Türkiye’de Cepten Yapılan Sağlık Harcamalarının Belirleyicileri: Koşulsuz Kantil Regresyon

Öz

Cepten yapılan sağlık harcamaları bireylerin sağlık mal ve hizmetlerine yaptığı doğrudan ve dolaylı ödemeleri kapsamaktadır. Bu çalışmada sağlık harcamalarının finansmanında en önemli kaynaklardan biri olan cepten yapılan sağlık harcamalarının belirleyicileri 2003-2015 Hanehalkı Bütçe Anketi verileriyle Firpo vd. (2009) tarafından önerilen Koşulsuz Kantil Regresyon yöntemi kullanılarak araştırılmıştır. Bu yöntem, koşullu kantil regresyon yöntemlerine nazaran birçok durumda; genelleştirilebilir, politik ve genel toplum açısından yorumlanabilir sonuçlar üretmeye olanak sağlamaktadır Çalışmadan elde edilen en önemli sonuç koşullu kantil regresyon yönteminin, koşulsuz kantil, en küçük kareler regresyon yöntemlerine nazaran cepten yapılan sağlık harcamaları gibi sağa çarpık dağılımlı gözlemler üzerinden yapılacak analizlerde daha tutarlı sonuçlar verdiğidir.

Anahtar Kelimeler

• Sağlık Harcamaları,Hanehalkı,Cepten Yapılan Harcamalar,Koşulsuz Kantil Regresyon

Determinants of Out of Pocket Health Expenditure in Turkey: Unconditional Quantile Regression

Öz

Out-of-pocket health expenditures include direct and indirect payments made by individuals for health goods and services. In this study, the determinants of out-of-pocket health expenditures, which are one of the most important sources of health expenditures financing, are investigated with the data of 2003-2015 Household Budget Survey using the Unconditional Quantitative Regression method proposed by Firpo et al. (2009). This method allows to produce generalizable and interpretable results in terms of political and general society compared with conditional quantitative regression methods. The most important result obtained from the study is that conditional quantitative regression method gives more consistent results than unconditional quantitative and least squares regression methods in the analyzes based on the right- skewed distribution observations such as out-of-pocket health expenditures.

Anahtar Kelimeler

• Health Expenditure,Household,Out of Pocket Expenditure,Unconditional Quantile Regression

Kaynakça

1. Arsenijevic, Jelena; Milena Pavlova; Wim Groot (2015), “Out-of-Pocket Payments for Health Care in Serbia”, Health Policy, 119(10), 1366-1374.
2. Ashour, Majdi (2018), “Changes in Out-of-Pocket Payments and Health-Seeking Behaviours in the Gaza Strip”, The Lancet, 391, 25.
3. Atella, Vincenzo; Agar Brugiavini; Noemi, Pace (2015), “The Health Care System Reform in China: Effects On Out-of-Pocket Expenses and Saving”, China Economic Review, 34, 182-195.
4. Barros, Aluísio; Andréa, Bertoldi (2008), “Out-of-Pocket Health Expenditure in a Population Covered by the Family Health Program in Brazil”, International Journal of Epidemiology, 37(4), 758-765.
5. Bahçe, Serdal; Köktaş, Altuğ Murat; Selçuk, Işıl Şirin; Akın, Cem (2014), “Türkiye’de Sağlık Reformu”, International Conference in Economics, Prag, Çek Cumhuriyeti, 03-05 Eylül 2014
6. Başaran, Berrak Bora; Şahin, İsmet (2008), “Türkiye’de Cepten Yapılan Sağlık Harcamalarını Etkileyen Etmenler”, Hacettepe Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 26(2), 319-340.
7. Borah, Bijan; Anirban, Basu (2013), “Highlighting Differences Between Conditional And Unconditional Quantile Reg-ression Approaches Through An Application to Assess Medication Adherence”, Health Economics, 22(9), 1052-1070.
8. Brown, Sarah; Arne Risa, Hole; Dilek, Kilic (2014), “Out-of-Pocket Health Care Expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys”, Economic Modelling, 41, 211-218.

