Sağlık Hizmetlerinde Yoksunluğun Katastrofik Sağlık Harcaması Üzerindeki Etkisini İncelenmesi: Panel Veri Analizi İle Tahminleme

Yıl 2025, Cilt: 10 Sayı: 1, 35 - 43, 30.06.2025

Zeynep Merve Dinler , Mahmut Akbolat

Öz

Katastrofik sağlık harcaması, cepten yapılan sağlık harcamalarının, hane halklarının temel yaşam ihtiyaçlarını karşılamalarını sağlayan harcamaları belirli bir oranda aşması durumunda ortaya çıkmaktadır. Bu durum arttıkça hane halklarını gittikçe yoksullaştıran bir etki yaratması dünya çapında önemli bir sorun olarak kabul edilmektedir. Bu çalışmada Türkiye’de ve Yunanistan’da gerçekleşen katastrofik sağlık harcamasının sağlık hizmetlerinde yoksun bırakıcı etkisinin ortaya konulması ve sosyo-ekonomik faktörlerin katastrofik sağlık harcamasına etkisinin incelenmesi amaçlanmaktadır. Panel yöntemi seçilmiştir. Panel yönteminde kullanılan veriler Türkiye Ekonomik İşbirliği ve Kalkınma Teşkilatı (OECD), Dünya Bankası (WHO) ve Türkiye İstatistik Kurumu (TÜİK) istatistiklerinden elde edilmiştir. Bulgular, Türkiye ve Yunanistan'da 2004-2020 yılları arasında katastrofik sağlık harcamaları ile sağlık hizmetine erişimde yoksunluk göstergeleri arasında istatistiksel olarak anlamlı bir ilişki olduğunu ortaya koymaktadır. Ayrıca sosyo-ekonomik faktörlerden olan Gini katsayısı ve yoksul hane oranı ile katastrofik sağlık harcaması arasında istatistiksel bakımdan anlamlı ilişki bulunmaktadır. Sonuç olarak, sağlık hizmetlerinin sunumunda temel unsur kabul edilen sağlık hizmetlerinde yoksunluk göstergelerinin iyileştirilmesi katastrofik sağlık harcamasının azaltılmasına katkı sağlamaktadır.

Anahtar Kelimeler

Katastrofik Sağlık Harcaması , Sağlık Hizmetlerinde Yoksunluk , Yoksulluk

Examining the Impact of Deprivation in Health Services on Catastrophic Health Expenditure: Estimation with Panel Data Analysis

Öz

Catastrophic health expenditure refers to out-of-pocket health expenses that surpass a certain percentage of household income, thereby hindering the household's ability to meet basic living needs. This issue is increasingly recognized as a significant global challenge due to its role in progressively impoverishing households. This study aims to analyze the impact of health service deprivation on catastrophic health expenditures in Turkey and Greece, as well as to explore the influence of socio-economic factors on these expenditures. The panel data method was identified as the most suitable approach for this analysis. Data for the panel method were obtained from the Organisation for Economic Co-operation and Development (OECD), the World Bank (WHO), and the Turkish Statistical Institute (TÜİK). The findings reveal a statistically significant correlation between catastrophic health expenditures and indicators of deprivation in access to healthcare from 2004 to 2020 in both Turkey and Greece. Moreover, a significant relationship was observed between catastrophic health expenditures and socio-economic factors, including the Gini coefficient and the poor household ratio. These results suggest that enhancing indicators of healthcare deprivation—considered a fundamental component of healthcare delivery—could help reduce catastrophic health expenditures.

