THE IMPACT OF SOCIO-ECONOMIC AND ENVIRONMENTAL DIMENSIONS OF SUSTAINABLE DEVELOPMENT ON HEALTH EXPENDITURES IN TURKEY

Yıl 2025, Cilt: 7 Sayı: 2, 264 - 287, 30.12.2025

Canan Şentürk , Aynur Toraman , Onur Sungur , Aslı Metin , İrem Şengün

Öz

To reinforce the concept of sustainable development, planning for green and sustainable transformations has become increasingly important across all economies, given the realities concerning ecosystem management and the natural limits of growth driven by linear processes. Considering the rapid output growth that generates high carbon emissions, the relationship between environmental quality and health has gained rising significance in both developed and developing countries. Within this framework, quality healthcare services viewed as a strategic sector with high added value and positive externalities, and the corresponding healthcare expenditures are regarded as key components of sustainable development.Accordingly, this study analyzes the impact of selected environmental and socio-economic indicators on health expenditures in Turkey from 1990 to 2023 using the Vector Error Correction Model (VECM). The findings reveal a long-term relationship among the variables: while improvements in environmental quality and education reduce healthcare expenditures, higher income, life expectancy, and urbanization increase them.

Anahtar Kelimeler

Sustainable Development , Health Expenditures , Load Capacity Factor , Vector Error Correction Model , Turkiye

TÜRKİYE’DE SÜRDÜRÜLEBİLİR KALKINMANIN SOSYO-EKONOMİK VE ÇEVRESEL BOYUTLARININ SAĞLIK HARCAMALARINA ETKİSİ

Öz

Sürdürülebilir kalkınma anlayışını pekiştirmek amacıyla, ekosistem yönetimi ve doğrusal süreçlerin yönlendirdiği ekonomik büyümenin doğal sınırlarına ilişkin gerçekler göz önünde bulundurulduğunda, tüm ekonomilerde yeşil ve sürdürülebilir çözüm/dönüşüm planlamaları önem kazanmaktadır. Öte yandan yine doğrusal süreçlerle desteklenen, yüksek karbon emisyonlarına yol açan hızlı çıktı büyümesi göz önünde bulundurulduğunda hem gelişmiş hem de gelişmekte olan ekonomilerde çevre kalitesi ve sağlık ilişkisi gündemde daha fazla yer bulmaktadır. Bu süreçte yüksek katma değere ve olumlu dışsallıklara sahip stratejik bir ekonomik ve sosyal sektör olarak kaliteli sağlık hizmetleri ve harcamaları, sürdürülebilir kalkınmanın yapı taşlarından biri olarak görülmektedir. Bu bağlamda çalışmada Türkiye’de 1990-2023 yılları arasında seçilmiş çevresel ve sosyo-ekonomik sürdürülebilir kalkınma unsurlarının sağlık harcamalarına etkisinin Vektör Hata Düzeltme Modeli ile analizi amaçlanmaktadır. Analiz sonuçlarına göre değişkenler arası uzun dönemli ilişkiye rastlanmaktadır. Çevre kalitesinde ve eğitim düzeyinde artış sağlık harcamalarının azalmasına sebep olmakta iken; gelir seviyesi, yaşam beklentisi ve kentleşmenin artması ise sağlık harcamalarında aynı yönlü etki yaratmaktadır.

Anahtar Kelimeler

Sürdürülebilir Kalkınma , Sağlık Harcamaları , Yük Kapasitesi Faktörü , Vektör Hata Düzeltme Modeli , Türkiye

Etik Beyan

Makalenin etik kurul izin belgesi gerektirmeyen bir çalışma olduğunu beyan ederiz.

Destekleyen Kurum

Bu çalışma, yazarlarının da araştırmacı olarak yer aldığı, Prof. Dr. Ramazan Erdem’in yönetimini üstlendiği “Tematik Araştırma Grubu (TAG-1)” kapsamında tamamlanmıştır.

