SAĞLIK HARCAMALARININ BELİRLEYİCİLERİ: BİR KANTİL REGRESYON UYGULAMASI

Öz

Bu çalışma sağlık harcamalarını etkileyen faktörlerin belirlenmesi ve belirlenen bu faktörlere yönelik çözüm önerileri getirilmesi amacıyla gerçekleştirilmiştir. Sağlık harcamalarını etkileyen birçok faktör bulunmakla beraber çalışma kapsamında Dünya Bankası veri tabanından 2019 yılına ait 138 ülkenin gelir, eğitim harcamaları, alkol ve tütün kullanım oranları, 65 yaş üstü nüfus oranı, kentsel nüfus oranı, kadın nüfus oranı ve hekim sayısı değişkenleri ele alınmıştır. Çalışmada, öncelikle klasik en küçük kareler regresyonu ve ardından kantil regresyon analizleri kullanılmıştır. Elde edilen sonuçlar %95 güven düzeyi üzerinden yorumlanmıştır. Yapılan analizler sonucunda kantil 0,25, kantil 0,50 ve kantil 0,75’te yer alan ülkelerde kişi başına düşen gelirin, eğitim harcamasının gayrisafi yurt içi hasıla içindeki payının ve 65 yaş üstü nüfus oranının artmasıyla kişi başına düşen sağlık harcamalarının da istatistiksel olarak anlamlı bir şekilde artış gösterdiği tespit edilmiştir. Alkol ve tütün kullanım oranları, kentsel nüfus oranı, kadın nüfus oranı ve hekim sayısı ile sağlık harcamaları arasında istatistiksel olarak anlamlı herhangi bir ilişkiye ise rastlanmamıştır.

Anahtar Kelimeler

• Sağlık Harcamaları
• Sağlık Harcamalarının Belirleyicileri
• Kantil Regresyon

DETERMINANTS OF HEALTHCARE EXPENDITURES: A QUANTILE REGRESSION APPLICATION

Abstract

This study was carried out to determine the factors affecting health expenditures and to propose solutions for these factors. Although there are many factors affecting health expenditures, the variables of income, education expenditures, alcohol and tobacco use rates, proportion of population over 65, proportion of urban population, proportion of female population and number of physicians of 138 countries in 2019 from the World Bank database are considered within the scope of the study. In the study, first classical least squares regression and then quantile regression analyses were used. The results obtained are interpreted at 95% confidence level. As a result of the analyses, it was found that in countries in quantiles 0.25, quantile 0.50 and quantile 0.75, per capita income, the share of education expenditure in gross domestic product and the proportion of population over 65 years of age increased, and per capita health expenditures increased in a statistically significant manner. No statistically significant relationship was found between alcohol and tobacco use rates, urban population ratio, female population ratio and number of physicians and health expenditures.

Keywords

• Health Expenditures
• Determinants of Health Expenditures
• Quantile Regression

Kaynakça

1. Acar, T., & Topdağ, D. (2022). OECD ülkelerinde sefalet endeksi ve ekonomik kalkınma ekseninde sağlık harcamalarının belirleyicileri: toplamsal olmayan sabit etkili panel kantil regresyon yaklaşımı. In Journal of Social Policy Conferences (No. 82, pp. 267-286). Istanbul University.
2. Ahmad, M., Akram, W., Ikram, M., Shah, A. A., Rehman, A., Chandio, A. A., & Jabeen, G. (2021). Estimating dynamic interactive linkages among urban agglomeration, economic performance, carbon emissions, and health expenditures across developmental disparities. Sustainable Production and Consumption, 26, 239-255.doi: 10.1016/j.spc.2020.10.006.
3. Akbulut, Ö., & Çapık, C. (2022). Çok değişkenli istatistiksel analizler için örneklem büyüklüğü. Journal of Nursology, 25(2), 111-116.
4. Akca, N., Sonmez, S., & Yilmaz, A. (2017). Determinants of health expenditure in OECD countries: A decision tree model. Pakistan Journal of Medical Sciences, 33(6), 1490.doi: 10.12669/pjms.336.13300
5. Alkaya, A., & Gülbahar, H. O. (2022). Sağlık harcamaları üzerinde sağlık harcamaları belirleyicileri etkisi: OECD ülkeleri panel regresyon analizi. Third Sector Social Economic Review, 57(1), 47-67.
6. Amiri, M. M., Kazemian, M., Motaghed, Z., & Abdi, Z. (2021). Systematic review of factors determining health care expenditures. Health Policy and Technology, 10(2), 100498.
7. Angko, W. (2013). The determinants of healthcare expenditure in Ghana. Journal of Economics and Sustainable Development, C.IV, S.15: s.102-124. Erişim adresi: http://hdl.handle.net/123456789/1654
8. Anvari, E., Ahangari, A. M., & 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.doi: 10.22059/IER.2020.78837

