Cerrahi Sağlık Hizmetlerinde Katastrofik Harcamalara Yol Açan Faktörlerin Analizi

Öz

Katastrofik sağlık harcamaları (CEH), hanelerin belirli bir dönemde sağlık hizmetlerini finanse etmek için temel harcamalarını azaltmaları ve bireylerin cepten harcamalarının hanenin harcamalarının veya gelirinin büyük bir kısmını aşması veya karşılaması durumunda ortaya çıkmaktadır. Bu çalışma, CEH düzeyi ile sağlık sisteminin yapısının ve ülkenin gelir düzeyinin temel bir göstergesi olan genel sağlık harcamalarındaki (HE) kamu sağlık harcamalarının payı arasındaki ilişkiyi analiz etmeyi amaçlamaktadır. Çalışma sonucunda satın alma gücü paritesi kullanılarak hesaplanan toplam HE'lerdeki kamu HE'lerinin oranının ve kişi başına düşen gelirin, cerrahi prosedürler için CHE'lerin riski üzerinde istatistiksel olarak anlamlı bir negatif etkiye sahip olduğunu bulunmuştur.

Anahtar Kelimeler

• Sağlık Ekonomisi
• Katastrofik Sağlık Harcamaları
• Cerrahi Bakım
• Gayri Safi Yurtiçi Hasıla

Analysing Factors Leading to Catastrophic Expenditure in Surgical Health Care

Öz

Catastrophic health expenditure (CHE) occurs when households reduce their basic expenses to finance health services in a certain period and when individuals' out-of-pocket expenses exceed or cover a large portion of the household's expenditure or income. This study analyzes the relationship between the CHE level and the share of public health expenditures in overall health expenditures(HE), an essential indicator of the health system's structure and the country's income level. The study found that the proportion of public HEs in total HEs and per capita income calculated using purchasing power parity had a statistically significant negative impact on the risk of CHEs for surgical procedures.

Anahtar Kelimeler

• Health Economics
• Catastrophic Health Expenditure
• Surgical Health Service
• Gross domestic product

Kaynakça

1. Atake, E., & Amendah, D. (2018). Porous Safety Net: Catastrophic Health Expenditure and Its Determinants among Insured Households in Togo. BMC Health Services Research, 18(175). https://doi.org/10.1186/s12913-018-2974-4 , (Accessed: 01.07.2024).
2. Azzani, M., Roslani, A., & Su, T. (2019). Determinants of Household Catastrophic Health Expenditure: A Systematic Review. Malaysian Journal of Medical Sciences, 26(1), 15-43.
3. Baltagi, B. H. (2013). Econometric Analysis of Panel Data. West Sussex UK: Wiley.
4. Bijlmakers, L., Wientjes, M., Mwapasa, G., Cornelissen, D., Eric Borgstein, E., Henk Broekhuizen, H., Gajewski,J. (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.
5. Das, P. (2019). Econometrics in Theory and Practice Analysis of Cross Section, Time Series and Panel Data with Stata 15.1. Springer Nature, Singapore.
6. Davies, J., Gelb, A., & Gore-Booth, J. (2021). Global surgery, obstetric, and anesthesia indicator definitions and reporting: An Utstein consensus report. Plos Med. Article, 18(8), e1003749.
7. Fazaeli, A. A., Ghaderi, H., Salehi, M., & Fazaeli, A. R. (2016). Health care expenditure and GDP in oil-exporting countries: Evidence from OPEC data, 1995-2012. Global Journal of Health Science, 2(8), 93-98.
8. Ghosh, S. (2010). Catastrophic payments and Impoverishment due to Out-of-Pocket health spending: The effects of recent health sector reforms in India. Asia Health Policy Program Working Paper No. 15, . https://ssrn.com/abstract=1658573 (Accessed: 01.07.2024)