Kaynakça

• Abegaz, K. H. ve Mohammed, A. A. (2018). Healthcare expenditure and GDP in Ethiopia from 1995 to 2014: A time-series analysis. Agriculture & Food Security, 7(1): 47. https://doi.org/10.1186/s40066-018-0199-8
• Ageli, M. M. (2022). Bootstrap ARDL on health expenditure, green energy, environmental sustainability, and economic growth nexus in Saudi Arabia. Frontiers in Environmental Science, 10: 993634. https://doi.org/10.3389/fenvs.2022.993634
• Ahmad, M., Rehman, A., Shah, S. A. A., Solangi, Y. A., Chandio, A. A. ve Jabeen, G. (2021). Stylized heterogeneous dynamic links among healthcare expenditures, land urbanization, and CO2 emissions across economic development levels. Science of the Total Environment, 753: 142228. https://doi.org/10.1016/j.scitotenv.2020.142228
• Alola, A. A., Yalçıner, K. ve Alola, U. V. (2021). The role of renewable energy consumption and environmental sustainability in health expenditures: Evidence from EU-27. The European Journal of Health Economics, 22: 167–181. https://doi.org/10.1007/s10198-021-01321-0
• Anvari, E., Ahangari, A. M. ve Jafari, E. (2020). The role of government health and education expenditure on economic growth in Iran and OPEC countries. Iranian Economic Review, 24(4): 1079–1098.
• Atılgan, E., Kılıç, D. ve Ertuğrul, H. M. (2017). The dynamic relationship between health expenditure and economic growth: Is the health-led growth hypothesis valid for Turkey? European Journal of Health Economics, 18: 567–574. https://doi.org/10.1007/s10198-016-0810-5
• Aydın, B. (2020). The impact of economic indicators on life expectancy: A panel data analysis. İstanbul İktisat Dergisi – Istanbul Journal of Economics, 70(1): 163–181. https://doi.org/10.26650/ISTJECON2019-0028
• Bloom, D. E., Canning, D. ve Sevilla, J. (2004). The effect of health on economic growth: A production function approach. World Development, 32(1): 1–13. https://doi.org/10.1016/j.worlddev.2003.07.002
• Boyacıoğlu, E. Z. (2012). The importance of health expenditures on sustainable development. International Journal of Social Sciences and Humanity Studies, 4(2): 147–158.
• Boz, C., Taş, N. ve Önder, E. (2020). The impacts of aging, income and urbanization on health expenditures: A panel regression analysis for OECD countries. Turkish Journal of Public Health, 18(1): 1–9. https://doi.org/10.20518/tjph.426494
• Bölükbaş, M. ve Szymańska, A. (2024). The nexus between CO2 emissions and health expenditure - Causality evidence from selected CEE countries. Comparative Economic Research. Central and Eastern Europe, 28(2): 97–113.
• Burgess, J. C. ve Barbier, E. B. (2001). Sustainable development. In N. J. Smelser ve P. B. Baltes (Eds.), International encyclopedia of the social & behavioral sciences (pp. 15329–15335). Pergamon. https://doi.org/10.1016/B0-08-043076-7/04164-4
• Chen-Xu, J., Corda, M. O., Varga, O. ve Viegas, S. (2024). Health burden and costs attributable to the carbon footprint of the health sector in the European Union. Environment International, 190: 108828. https://doi.org/10.1016/j.envint.2024.108828
• Cutler, D. M. ve Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1): 1–28. https://doi.org/10.1016/j.jhealeco.2009.10.003.
• Cetin, M. ve Ecevit, E. (2010). Sağlık harcamalarının ekonomik büyüme üzerindeki etkisi: OECD ülkeleri üzerine bir panel regresyon analizi. Doğuş Üniversitesi Dergisi, 11(2): 166–182.
• D’Adamo, I., Di Carlo, C., Gastaldi, M., Rossi, E. N. ve Uricchio, A. F. (2024). Economic performance, environmental protection and social progress: A cluster analysis comparison towards sustainable development. Sustainability, 16(12): 5049. https://doi.org/10.3390/su16125049
• Davim, J. P. (2024). Sustainable and intelligent manufacturing: Perceptions in line with 2030 agenda of sustainable development. BioResources, 19(1): 4–5.
• Dickey, D. A. ve Fuller, W. A. (1979). Distribution of the estimators for autoregressive time series with a unit root. Journal of the American Statistical Association, 74(366a): 427-431.
• Dickey, D. A. ve Fuller, W. A. (1981). Likelihood ratio statistics for autoregressive time series with a unit root. Econometrica: Journal of the Econometric Society, 1057-1072.