9. Anyanwu, J. C., & Erhijakpor, A. E. (2009). Health expenditures and health outcomes in Africa. African Development Review, 21(2), 400-433.doi: 10.1111/j.1467-8268.2009.00215.x
10. Arah, O. A., Westert, G. P., Hurst, J., & Klazinga, N. S. (2006). A conceptual framework for the OECD health care quality indicators project. International Journal for Quality in Health Care, 18(suppl_1), 5-13.doi: 10.1093/intqhc/mzl024
11. Arun, J. V., & Kumar, D. (2016). Public health expenditure of BRICS countries—an empirical analysis. Int J Med Sci Public Health, 5(11), 2212-6.
12. Attia-Konan, A. R., Oga, A. S. S., Touré, A., & Kouadio, K. L. (2019). Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d’Ivoire. BMC Research Notes, 12, 1-8.doi: 10.1186/s13104-019-4048-z
13. Aydın, J. C., & Yaşar, G. Y. (2023). Sağlık Harcamalarının Belirleyicileri: Oecd Ülkeleri İçin Panel Veri Analizi1. Hacettepe Sağlık İdaresi Dergisi, 26(2), 335-352.
14. Azwardi, A., Sukanto, S., & Adnan, N. (2023). Determinants of health expenditures: income level countries analysis. Jurnal Perspektif Pembiayaan dan Pembangunan Daerah, 11(1), 17-30.doi: 10.22437/ppd.v11i1.21502
15. Balçık, P. Y., Konca, M., & Biçer, İ. (2021). Yaşlı nüfus ile sağlık harcamaları arasındaki ilişkinin incelenmesi: Panel veriye dayalı bir uygulama. Iğdır Üniversitesi Sosyal Bilimler Dergisi, 26, 314-324.
16. Baltagi, B. H., & Moscone, F. (2010). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic modelling, 27(4), 804-811.doi: 10.1016/j.econmod.2009.12.001
17. Baltagi, B. H., Lagravinese, R., Moscone, F., & Tosetti, E. (2017). Health care expenditure and income: A global perspective. Health economics, 26(7), 863-874.doi: 10.1002/hec.3424
18. Bammann, K., Peplies, J., Sjöström, M., Lissner, L., De Henauw, S., Galli, C., ... & IDEFICS consortium. (2006). Assessment of diet, physical activity and biological, social and environmental factors in a multi-centre European project on diet-and lifestyle-related disorders in children (IDEFICS). Journal of Public Health, 14, 279-289.doi: 10.1007/s10389-006-0058-0
19. Belaïd, F., Youssef, A. B., & Lazaric, N. (2020). Scrutinizing the direct rebound effect for French households using quantile regression and data from an original survey. Ecological Economics, 176, 106755.doi: 10.1016/j.ecolecon.2020.106755
20. Bentley, R., Baker, E., Martino, E., Li, Y., & Mason, K. (2021). Alcohol and tobacco consumption: What is the role of economic security?. Addiction, 116(7), 1882-1891.doi: 10.1111/add.15400
21. Bhowmik, D. (2020). Determinants of India’s health expenditure: An econometric analysis. International Journal on Recent Trends in Business and Tourism (IJRTBT), 4(1), 13-23.
22. Bilgili, F., Kuşkaya, S., Khan, M., Awan, A., & Türker, O. (2021). The roles of economic growth and health expenditure on CO2 emissions in selected Asian countries: a quantile regression model approach. Environmental Science and Pollution Research, 28(33), 44949-44972.doi: 10.1007/s11356-021-13639-6
23. Birol, Y. E., & Demirgil, B. (2022). Sağlık harcamaları ve ekonomik büyüme ilişkisi: MIST ülkeleri üzerine uygulamalı bir çalışma. Sosyal Bilimler Araştırmaları Dergisi, 17(1), 69-78.
24. Blomqvist, Å. G., & Carter, R. A. (1997). Is health care really a luxury?. Journal of health economics, 16(2), 207-229.
