EXAMINING THE RELATIONSHIP BETWEEN DISABILITY ADJUSTED LIFE YEARS (DALYs) AND CURRENT HEALTH EXPENDITURES PER CAPITA BY COUNTRY INCOME GROUPS

Yıl 2024, Cilt: 27 Sayı: 3, 481 - 498, 26.09.2024

Deniz Tugay Arslan

https://doi.org/10.61859/hacettepesid.1441815

Öz

Efforts to control increasing healthcare expenditures of countries highlight the necessity to evaluate the relationship between health outcomes and healthcare spending. Within this context, the primary aim of this study is to determine the relationship between per capita current health expenditure and Disability-Adjusted Life Years (DALY) in country groups classified by income levels. In line with the main objective of the study, it is intended to determine the trends of per capita current health expenditure and DALY from the year 2000 to 2019. Data were collected from the databases of the World Bank, the Institute for Health Metrics and Evaluation (IHME), and the World Health Organization. The study covers the years 2000 to 2019. Initially, a trend analysis was conducted. The Spearman correlation coefficient was used to test the relationship between DALY and per capita current health expenditure. The Kruskal-Wallis H test method was used to test the relationship between DALY and per capita current health expenditure within country groups. When a significant difference was detected among three or more groups, the Bonferroni correction was applied for pairwise comparisons of the variables. According to the analysis results, while per capita current health expenditure increased across all country groups from 2000 to 2019, DALY rates decreased. A significant negative relationship was found between per capita current health expenditure and DALY rates. Within country groups, a significant relationship between per capita current health expenditure and DALY was not found only in low-income economies. It is considered that improvements in health outcomes can be achieved by increasing health expenditures. Additionally, it was concluded that the cost per preventable DALY might vary according to income groups. It is hypothesized that the cost per preventable DALY in low-income countries might be lower than in high-income countries. In this regard, it is recommended that future studies calculate the cost per preventable DALY according to country groups and consider the social determinants of health that may be related to DALY, especially in low-income economies.

Anahtar Kelimeler

Burden of Disease, Disability Adjusted Life Years (DALYs), Health Expenditure

ENGELLİLİĞE AYARLANMIŞ YAŞAM YILLARI (DALY) İLE KİŞİ BAŞI CARİ SAĞLIK HARCAMASI İLİŞKİSİNİN ÜLKE GELİR GRUPLARINA GÖRE İNCELENMESİ

Öz

Ülkelerin artan sağlık harcamalarını kontrol altına alma çabası sağlık sonuçları ile sağlık harcamaları arasındaki ilişkinin değerlendirilmesi gerekliliğini ortaya çıkarmaktadır. Bu kapsamda çalışmanın temel amacı gelir düzeyine göre belirlenen ülke gruplarında kişi başı cari sağlık harcaması ve DALY arasındaki ilişkinin belirlenmesidir. Çalışmanın temel amacına bağlı olarak 2000 yılından 2019 yılına kadar kişi başı cari sağlık harcaması ve DALY eğiliminin belirlenmesi amaçlanmıştır. Dünya Bankası, Sağlık Ölçümleri ve Değerlendirme Enstitüsü (Institute for Health Metrics and Evaluation – IHME) ve Dünya Sağlık Örgütü veri tabanlarından veriler toplanmıştır. Veriler 2000 – 2019 yıllarını kapsamaktadır. Çalışmada öncelikle eğilim analizi gerçekleştirilmiştir. DALY ve kişi başı cari sağlık harcaması arasındaki ilişkinin test edilmesinde Spearman korelasyon katsayısı kullanılmıştır. Ülke grupları içerisinde DALY ve kişi başı cari sağlık harcaması arasındaki ilişkinin test edilmesinde ise Kruskal-Wallis H test yöntemi kullanılmıştır. Üç veya daha fazla grup arasında anlamlı fark tespit edildiğinde değişkenlerin ikili kıyaslanmasında Bonferroni düzeltmesi uygulanmıştır. Analiz sonuçlarına göre tüm ülke gruplarında 2000 – 2019 yılları arasında kişi başı cari sağlık harcaması artarken; DALY oranları azalmıştır. Kişi başı cari sağlık harcaması ile DALY oranı arasında negatif yönde anlamlı ilişki saptanmıştır. Ülke grupları içerisinde sadece düşük gelirli ekonomilerde kişi başı cari sağlık harcaması ve DALY arasında anlamlı ilişki tespit edilmemiştir. Sağlık harcamalarının artırılmasıyla sağlık sonuçlarında iyileşmelerin yaşanabileceği düşünülmektedir. Ayrıca gelir gruplarına göre önlenebilir DALY başı maliyetin de farklılaşabileceği sonucuna varılmıştır. Düşük gelirli ülkelerde DALY başı maliyetin yüksek gelirli ülkelere göre daha düşük olabileceği varsayılmaktadır. Bu doğrultuda sonraki çalışmalarda ülke gruplarına göre önlenebilir DALY başı maliyetin hesaplanması ve özellikle düşük gelirli ekonomilerde DALY ile ilişki olabilecek sağlığın sosyal belirleyicilerinin de değerlendirilmeye alınması önerilmektedir.

Anahtar Kelimeler

Engelliliğe Ayarlanmış Yaşam Yılları (DALY), Hastalık Yükü, Sağlık Harcaması

Etik Beyan

Çalışmaya dahil edilen ve analiz edilen veriler açık veri kaynaklarından elde edildiği için etik kurul iznine gerek bulunmamaktadır.

Destekleyen Kurum

Çalışma gerçekleştirilirken herhangi bir ticari kuruluştan veya kar amacı gütmeyen bir kuruluştan finansal destek alınmamıştır.

Kaynakça

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