• Dritsaki, M. ve Dritsaki, C. (2024). The relationship between health expenditure, co2 emissions, and economic growth in g7: evidence from heterogeneous panel data. Journal of the Knowledge Economy, 15: 4886-4911. https://doi.org/10.1007/s13132-023-01349-y.
• Enders, W. (2015). Applied econometric time series (4th ed.). John Wiley & Sons.
• Engle, R. F. ve Granger, C. W. J. (1987). Co-Integration and error correction: representation, estimation, and testing. Econometrica, 55(2): 251–276. https://doi.org/10.2307/1913236
• Erçelik, G. (2018). The Relationship between health expenditure and economic growth in Turkey from 1980 to 2015. Journal of Politics, Economy and Management, 1(1): 1-8.
• Erdil Şahin, B. (2019). Türkiye’de enflasyon ve işsizlik arasındaki ilişkinin vektör hata düzeltme modeli ile analizi. Mali Çözüm Dergisi, 29(152): 63-75.
• Global Footprint Network, (2025). https://data.footprintnetwork.org/#/, (Erişim Tarihi: 27.07.2025).
• Gujarati, D. N. ve Porter, D. C. (2009). Basic econometrics (5. baskı). McGraw-Hill/Irwin.
• Harris, R. ve Sollis, R. (2003). Applied time series modelling and forecasting. John Wiley & Sons.
• Harvey, D. I. ve Mills, T. C. (2002). Unit roots and double smooth transitions. Journal of Applied Statistics, 29(5): 675-683.
• Hassan, M.S. ve Kalim, R. (2012). The triangular causality among education, health and economic growth: A time series analysis of Pakistan. World Applied Sciences Journal, 18(2): 196-207. doi:10.5829/idosi.wasj.2012.18.02.3332
• Huilan, L., Muhammad, S. ve Usman, A. (2022). Impact of trade liberalization and renewable energy on load capacity factor: Evidence from novel dual adjustment approach. Renewable Energy, 191: 260-273. https://doi.org/10.1016/j.renene.2022.04.064.
• Irawan, R. ve Pasaribu, E. (2024). The Effect Of Health Expenditure On Life Expectancy In Bengkulu. Jurnal Ekonomi, 29(3): 552-569.
• Islam, M.F., Debnath, S., Das, H., Hasan, F., Sultana, S., Datta, R., Mallik, B. ve Halimuzzaman, M. (2024). Impact of rapid economicd with rising carbon emissions on public health and healthcare costs in Bangladesh. Journal of Angiotherapy, 8(7): 1-9. https://doi.org/10.25163/angiotherapy.879828.
• İlgün, G., Konca, M. ve Sönmez, S. (2022). The granger causality between health expenditure and gross domestic product in OECD countries. Journal of Health Management, 24(3): 356-361. https://doi.org/10.1177/09720634221109306.
• Jaba, E., Balan, C.B. ve Robu, I.-B. (2014). The relationship between life expectancy at birth and health expenditures estimated by a cross-country panel data model. Procedia Economics and Finance, 15: 108-114. Johansen, S. (1988). Statistical analysis of cointegration vectors. Journal of economic dynamics and control, 12(2-3): 231-254.
• Johansen, S. ve Juselius, K. (1990). Maximum likelihood estimation and inference on cointegration--with applications to the demand for money. Oxford Bulletin of Economics & Statistics, 52(2): 169–210. https://doi.org/10.1111/j.1468-0084.1990.mp52002003.x
• Khan, K., Zeeshan, M., Moiz, A., Bano, R., Khan, M.H., Ahmad, S., Javed, Y., ElAffendi, M. ve Ateya, A.A. (2024). Influence of government effectiveness, health expenditure, and sustainable development goals on life expectancy: Evidence from time series data. Sustainability, 16(14): 1-16, https://doi.org/10.3390/su16146128.
• Kocakoç, İ.D. ve Aydemir, M. (2023). Türkiye’de sağlık harcamalarının yaşam beklentisine etkisi: Panel veri analizi. PEMSJ, 4(1): 55-65.
• Kolçak, M., Kalabak, A. Y. ve Boran, H. (2017). Kamu harcamaları büyüme üzerinde bir politika aracı olarak kullanılmalı mı? VECM analizi ve yapısal kırılma testleri ile ampirik bir analiz: 1984-2014 Türkiye örneği. Ankara Üniversitesi SBF Dergisi, 72(2): 467-486.
• Kumar, V., Leone, R. P. ve Gaskins, J. N. (1995). Aggregate and disaggregate sector forecasting using consumer confidence measures. International Journal of Forecasting, 11(3): 361-377.