25. Boz, C., Taş, N., & 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.doi: 10.20518/tjph.426494 Cantarero, D., & Lago-Peñas, S. (2009). Decomposing the determinants of health care expenditure: the case of Spain.doi: 10.2139/ssrn.1406474
26. Chaabouni, S., & Abednnadher, C. (2014). The determinants of health expenditures in Tunisia: An ARDL bounds testing approach. International Journal of Information Systems in the Service Sector (IJISSS), 6(4), 60-72.
27. Choung, R. S., Branda, M. E., Chitkara, D., Shah, N. D., Katusic, S. K., Locke III, G. R., & Talley, N. J. (2011). Longitudinal direct medical costs associated with constipation in women. Alimentary pharmacology & therapeutics, 33(2), 251-260. doi: 10.1111/j.1365-2036.2010.04513.x
28. Claeson, M., & Waldman, R. J. (2000). The evolution of child health programmes in developing countries: from targeting diseases to targeting people. Bulletin of the world health organization, 78(10), 1234-1245.
29. Clemente, J., Marcuello, C., Montañés, A., & Pueyo, F. (2004). On the international stability of health care expenditure functions: are government and private functions similar?. Journal of health economics, 23(3), 589-613.doi: 10.1016/j.jhealeco.2003.08.007
30. Cylus, J., Hartman, M., Washington, B., Andrews, K., & Catlin, A. (2011). Pronounced gender and age differences are evident in personal health care spending per person. Health Affairs, 30(1), 153-160.doi: 10.1377/hlthaff.2010.0216
31. Çamurlu, S., & Erilli, N. (2018). Kantil regresyon analizinde bootstrap tahmini. Erciyes Üniversitesi Fen Bilimleri Enstitüsü Fen Bilimleri Dergisi, 35(2), 16-25.
32. Çetin, M. A., & Bakırtaş, İ. (2019). Does urbanization induce the health expenditures? A dynamic macro-panel analysis for developing countries. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi, (61), 208-222.
33. Çetin, M. E., Bükey, A. M., & Denli, M. B. (2022). Sağlık harcamalarına etki eden faktörler: hekim ve hemşire istihdamı üzerine bir çalışma. JOEEP: Journal of Emerging Economies and Policy, 7(2), 224-232.
34. Dünya Bankası, (2024).https://data.worldbank.org/. Erişim Tarihi: 02.02.2024.
35. Ecevit, E., Çetin, M., & Yücel, A. G. (2018). Türki cumhuriyetlerinde sağlik harcamalarinin belirleyicileri: Bir panel veri analizi. Akademik Araştırmalar ve Çalışmalar Dergisi (AKAD), 10(19), 318-334.doi: 10.20990/kilisiibfakademik.407522
36. Effiong, U. E., Okijie, S. R., & Ridwan, M. (2021). Urbanization and health conditions in Nigeria: dealing with the urban health challenges. SIASAT, 6(4), 190-203.doi: 10.33258/siasat.v6i4.104
37. Ekpu, V. U., & Brown, A. K. (2015). The economic impact of smoking and of reducing smoking prevalence: review of evidence. Tobacco use insights, 8, TUI-S15628.
38. Ercan, U. (2021). Türkiye hanehalkı sağlık harcamaları belirleyicilerinin kantil regresyon yöntemiyle incelenmesi. Bingöl Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 5(1), 141-172.doi: 10.33399/biibfad.835976
39. Fan, V. Y., & Savedoff, W. D. (2014). The health financing transition: a conceptual framework and empirical evidence. Social science & medicine, 105, 112-121.doi: 10.1016/j.socscimed.2014.01.014