Anahtar Kelimeler

Catastrophic Health Expenditure , Deprivation in Health Services , Poverty

Kaynakça

• Acemoglu, D., Johnson, S., Kermani, A., Kwak, J., & Mitton, T. (2016). The value of connections in turbulent times: Evidence from the United States. Journal of Financial Economics, 121(2), 368–391. https://doi.org/10.1016/j.jfineco.2015.10.001
• Alem, Y., & Köhlin, G. (2014). The persistence of subjective poverty in urban Ethiopia. World Development, 56, 51–61.
• Aregbeshola, B. S., & Khan, S. M. (2018). Out-of-pocket payments, catastrophic health expenditure, and poverty among households in Nigeria 2010. International Journal of Health Policy and Management, 7(9), 798–806. https://doi.org/10.15171/ijhpm.2018.19
• Arsenijevic, J., Pavlova, M., Rechel, B., & Groot, W. (2016). Catastrophic healthcare expenditure among older people with chronic diseases in 15 European countries. PLoS One, 11(7), e0157765. https://doi.org/10.1371/journal.pone.0157765
• Azzopardi-Muscat, N., Buttigieg, S., Calleja, N., & Merkur, S. (2017). Malta: Health system review. Health Systems in Transition, 19(1), 1–137.
• Bijlmakers, L., Wagemakers, A., van der Horst, M., Mkandawire, M., & Broekhuizen, H. (2019). Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi—A cross-sectional patient survey. Annals of Medicine and Surgery, 43, 85–90. https://doi.org/10.1016/j.amsu.2019.06.003
• Boyer, L., Baumstarck, K., Iordanova, T., Fernandez, J., Jean, P., & Auquier, P. (2014). A poverty-related quality of life questionnaire can help to detect health inequalities in emergency departments. Journal of Clinical Epidemiology, 67(3), 285–295. https://doi.org/10.1016/j.jclinepi.2013.07.021
• Brown, S., Hole, A. R., & Kilic, D. (2014). Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 household budget surveys. Economic Modelling, 41, 211–218.
• Chowdhury, A. M. R., Bhuiya, A., Chowdhury, M. E., Rasheed, S., Hussain, Z., & Chen, L. C. (2013). The Bangladesh paradox: Exceptional health achievement despite economic poverty. The Lancet, 382(9906), 1734–1745. https://doi.org/10.1016/S0140-6736(13)62148-0
• Çelik, M. (2020). En küçük kareler yöntemi (Least squares method). YouTube. Retrieved March 12, 2020, from https://www.youtube.com/watch?v=zokkncTmkfU
• Çıraklı, Ü. (2018). The impact of the 2009 economic crisis and 2007 legislation amendment on the household rate with catastrophic health expenditures. Social Sciences Studies Journal, 4(22), 3862–3869.
• Demir, H., & Kurt, M. (2017). Yolsuzluk ve katastrofik sağlık harcamaları (Corruption and catastrophic health expenditures). Dicle University Journal of Faculty of Economics and Administrative Sciences, 7(14), 363–384.
• Devadasan, N., Criel, B., Van Damme, W., Ranson, K., & Van Der Stuyft, P. (2007). Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Services Research, 7, 43. https://doi.org/10.1186/1472-6963-7-43
• Dinler, Z. M., & Akbolat, M. (2023). Sağlık hizmetlerinden yoksunluk göstergeleri açısından Türkiye ve seçilmiş OECD ülkelerinin karşılaştırılması (The comparison of Turkey and some selected OECD countries in terms of health care deprivation indicators). Süleyman Demirel University Visionary Journal, 14(100th Anniversary Special Issue), 305–318.
• Economou, C., Kaitelidou, D., Kentikelenis, A., Maresso, A., & Sissouras, A. (2015). The impact of the crisis on the health system and health in Greece. In Economic crisis, health systems and health in Europe: Country experience. European Observatory on Health Systems and Policies.
• Expenditure, C. H. (2016). The SAGE encyclopedia of world poverty. Choice Reviews Online, 53(12), 53-5088-53–5088. https://doi.org/10.5860/choice.196918
• Galárraga, O., Sosa-Rubí, S. G., Salinas-Rodríguez, A., & Sesma-Vázquez, S. (2010). Health insurance for the poor: Impact on catastrophic and out-of-pocket health expenditures in Mexico. The European Journal of Health Economics, 11, 437–447.
• Gilthorpe, M. S., & Wilson, R. C. (2003). Rural/urban differences in the association between deprivation and healthcare utilization. Social Science & Medicine, 57(11), 2055–2063. https://doi.org/10.1016/S0277-9536(03)00071-6
• Gujarati, D. N. (2011). Temel ekonometri (Ü. Şenesen & G. Günlük Şenesen, Trans.). İstanbul: Literatür Yayıncılık.
• Hatt, L. E. (2006). Measuring risk factors for catastrophic health expenditures in Peru, and their effects on families over time. ProQuest.
• Ilunga-Ilunga, F., Levêque, A., Laokri, S., & Dramaix, M. (2015). Incidence of catastrophic health expenditures for households: An example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo. Journal of Infection and Public Health, 8(2), 136–144. https://doi.org/10.1016/j.jiph.2014.08.008
• Karagöz, Y. (2014). SPSS 21.1 uygulamalı biyoistatistik. Nobel Yayın Dağıtım.
• Kasapoğlu, A. (2016). Türkiye’de sağlık hizmetlerinin dönüşümü. Sosyoloji Derneği Dergisi, 19(2), 132–172.