• Li, F., Chang, T., Wang, M.C. ve Zhou, J. (2022). The relationship between health expenditure, CO2 emissions, and economic growth in the BRICS countries—based on the Fourier ARDL model. Environmental Science and Pollution Research, 29: 10908-10927. https://doi.org/10.1007/s11356-021-17900-w.
• Luck, J. Shi, L. ve Smit, E. (2021). Panel survey estimation of the impact of urbanization in China: Does level of urbanization affect healthcare expenditure, utilization or healthcare seeking behavior? The Chinese Economy, 54(3), 145–156. https://doi.org/10.1080/10971475.2020.1848472.
• Lütkepohl, H. (2005). New introduction to multiple time series analysis. Springer.
• Magida, N., Ncanywa, T., Sibanda, K. ve Asaleye, A.J. (2025). Human capital development and public health expenditure: Assessing the long-term sustainability of economic development models. Social Sciences, 14(6): 1-27, https://doi.org/10.3390/socsci14060351.
• Mehfooz, M. (2024). Role of government health expenditure in achieving India’s sustainable development goals. Journal of Social Review and Development, 3(Special 1): 30–33.
• Mehfooz, S., Mansha, M., Khan, M. ve Musharaf, S. (2023). CO2 emissions, health expenditures, and economic growth nexus in Pakistan. iRASD Journal of Energy & Environment, 4(1): 16-29. https://doi.org/10.52131/jee.2023.0401.0032.
• Meiling, L., Taspinar, N., Yahya, F., Hussain, M. ve Waqas, M. (2022). The symmetric and asymmetric effect of defense expenditures, financial liberalization, health expenditures on sustainable development. Frontiers in Environmental Science, 10: 1-14, https://doi.org/10.3389/fenvs.2022.877285.
• Mhlari, H. ve Mosikari, T.J. (2020). The effects of determinants of government expenditure on education and health. Journal of Reviews on Global Economics, 9: 379-386.
• Miranda-Lescano, R., Muinelo-Gallo, L. ve Roca-Sagalés, O. (2023). Human development and decentralisation: The importance of public health expenditure. Annals of Public and Cooperative Economics, 94: 191-219.
• Morton, S., Pencheon, D. ve Bickler, G. (2019). The sustainable development goals provide an important framework for addressing dangerous climate change and achieving wider public health benefits. Public Health, 174: 65–68. https://doi.org/10.1016/j.puhe.2019.03.022
• Munkaila, M., Salisu, A.S., Bilyaminu, A., Mohammed, A., Umar, I.E. ve Ashaka, M.H. (2022). Impact of education expenditure on economic growth: a study of west african monetary zone countries. International Journal of Advanced Research in Statistics, Management and Finance (IJARSMF), 9(1): 54-66. https://doi.org/10.48028/iiprds/ijarsmf.v9.i1.04.
• Nguyen-Phung, H.T. ve Le, H. (2024). Urbanization and health expenditure: An empirical investigation from households in Vietnam. Economies, 12(6): 153. https://doi.org/10.3390/economies12060153.
• Nuhu, K.M., McDaniel, J.T., Alorbi, G.A. ve Ruiz, J.I. (2018). Effect of healthcare spending on the relationship between the Human Development Index and maternal and neonatal mortality. International Health, 10: 33-39.
• Pata, U. K. (2021). Do renewable energy and health expenditures improve load capacity factor in the USA and Japan? A new approach to environmental issues. The European Journal of Health Economics, 22(9): 1427–1439. https://doi.org/10.1007/s10198-021-01321-0
• Pati, K., Nayak, P.P. ve Mallick, R.K. (2025). Health expenditure and economic growth in India: A sustainable development approach. Journal of Business Management Commerce & Research, XII(I): 28-34, https://doi.org/10.61101/2319-250X.vol.12.issue 1.4.
• Peña-Sánchez, A.R., Ruiz-Chico, J. ve Jiménez-García, M. (2021). Dynamics of public spending on health and socio-economic development in the European Union: An analysis from the perspective of the sustainable development goals. Healthcare, 9(3), 1-20, https://doi.org/10.3390/healthcare9030353.
• Phillips, P. C. ve Perron, P. (1988). Testing for a unit root in time series regression. Biometrika, 75(2): 335-346.
• Piekut, M. ve Kludacz, M. (2015). Determinants of health expenditure in Poland. In The 9th International Days of Statistics and Economics (pp. 1316–1325). Prague, Czech Republic.