40. Fuino, M., Trein, P., & Wagner, J. (2022). How does regulating doctors’ admissions affect health expenditures? Evidence from Switzerland. BMC Health Services Research, 22(1), 495.doi: 10.1186/s12913-022-07735-7. doi: 10.1186/s12913-022-07735-7
41. Furuoka, F., FUI YEE, B. L., Kok, E., Hoque, M. Z., & Munir, Q. (2011). What are the determinants of health care expenditure? Empirical results from Asian countries. Sunway Academic Journal, 8.
42. Garcia, M., Alderman, H., & Sathar, Z. A. (1989). Patterns and determinants of malnutrition in children in Pakistan: impact of community health [with comments]. The Pakistan Development Review, 28(4), 891-902.
43. Gerdtham, U. G., Søgaard, J., Andersson, F., & Jönsson, B. (1992). An econometric analysis of health care expenditure: A cross-section study of the OECD countries. Journal of health economics, 11(1), 63-84.doi: 10.1016/0167-6296(92)90025-V
44. Ghaemi Asl, M., & Mirzaei Abbasabadi, H. (2021). Age effects on health expenditures: a global view. Journal of Population Ageing, 14(2), 247-270.
45. Gözen, M.Ç., & Bostancı, F.C. (2021). Konut özelliklerinin konut fiyatlarına etkisinin kantil regresyon yöntemi ile incelenmesi: İzmit örneği. Iğdır Üniversitesi Sosyal Bilimler Dergisi, 26, 506-532.
46. Hajibabaei, H., Sadeghi Soghdel, H., Faraji Dizaji, S., & Ahmadi, A. (2020). Health expenditures in developing countries: determinants and guidelines. Journal of Research and Health, 10(4), 257-266.
47. Han, K., Cho, M., & Chun, K. (2013). Determinants of health care expenditures and the contribution of associated factors: 16 cities and provinces in Korea, 2003-2010. Journal of Preventive Medicine and Public Health, 46(6), 300.doi: 10.3961/jpmph.2013.46.6.300
48. Hartwig, J. (2008). What drives health care expenditure?—Baumol's model of ‘unbalanced growth’revisited. Journal of health economics, 27(3), 603-623.doi: 10.1016/j.jhealeco.2007.05.006.
49. Hassan, M. S., & 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.
50. Hatam, N., Tourani, S., HOMAIE, R. E., & Bastani, P. (2016). Estimating the relationship between economic growth and health expenditures in ECO countries using panel cointegration approach.
51. Huang, Q., Zhang, H., Chen, J., & He, M. J. J. B. B. (2017). Quantile regression models and their applications: A review. Journal of Biometrics & Biostatistics, 8(3), 1-6.doi: 10.4172/2155-6180.1000354
52. John, O. O., & Nduka, E. C. (2009). Quantile regression analysis as a robust alternative to ordinary least squares. Scientia Africana, 8(2), 61-65.
53. Kaiser, B. & Schmid, C. (2016). Does physician dispensing increase drug expenditures? Empirical evidence from Switzerland. Health economics, 25(1), 71-90.doi: 10.1002/hec.3124
54. Ke, X. U., Saksena, P. & Holly, A. (2011). The determinants of health expenditure: a country-level panel data analysis. Geneva: World Health Organization, 26(1-28).
55. Koenker, R. & Bassett, G. (1978). Regression quantiles. Econometrica: Journal of the EconometricSociety,2, 33-50. Koenker, R., & Bassett Jr, G. (1982). Robust tests for heteroscedasticity based on regression quantiles. Econometrica: Journal of the Econometric Society, 43-61.
56. Krůtilová, V. & Yaya, S. (2012). Unexpected impact of changes in out-of-pocket payments for health care on Czech household budgets. Health policy, 107(2-3), 276-288.doi: 10.1016/j.healthpol.2012.07.002
