Grossman'ın Genelleştirilmiş Sağlık Talebi Modeli: Türkiye Üzerine Uygulama

Yıl 2024, Cilt: 39 Sayı: 3, 806 - 821

Oğuz Kara

https://doi.org/10.24988/ije.1466447

Öz

Sağlık, ekonomik faaliyetlerin ve beşeri sermayenin ana kaynağıdır. Her birey bireysel faydasını maksimize etmek için yaşamı boyunca sağlıklı olmak ister ve bunun için çabalar. Bireylerin sağlık talebini inceleyen bu çalışmada, sağlık talebi konusunda araştırmalara öncülük eden Grossman'ın sağlık talebi (tüketim ve yatırım) modeli referans alınmıştır. Türkiye'de 2016 ve 2019 sağlık araştırması mikro veri setinde yer alan 25825 bireyin tıbbi bakım talepleri negatif binom regresyon modeli kullanılarak incelenmiştir. Ayrıca, beşeri sermaye bileşenlerinin (eğitim, gelir vb.) bireylerin genel sağlık durumu üzerindeki etkileri ordinal logit modeli kullanılarak analiz edilmiştir. Sağlık talebi, ekonomik değişkenlerin yanı sıra sosyal ve kültürel faktörlerden ve bireylerin yaşamsal davranışlarından etkilenmektedir. Bu tür değişkenlere de analizde yer verilmiştir. Sonuçlara göre, kronik hastalığı olan bireylerin böyle bir hastalığı olmayanlara göre tıbbi bakım alma olasılıklarının daha yüksek olduğu görülmüştür. Ayrıca, eğitim, gelir ve spor egzersizlerinin bireylerin sağlık durumunu iyileştirdiği, yaşlanma ve hastalık sayısındaki artışın ise sağlık durumunu kötüleştirdiği sonucuna varılmıştır.

Anahtar Kelimeler

Sağlık Talebi, Grossman Modeli, Possion Regresyon, Sıralı Lojit Regresyon

Grossman’s Generalised Health Demand Model: An Application on Türkiye

Öz

Health is the main source of economic activity and human capital. Each individual wants to be healthy throughout her life in order to maximize his/her individual benefit and strives for this. In this study, which examined the health demand of individuals, Grossman's health demand (consumption and investment) model, which pioneered research on health demand, was referenced. The demands of 25825 individuals for medical care included in the 2016 and 2019 health research micro datasets in Türkiye were examined using the negative binomial regression model. In addition, the effects of human capital components (education, income, etc.) on the general health status of individuals were analyzed using the ordinal logit model. Health demand is influenced by economic variables as well as social and cultural factors and individuals' life behaviors. Such variables are also included in the analysis. According to the results, it was seen that individuals with chronic diseases are more likely to receive medical care than those who do not have such a disease. Besides, it was concluded that education, income, and sports exercises improve the health status of individuals, whereas aging and an increase in the number of diseases worsen the health status.