9. Carpenter, Anthony; Islam, Mofizul; Yen, Laurann; Mcrae, Ian (2015), “Affordability of Out-of-Pocket Health Care Expenses among Older Australians”, Health Policy, 119(7), 907-914.
10. Correa-Burrows, Paulina (2012), “Out-of-Pocket Health Care Spending by the Chronically Ill in Chile”, Procedia Eco-nomics and Finance, 1, 88-97.
11. Çınaroğlu, Songül (2018), “Cepten Sağlık Harcamalarının Finansmanında Eşitsizlik ve Hakkaniyet: Uygulamalı Bir Ekonometrik Yaklaşım”, İşletme Araştırmaları Dergisi, 10(1), 876-897.
12. Erus, Burcay; Aktakke, Nazli (2012), “Impact of Healthcare Reforms on Out-of-Pocket Health Expenditures in Turkey for Public Insurees”, The European Journal of Health Economics, 13(3), 337-346.
13. Firpo, Sergio; Nicole, Fortin; Thomas, Lemieux (2009), “Unconditional Quantile Regressions”, Econometrica, 77(3), 953-973.
14. Garcia-Diaz, Rocio; Sosa-Rub, Sandra (2011), “Analysis of the Distributional Impact of Out-of-Pocket Health Payments: Evidence from a Public Health Insurance Program for the Poor in Mexico”, Journal of Health Economics, 30(4), 707-718.
15. Giovanis, Eleftherios; Ozdamar, Oznur (2017), “The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey”, Akdeniz University Faculty of Economics & Administrative Sciences, 36, 71-102.
16. Grigorakis, Nikolaos; Floros, Christos; Tsangari, Haritini; Tsoukatos, Evangelos (2016), “Out of Pocket Payments and Social Health Insurance for Private Hospital Care: Evidence from Greece”, Health Policy, 120(8), 948-959.
17. Hua, Xinyang; Erreygers, Guido; Chalmers, Jhon; Laba, Tracey-Lea; Clarke, Philip (2017), “Using Administrative Data to Look at Changes in the Level and Distribution of Out-of-Pocket Medical Expenditure: an Example Using Medicare Data from Australia”, Health Policy, 121(4), 426-433.
18. Kim, Younhee; Yang, Bongmin (2011), “Relationship Between Catastrophic Health Expenditures and Household Incomes and Expenditure Patterns in South Korea”, Health Policy, 100(2-3), 239-246.
19. Koch, Kira Johanna; Camilo, Cid Pedraza; Andreas, Schmid (2017), “Out-of-Pocket Expenditure and Financial Protection in the Chilean Health Care System—a Systematic Review”, Health Policy, 121(5), 481-494.
20. Koenker, Roger; Bassett, Gilbert (1978), “Quantile Regressions”, Econometrica 46(1):33–50
21. Krutilova, Veronika Kočiš; Dominika, Doubková (2018), “The Out-of-Pocket Health Burden in the Czech Republic–Should We Care?”, Kontakt, 20(1), E99-E107
22. Krutilova, Veronika Kočiš; Yaya, Sanni (2012), “Unexpected Impact of Changes in Out-of-Pocket Payments for Health Care on Czech Household Budgets”, Health Policy, 107(2-3), 276-288.
23. Maclean, Johanna Catherine; Douglas, Webber; Joachim, Marti (2014), “An Application of Unconditional Quantile Regression to Cigarette Taxes”, Journal of Policy Analysis and Management, 33(1), 188-210.
24. Thakur, Ramna; Sangar, Shivendra; Ram, B.; Faizan, M. (2018), “Quantifying the Burden of Out-of-Pocket Health Expenditure in India”, Public Health, 159, 4-7.
25. TÜİK, Hanehalkı Bütçe Anketleri 2003-2015.
26. Sağlık Bakanlığı (2007), “21. Hedefte Türkiye, Sağlıkta Gelecek”, T.C. Sağlık Bakanlığı Refik Saydam Hıfzısıhha Merkezi, Hıfzısıhha Mektebi, Ankara, 1-2.
27. Peeters, Ludo; Eloi, Schreurs; Steven, Van Passel (2017), “Heterogeneous Impact of Soil Contamination on Farmland Prices in the Belgian Campine Region: Evidence from Unconditional Quantile Regressions”, Environmental and Reso-urce Economics, 66(1), 135-168.
28. Powell, David; Wagner, Joachim (2014), “The Exporter Productivity Premium along the Productivity Distribution: Evidence from Quantile Regression with Nonadditive Firm Fixed Effects”, Review of World Economics, 150(4), 763-785
29. Tokatlioğlu, Yağmur; Tokatlioğlu, İbrahim (2018), “Türkiye’de Katastrofik Sağlık Harcamaları ve Bu Harcamaları Belirleyen Faktörler: 2002-2014 Dönemi”, Sosyoekonomi, 26(35), 59-78.
30. Van Minh, Hoang; Phuong Nguyen Ti Kim; Saksena, Priyanka; James, Chris; Xu, Ke (2013), “Financial Burden of Hou-sehold Out-of Pocket Health Expenditure in Viet Nam: Findings from the National Living Standard Survey 2002–2010”, Social Science & Medicine, 96, 258-263.
31. Wirtz, Veronica; Santa-Ana-Tellez, Yared; Servan-Mori, Edson; Avila-Burgos, Leticia (2012), “Heterogeneous Effects of Health Insurance on Out-of-Pocket Expenditure on Medicines in Mexico”, Value in Health, 15(5), 593-603.
32. Yardım, Mahmut Saadi; Çilingiroğlu, Nesrin; Yardım, Nazan (2010), “Catastrophic Health Expenditure and Impo-verishment in Turkey”, Health Policy, 94(1), 26-33.
33. Yereli, Ahmet Burçin; Köktaş, Altuğ Murat; Selçuk, Işıl Şirin (2014), “Türkiye'de Katastrofik Sağlık Harcamalarını Etkileyen Faktörler”, Sosyoekonomi, 22(22), 274-296.
34. You, Xuedan; Kobayashi, Yasuki (2011), “Determinants of Out-of-Pocket Health Expenditure in China”, Applied Health Economics and Health Policy, 9(1), 39-49