjqcco/qcz022
• Kelly, E., & Stoye, G. (2020). The impacts of private hospital entry on the public market for elective care in England. Journal of Health Economics, 73, 102353. https://doi.org/10.1016/j.jhealeco.2020.102353
• Kimura, F., Thangavelu, S. M., Narjoko, D., & Findlay, C. (2020). Pandemic (COVID‐19) policy, regional cooperation, and the emerging global production network. Asian Economic Journal, 34(1), 3-27. https://doi.org/10.1111/asej.12198
• Koh, W. C. (2017). Fiscal policy in oil‐exporting countries: The roles of oil funds and institutional quality. Review of Development Economics, 21(3), 567-590. https://doi.org/10.1111/rode.12293
• Kramaric, T. P., Miletic, M., & Pavic, I. (2017). Profitability determinants of insurance markets in selected central and eastern European countries. International Journal of Economic Sciences, 6(2), 100-123. DOI: 10.20472/ES.2017.6.2.006
• Lu, Z. N., Chen, H., Hao, Y., Wang, J., Song, X., & Mok, T. M. (2017). The dynamic relationship between environmental pollution, economic development and public health: Evidence from China. Journal of Cleaner Production, 166, 134-147. https://doi.org/10.1016/j.jclepro.2017.08.010
• Makin, A. J. (2019). Lessons for macroeconomic policy from the Global Financial Crisis. Economic Analysis and Policy, 64, 13-25. https://doi.org/10.1016/j.eap.2019.07.008
• McKibbin, W., & Fernando, R. (2021). The global macroeconomic impacts of COVID-19: Seven scenarios. Asian Economic Papers, 20(2), 1-30. https://doi.org/10.1162/asep_a_00796
• Niemann, S., & Pichler, P. (2020). Optimal fiscal policy and sovereign debt crises. Review of Economic Dynamics, 37, 234-254. https://doi.org/10.1016/j.red.2020.02.003
• Ouedraogo, R., & Sourouema, W. S. (2018). Fiscal policy pro-cyclicality in Sub-Saharan African countries: The role of export concentration. Economic Modelling, 74, 219-229. https://doi.org/10.1016/j.econmod.2018.05.017
• Özer, M., & Karagöl, V. (2018). Relative effectiveness of monetary and fiscal policies on output growth in Turkey: an ARDL bounds test approach. Equilibrium. Quarterly Journal of Economics and Economic Policy, 13(3), 391–409. https://doi.org/10.24136/eq.2018.019
• Rajkumar, A. S. (2008). Public spending and outcomes: Does governance matter? Journal of development economics, 86(1), 96-111. https://doi.org/10.1016/j.jdeveco.2007.08.003
• Ridzuan, M. R., & Abd Rahman, N. A. S. (2021). The deployment of fiscal policy in several ASEAN countries in dampening the impact of COVID-19. Journal of Emerging Economies & Islamic Research, 9(1), 16-28. https://doi.org/10.24191/jeeir.v9i1.9156
• Rojas‐García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018). Impact and experiences of delayed discharge: A mixed‐studies systematic review. Health Expectations, 21(1), 41-56. https://doi.org/10.1111/hex.12619
• Sorenson, C., Drummond, M., & Khan, B. B. (2013). Medical technology as a key driver of rising health expenditure: disentangling the relationship. ClinicoEconomics and outcomes research: CEOR, 5, 223.
• Thomson, S., García-Ramírez, J. A., Akkazieva, B., Habicht, T., Cylus, J., & Evetovits, T. (2022). How resilient is health financing policy in Europe to economic shocks? Evidence from the first year of the COVID-19 pandemic and the 2008 global financial crisis. Health Policy, 126(1), 7-15. https://doi.org/10.1016/j.healthpol.2021.11.002
• Wagstaff, A., Flores, G., Hsu, J., Smitz, M. F., Chepynoga, K., Buisman, L. R., ... & Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health, 6(2), e169-e179. https://doi.org/10.1016/S2214-109X(17)30429-1
• Yan, B., Zhang, X., Wu, L., Zhu, H., & Chen, B. (2020). Why do countries respond differently to COVID-19? A comparative study of Sweden, China, France, and Japan. The American review of public administration, 50(6-7), 762-769. https://doi.org/10.1177/0275074020942445
• Zulfiqar, K. (2018). Fiscal policy for inclusive growth. Pakistan Economic and Social Review, 56(1), 21-46. https://www.jstor.org/stable/26616731