9. Hsiao, C. (2003). Analysis of Panel Data. Cambridge: Cambridge University Press.
10. Hsiao, C. (2007). Panel Data Analysis- Advantages and Challenges. Cambridge: Cambridge University Press.
11. Hübler, A. W. (2005). Predicting complex systems with a holistic approach: The “throughput” criterion. Wiley The Simply Complex. doi:https://doi.org/10.1002/cplx.20071
12. Kimman, M., Jan, S., & Kingston, D. (2015). Catastrophic Health Expenditure and 12-Month Mortality Associated with Cancer in Southeast Asia: Results from a Longitudinal Study in Eight Countries. BMC Med,, 13, 1-11.
13. Kimman, M., Jan, S., Yip, C., Thabrany, H., Peters, S., & Bhoo-Pathy, N. (2015). Catastrophic Health Expenditure and 12-Month Mortality Associated with Cancer in Southeast Asia: Results from a Longitudinal Study in Eight Countries. BMC Med(13), 1-11.
14. Lee, M. L. (2024). Health Insurance and Consumption Risk. University of Virginia and NBER. https://leelockwood.droppages.com/AI.pdf
15. Meara, J., Leather, A., & Hagander, L. (2015). Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development. The Lancet(386), 569-624.
16. Njuguna, S., Yan, X., Gituru, R., Wang, Q., & Wang, J. (2017). Assessment of macrophyte, heavy metal, and nutrient concentrations in the water of the Nairobi River, Kenya. Environmental Monitoring and Assessment , 454.
17. O’Donnell, O., Van, D. E., Rannan, E. R., Somanathan, A., Adhikari, S., & Akkazieva, B. (2008). Who pays for health care in Asia? J Health Econ, 27(2), 460-475.
18. Onoka, C., Onwujekwe, O., Hanson, K., & Uzochukwu, B. (2011). Examining Catastrophic Health Expenditures at Variable Thresholds Using Household Consumption Expenditure Diaries. Trop Med Int Health, 16, 1334-1341.
19. OWD, O. W. (2024). https://ourworldindata.org/grapher/share-of-the-population-at-risk-of-catastrophic-expenditure-when-surgical-care-is-required (Accessed: 05.07.2024)
20. Park, H. (2011). Practical Guides to Panel Data Modeling: A Step-by-Step Analysis Using Stata. Minami Uonuma.: Tutorial Working Paper, International University of Japan.
21. Paul, A., Malick, S., Mondal, S., & Saibendu, L. (2018). Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal. Int J Community Med Public Healty, 5, 2522-2528.
22. Sharifa Ezati, W., & Almualm, Y. (2017). Catastrophic Health Expenditure among Developing Countries. Health Syst Policy Res, 4.
23. Shrime, M., Dare, A., Alkire, B., O'Neill, K., & Meara, J. (2015). Catastrophic expenditure to pay for surgery worldwide: a modeling study. Lancet Glob Health, 27(3), 38-44. doi:doi: 10.1016/S2214-109X(15)70085-9.
24. Smith, P. C., & Papanicolas, I. (2013). Health system performance comparison: an agenda for policy, information and research. LSE Research Online Open University Press,, 1-51.
25. Stock, J., & Watson, M. (2007). Introduction To Econometrics. Boston: Pearson Addison Wesley.
26. Wagstaff, A. (2009). Measuring Financial Protection in Health”. In: Smith P(ed.). Performance Measurement for Health System Improvement: Experiences, Challenges, and Prospects.Performance Measurement for Health System Improvement: Experiences, Challenges, and Prospects. Cambridge: Cambridge University Press.
27. Wagstaff, A., Flores, G., & Hsu, J. (2018). Progress on Catastrophic Health Spending in 133 Countries: A Retrospective Observational Study. Lancet Glob Health(6), 169-179.
28. Waldo, D., & Helen, C. L. (1984). Demographic Characteristics and Health Care Use and Expenditures by the Aged in the United States: 1977-1984. Health Care Financing Review, 6(1), 1.
29. Weraphong, J., Pannarunothai, S., Luxananun, T., Junsri, N., & Deesawatsripetch, S. (2013). Catastrophic health expenditure in an urban city: seven years after universal coverage policy in Thaıland. Southeast Asian J Trop Med Public Health, 44(1), 124-136.
30. WHO, W. H. (2010). The World Health Report: Health Systems Financing: The Path to Universal Coverage. February 5, 2024 tarihinde https://apps.who.int/iris/handle/10665/44371 (Accessed: 01.07.2024)
31. Wooldridge, J. M. (2010). Econometric Analysis of Cross Section and Panel Data (Cilt 2). The MIT Press.
32. Xu, K., Evans, D., Carrin, G., & Aguilar-Rivera, A. (2005). Designing Health Systems To Reduce Catastrophic Health Expenditure. World Health Organization, Department of Health Financing. Health Financing Policy, Genava,. June 24, 2024 tarihinde https://iris.who.int/handle/10665 adresinden alındı
33. Xu, K., Evans, D., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. (2003). Household catastrophic health expenditure: a multicountry analysis. The Lancet (362), 111-117.
34. You, X., & Kobayashı, Y. (2012). Determinants of Out-of-Pocket Health Expenditure in China. Applied Health Economics and Health Policy, 9(1), 39-49.
35. Zhao, J., Langerman, A., & Schneider, D. F. (2020). The Value of the Surgeon Informatician. 252, 264-271.