57. Matteo, D., L. (2005). The macro determinants of health expenditure in the United States and Canada: Assessing the impact of income, age distribution and time. Health Policy, 71, 23-42.doi: 10.1016/j.healthpol.2004.05.007
58. Matteo, D., L. (2014). Physician numbers as a driver of provincial government health spending in Canadian health policy. Health policy, 115(1), 18-35.
59. Mishra, P. K. & Mishra, S. K. (2015). The Triangulation Dynamics between Education, Health and Economic Growth in India. Journal of Commerce (22206043), 7(2).
60. Mondal, B. & Dubey, J. D. (2020). Gender discrimination in health-care expenditure: An analysis across the age-groups with special focus on the elderly. Social Science & Medicine, 258, 1-17.doi: 10.1016/j.socscimed.2020.113089
61. Murthy, V. N., & Okunade, A. A. (2016). Determinants of US health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration. Economic Modelling, 59, 67-73.doi: 0.1016/j.econmod.2016.07.001
62. Newey, W.K., & Powell, J L. (1987). Asymmetric least squares estimation and testing. Econometrica: Journal of the Econometric Society, 819-847.
63. Nghiem, S. H., & Connelly, L. B. (2017). Convergence and determinants of health expenditures in OECD countries. Health economics review, 7, 1-11.doi: 10.1186/s13561-017-0164-4
64. Nguyen, C. V., Thi Le, T., & Nguyen, N. H. (2023). The crowding-out effect of tobacco expenditure on health expenditure: evidence from a lower-middle-income country. Nicotine and Tobacco Research, 25(11), 1744-1752.doi: 10.1093/ntr/ntad106
65. Ojo, T. J., & Ojo, S. I. (2022). Health expenditure, education and economic growth in Nigeria. Open J Soc Sci Humanities (ISSN: 2734-2077), 3, 01-17.doi: 10.52417/ojssh.v3i1.308
66. Okunade, A. A. (2005). Analysis and implications of the determinants of healthcare expenditure in African countries. Health Care Management Science, 8, 267-276.
67. Olasehınde, N. A. (2014). Gender patterns in household health expenditure allocation in Nigeria (Doctoral dissertation).
68. Olasehinde, N., & Olaniyan, O. (2017). Determinants of household health expenditure in Nigeria. International Journal of Social Economics, 44(12), 1694-1709.doi: 10.1108/IJSE-12-2015-0324
69. Osborne, J. W. (2019). Prediction in multiple regression. Practical Assessment, Research, and Evaluation, 7(1), 2.doi: 10.7275/7j20-gg86
70. Owens, G. (2008). Gender differences in health care expenditures, resource utilization, and quality of care. Journal of Managed Care Pharmacy, 14(3), 2-6.
71. Parker, S. W., & Wong, R. (1997). Household income and health care expenditures in Mexico. Health Policy, 40(3), 237-255.doi: 10.1016/S0168-8510(97)00011-0
72. Payandeh, A., Mehrabi, Y., Zayeri, F., & Ghahroodi, Z. R. (2017). Health expenditure modelling in southeast of Iran: a population-based setting using quantile regression perspective. Health Scope, 6(4).doi: 10.5812/jhealthscope.64185
73. Phi, G. (2017). Determinants of health expenditures in OECD countries.
74. Plümper, T., & Neumayer, E. (2013). Health spending, out‐of‐pocket contributions, and mortality rates. Public Administration, 91(2), 403-418.doi: 10.1111/j.1467-9299.2012.02039.x
75. Rahman, M. M. (2011). Causal relationship among education expenditure, health expenditure and GDP: A case study for Bangladesh. International Journal of Economics and Finance, 3(3), 149-159.