Anahtar Kelimeler

Health Demand, Grossman Model, Poisson Regression, Ordered Logit Regression

Kaynakça

• Acton, J. P. (1975). Nonmonetary factors in the demand for medical services: some empirical evidence. Journal of Political Economy, 83(3), 595-614.
• Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 95-124.
• Arrow K. J. (1963). Uncertainty and the welfare economics of medical care. The American Economic Review, (53), 941-973.
• Bentham, J. (1970). An Introduction to the Principles of Morals and Legislation (1789), J. H Burns and HLA Hart (Ed.), London.
• Batinti, A. (2015). On Medical Progress and Health Care Demand: A Ces Perspective Using the Grossman Model of Health Status. Health Economics, 24(12), 1632-1637.
• Burggraf, C., Glauben, T., & Grecksch, W. (2016). New impacts of Grossman’s health investment model and the Russian demand for medical care. Journal of Public Health, 24, 41-56.
• Cropper, M. L. (1977). Health, investment in health, and occupational choice. Journal of political economy, 85(6), 1273-1294.
• Dowie, J. (1975). The portfolio approach to health behaviour. Social Science & Medicine (1967), 9(11-12), 619-631.
• Dunlop, S., Coyte, P. C., & McIsaac, W. (2000). Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Social science & medicine, 51(1), 123-133.
• Eisenring, C. (2000). Is there a trade‐off between longevity and quality of life in Grossman's pure investment model?. Health economics, 9(8), 669-680.
• Eme Ichoku, H., & Leibbrandt, M. (2003). Demand for healthcare services in Nigeria: A multivariate nested logit model. African Development Review, 15(2‐3), 396-424.
• Emeç H. (2002). Ege Bölgesi Tüketim Harcamaları İçin Sıralı Logit Tahminleri ve Senaryo Sonuçları. Dokuz Eylül Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 4(2): 13-29
• Geitona, M., Zavras, D., & Kyriopoulos, J. (2007). Determinants of healthcare utilization in Greece: implications for decision-making. The European journal of general practice, 13(3), 144-150.
• Grossman M. (1999). The Human Capital Model of The Demand for Health. National Bureau of Economic Research, Cambridge, Working Paper No. w7078
• Grossman M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2): 223-255.
• Gupta I. G. & Dasgupta P. (2000). Demand for curative health care in rural India: choosing between private, public, and no care, Working Paper Series - National Council for Applied Economic Research, No. No.82, 38 pp. ref. 21, New Delhi
• Güneri, Ö. İ., & Durmuş, B. (2020). Aşırı ya da eksik yayılım durumunda poisson ve negatif binom regresyon modellerinin karşılaştırılması. Uluslararası Doğu Anadolu Fen Mühendislik ve Tasarım Dergisi, 2(1), 48-66.
• Hartwig, J., & Sturm, J. E. (2018). Testing the Grossman model of medical spending determinants with macroeconomic panel data. The European Journal of Health Economics, 19(8), 1067-1086.
• Henderson JM, Quandt RE. (1998) Microeconomic Theory. (4rd edn) McGraw-Hill: New York.
• Hren, R. (2012). Theoretical shortcomings of the Grossman model. Bulletin: Economics, Organisation and Informatics in Healthcare, 28(1), 63-75.
• Jacobson, L. (2000). The family as producer of health—an extended Grossman model. Journal of health economics, 19(5), 611-637.
• Jones, A. M., Laporte, A., Rice, N., & Zucchelli, E. (2019). Dynamic panel data estimation of an integrated Grossman and Becker–Murphy model of health and addiction. Empirical Economics, 56, 703-733.
• Kara, O., & Kurutkan, M. N. (2018). Mikro İktisadi Açıdan Sağlık Hizmetleri Piyasasının Analizi. Nobel Bilimsel Eserler,(113).
• Kara, O., & Yıldırım, M. (2020). Grossman Modeli Çerçevesinde Sağlık Talebinin Analizi. Yaşar Üniversitesi E-Dergisi, 15, 180-191.
• Keeler, E. B., Newhouse, J. P., & Phelps, C. E. (1977). Deductibles and the demand for medical care services: The theory of a consumer facing a variable price schedule under uncertainty. Econometrica: Journal of the Econometric Society, 641-655.
• Kök, R., Dündar, Ö., & Ekinci, R. (2018). Ömür Eğrilerine Kuznets Uyarlamalı Bir Yaklaşım: Asya Ülkeleri Üzerine GMM Modeli. In International Conference on Eurasian Economies (pp. 224-234).
• Kutner, M. H., Nachtsheim, C. J., Neter, J., & Li, W. (2005). Applied linear statistical models. McGraw-Hill. New York.
• Lépine, A., & Le Nestour, A. (2011). Health Care Utilisation in Rural Senegal: the facts before the Extension of Health Insurance to Farmers. International Labour Office, Geneva.
• Liljas, B. (2000). Insurance and imperfect financial markets in Grossman's demand for health model—a reply to Tabata and Ohkusa. Journal of Health Economics, 19(5), 821-827.
• Lindelow, M. (2005). The utilisation of curative healthcare in Mozambique: does income matter?. Journal of African Economies, 14(3), 435-482.
• Mocan, H. N., Tekin, E., & Zax, J. S. (2004). The demand for medical care in urban China. World Development, 32(2), 289-304.
• Moos, R. H., & Moos, B. S. (2005). Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders. Drug and alcohol dependence, 80(3), 337-347.
• Muurinen, J. M. (1982). Demand for health: a generalised Grossman model. Journal of Health economics, 1(1), 5-28.
• Nandakumar, A. K., Chawla, M., & Khan, M. (2000). Utilization of outpatient care in Egypt and its implications for the role of government in health care provision. World Development, 28(1), 187-196.
• Nocera, S., & Zweifel, P. (1998). The demand for health: an empirical test of the Grossman model using panel data. In Health, the medical profession, and regulation (pp. 35-49). Boston, MA: Springer US.
• Phelps, C. E. (1973). Demand for Health Insurance: A Theoretical and Empirical Investigation (Doctoral dissertation, The University of Chicago).
• Phelps, C. E., & Newhouse, J. P. (1974). Coinsurance, the price of time, and the demand for medical services. the Review of Economics and Statistics, 334-342.
• Sepehri, A. (2015). A critique of Grossman’s canonical model of health capital. International Journal of Health Services, 45(4), 762-778.
• Ssewanyana S, Nabyonga JO, Kasirye I, Lawson D. (2004). Demand for health care services in Uganda: Implications for poverty reduction , Economic Policy Research Centre (EPRC) Research Series, 150529. No: 677-2016-46634
• Tabata, K., & Ohkusa, Y. (2000). Correction note on “the demand for health with uncertainty and insurance”. Journal of Health Economics, 19(5), 811-820.
• Zweifel, P. (2012). The Grossman model after 40 years. The European Journal of Health Economics, 13(6), 677-682.