• Raghupathi, V. ve Raghupathi, W. (2020). Healthcare expenditure and economic performance: Insights from the https://doi.org/10.3389/fpubh.2022.850872.United States data. Frontiers in Public Health, 8: 156. https://doi.org/10.3389/fpubh.2020.00156
• Serdar, Y. (2020). The relationship between health expenditures and economic growth in G7 Countries. İstatistik ve Uygulamalı Bilimler Dergisi, 1(1): 336-359.
• Shao, Q., Tao, R. ve Luca, M.M. (2022). The effect of urbanization on health care expenditure: Evidence from China. Frontiers in Public Health, 10: 850872. https://doi.org/10.3389/fpubh.2022.850872.
• Shang, Y., Razzaq, A., Chupradit, S., Binh An, N. ve Abdul-Samad, Z. (2022). The role of renewable energy consumption and health expenditures in improving load capacity factor in ASEAN countries: Exploring new paradigm using advanced panel models. Renewable Energy, 191: 715–722. https://doi.org/10.1016/j.renene.2022.04.013
• Shi, L., Smit, E. ve Luck, J. (2021). Panel survey estimation of the impact of urbanization in China: Does level of urbanization affect healthcare expenditure, utilization or healthcare seeking behavior? The Chinese Economy, 54(3): 145-156. https://doi.org/10.1080/10971475.2020.1848472.
• Sims, C. A. (1980). Macroeconomics and reality. Econometrica: Journal of the Econometric Society, 48(1): 1-48. Slathia, P. ve Vashishtha, A. (2025). De-carbonising Asia: Examining the linkages between Consumption Emissions, Healthcare Spending and Renewable Energy Transition. Economic Issues, 30(1): 22-43.
• Stepovic, M. (2019). GDP Growth and health care expenditures worldwide. The Open Pharmacoeconomics & Health Economics Journal, 7: 9-18.
• Suhrcke, M., McKee, M., Stuckler, D., Arce, R. S., Tsolova, S. ve Mortensen, J. (2006). The contribution of health to the economy in the European Union. Public Health, 120(11): 994–1001. https://doi.org/10.1016/j.puhe.2006.08.011
• Sun, W., Shao, M. ve Yang, D. (2024). Impact of metallic and non-metallic mineral production on the sustainable development index (SDI) within the Regional Comprehensive Economic Partnership (RCEP) countries from 1995 to 2020. Resources Policy, 90: 1-7, https://doi.org/10.1016/j.resourpol.2024.104716.
• Şentürk, C., Sart, G., Şaşmaz, M.Ü. ve Bayar, Y. (2023). Health expenditures, human capital, and sustainable development: Panel evidence from the new EU member countries. Sustainability, 15(19): 1-14, https://doi.org/10.3390/su151914514.
• Türkiye İstatistik Kurumu (TÜİK), (2025). https://data.tuik.gov.tr, (Erişim Tarihi: 27.07.2025).
• United Nations General Assembly. (2015). Transforming our world: The 2030 agenda for sustainable development (A/RES/70/1). https://docs.un.org/en/A/RES/70/1
• UNDP, (2025). https://data.undp.org/access-all-data, (Erişim Tarihi: 27.07.2025).
• Wang C. M., Hsueh H. P., Li F. ve Wu C. F., (2019) Bootstrap ARDL on health expenditure, co2 emissions, and gdp growth relationship for 18 OECD Countries. Front. Public Health 7:324. doi: 10.3389/fpubh.2019.00324.
• World Bank, (2025). https://data.worldbank.org, (Erişim Tarihi: 27.07.2025).
• Xhindi, T., Kripa, E. ve Shestani, K. (2020). Causality between economic growth and health expenditure: A time series analysis from 1996 till 2017 in Albania. WSEAS Transactions on Environment and Development, 16: 276-285.
• Yavuz, E., Kılıç, E. ve Akçay, F. (2024). What is the role of environmental stress on public health? Asymmetric evidence on carbon emissions, ecological footprint, and load capacity factor. Environmental Research and Technology, 7(3): 291-302. https://doi.org/10.35208/ert.1419914
• Zhang, X., Liu, Z., Li, J. ve Wang, Y. (2023). Health expenditure, energy structure transition, and ecological footprint: New insights from China. Environmental Science and Pollution Research, 30: 12345-12365. https://doi.org/10.1007/s11356-023-25747-6.
• Zhong, R., Ren, X., Akbar, M.W., Zia, Z. ve Sroufe, R. (2022). Striving towards sustainable development: How environmental degradation and energy efficiency interact with health expenditures in SAARC countries. Environmental Science and Pollution Research, 29: 46898–46915. https://doi.org/10.1007/s11356-022-18819-6.