• Kelly, H. (2018). Putting families at the heart of their baby’s care. Journal of Neonatal Nursing, 24(1), 13–16. https://doi.org/10.1016/j.jnn.2017.11.005
• Köktaş, A. M., & Eren, A. A. (2017). Katastrofik sağlık harcaması: Literatür taraması (Catastrophic health expenditure: A literature review). Fiscaoeconomia, Special Issue 1, 1–4.
• Lavers, T. (2019). Towards universal health coverage in Ethiopia’s “developmental state”? The political drivers of health insurance. Social Science & Medicine, 228, 60–67. https://doi.org/10.1016/j.socscimed.2019.03.007
• Leng, A., Jing, J., Nicholas, S., & Wang, J. (2019). Catastrophic health expenditure of cancer patients at the end-of-life: A retrospective observational study in China. BMC Palliative Care, 18(1), 1–10. https://doi.org/10.1186/s12904-019-0426-5
• Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada's universal health-care system: Achieving its potential. The Lancet, 391(10131), 1718–1735.
• Metin, B. (2013). “Neoliberal yapısal uyum politikalarından”“kapsayıcı kalkınma çerçevesine” Dünya Bankası’nın yoksulluk sorununa yaklaşımı. Çalışma ve Toplum, 2(37), 211–234.
• Odekon, M. (2015). The SAGE encyclopedia of world poverty. SAGE Encyclopedias. https://doi.org/10.4135/9781483345727
• Organisation for Economic Co-operation and Development (OECD). (2020). Health status. Retrieved October 23, 2020, from https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT
• Papanicolas, I., & Smith, P. C. (2013). Health system performance comparison. World Health Organization.
• Pavlušová, M. (2018). Chronic heart failure – Impact of the condition on patients and the healthcare system in the Czech Republic: A retrospective cost-of-illness analysis. Cor Vasa, 60(3), e224–e233. https://doi.org/10.1016/j.crvasa.2018.03.002
• Prentice, J. C., & Pizer, S. D. (2007). Delayed access to health care and mortality. Health Services Research, 42(2), 644–662. https://doi.org/10.1111/j.1475-6773.2006.00626.x
• Raj, B., & Baltagi, B. H. (Eds.). (2012). Panel data analysis. Springer Science & Business Media.
• Rice, T., Rosenau, P., Unruh, L., Barnes, A., Saltman, R., & Van Ginneken, E. (2013). United States of America: Health system review. European Observatory on Health Systems and Policies.
• Seeberg, J., Pannarunothai, S., Padmawati, R. S., Trisnantoro, L., Barua, N., & Pandav, C. S. (2014). Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia, and Thailand. Social Science & Medicine, 102, 49–57. https://doi.org/10.1016/j.socscimed.2013.11.039
• Sims, A. (2006). Deprivation and health: Social inequality and equity of access to healthcare services. Hallam University.
• Şimşek, K. O., Doğruyol, A. R., & Özgülnar, N. (2022). COVID-19 pandemisinde sağlık sistemleri: Yunanistan. Toplum ve Hekim Dergisi, 37(4), 1–12.
• Tokatlıoğlu, Y., & Tokatlıoğlu, İ. (2018). Catastrophic health expenditures in Turkey and the determinants of these expenditures: 2002–2014 period. Sosyoekonomi, 26(35), 59–78. https://doi.org/10.17233/sosyoekonomi.302930
• TÜİK (2020). Bölgesel istatistikler (Regional statistics). Retrieved October 23, 2020, from https://biruni.tuik.gov.tr/bolgeselistatistik/anaSayfa.do?dil=tr
• Türkiye Statistical Institute (2020). Retrieved February 21, 2023, from https://data.tuik.gov.tr
• Vahedi, S., Rezapour, A., Faraji Khiavi, F., Esmaeilzadeh, F., Javan-Noughabi, J., Almasiankia, A., & Ghanbari, A. (2020). Decomposition of socioeconomic inequality in catastrophic health expenditure: An evidence from Iran. Clinical Epidemiology and Global Health, 8(2), 437–441. https://doi.org/10.1016/j.cegh.2019.10.004
• World Bank. (2005). World health report. Retrieved November 19, 2020, from https://www.who.int/whr/2005/en/
• Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. L. (2003). Household catastrophic health expenditure: A multicountry analysis. The Lancet, 362(9378), 111–117. https://doi.org/10.1016/S0140-6736(03)13861-5
• Yap, A., Fitzgerald, T. N., Mergesa, B., Kisuule, F., Namukwaya, H., & Sekabira, J. (2018). From procedure to poverty: Out-of-pocket and catastrophic expenditure for pediatric surgery in Uganda. Journal of Surgical Research, 232, 484–491. https://doi.org/10.1016/j.jss.2018.05.077
• Yardım, M. S., Cilingiroglu, N., & Yardım, N. (2010). Catastrophic health expenditure and impoverishment in Turkey. Health Policy, 94(1), 26–33. https://doi.org/10.1016/j.healthpol.2009.08.006
• Yılmaz, F., & Yılmaz, B. (2017). Birinci basamak sağlık hizmetlerinde yoksunluk anketinin DiPCare Q Türkçe geçerlik ve güvenirlik çalışması. Turkish Journal of Family Medicine and Primary Care, 11(2), 79–87.
• Zhao, Y., Zhang, L., Zhao, S., & Zhang, L. (2019). Impact of multimorbidity on health service use and catastrophic health expenditure in China: An analysis of data from a nationwide longitudinal survey. The Lancet, 394(1), S69. https://doi.org/10.1016/s0140-6736(19)32405-5