76. Rahman, T. (2008). Determinants of public health expenditure: some evidence from Indian states. Applied Economics Letters, 15(11), 853-857.doi: 10.1080/13504850600770970
77. Rana, R. H., Alam, K., & Gow, J. (2020). Health expenditure and gross domestic product: causality analysis by income level. International journal of health economics and management, 20(1), 55-77.doi: 10.1007/s10754-019-09270-1
78. Rezaei, S., Fallah, R., Karyani, A. K., Daroudi, R., Zandiyan, H., & Hajizadeh, M. (2016). Determinants of healthcare expenditures in Iran: evidence from a time series analysis. Medical journal of the Islamic Republic of Iran, 30, 313.
79. Rout, H. S. (2010). Gender and Household Health Expenditure in Odisha, India. Journal of Health Management, 12(4), 445-460.
80. Samadi, A., & Rad, E. H. (2013). Determinants of healthcare expenditure in Economic Cooperation Organization (ECO) countries: Evidence from panel cointegration tests. International journal of health policy and management, 1(1), 63.doi: 10.15171/ijhpm.2013.10
81. Santos, J. V., Martins, F. S., Pestana, J., Souza, J., Freitas, A., & Cylus, J. (2023). Should we adjust health expenditure for age structure on health systems efficiency? A worldwide analysis. Health Economics Review, 13(1), 11.doi: 10.1186/s13561-023-00421-2
82. Sturm, R. A. N. R., An, R., Maroba, J., & Patel, D. (2013). The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme. South African Medical Journal, 103(11), 840-844.
83. Su, T. T., Pokhrel, S., Gbangou, A., & Flessa, S. (2006). Determinants of household health expenditure on western institutional health care. The European Journal of Health Economics, 7, 195-203.doi: 10.1007/s10198-006-0354-1.
84. Swain, C. K. The Impact of Alcohol, Smoking, and Tobacco Consumption on Health Expenditure in Odisha. Social Sector in India: COVID-19 Issues and Challenges, 131.
85. Tang, C. F., ve Lai, Y. W. (2011). The causal relationship between health and education expenditures in Malaysia. Theoretical and Applied Economics, 8(8), 61-74.
86. Tıraş, H. H. (2022). Sağlık Harcamalarını Etkileyen Faktörler ve Sağlık Harcamalarının Optimal Düzeyi. Sağlık Yönetimi Güncel Konular Üzerine Akademik Değerlendirmeler, 71
87. Tıraş, H. H., & Ağır, H. (2018). OECD ülkelerinde sağlık harcamaları ve ekonomik büyüme ilişkisi: Panel nedensellik analizleri. Siyaset, Ekonomi ve Yönetim Araştırmaları Dergisi, 6(4), 13-29.
88. Tian, F., Gao, J., & Yang, K. (2018). A quantile regression approach to panel data analysis of health‐care expenditure in Organisation for Economic Co‐operation and Development countries. Health Economics, 27(12), 1921-1944.
89. Toor, I. A., & Butt, M. S. (2005). Determinants of health care expenditure in Pakistan. Pakistan Economic and Social Review, 133-150.
90. Moyen Uddin, M. M., & Sharif, T. (2017). Identifying causal relationships among education, income and health expenditures in South Asian countries: An econometric analysis. New Zealand Journal of Applied Business Research, 15(2), 41-57.
91. Varol İyidoğan, P., Balıkçıoğlu, E., & Yılmaz, H. (2017). Aging Effect on the Public Health Expenditures: A Reexamination.
92. Venkataraman, S., Anbazhagan, S., & Anbazhagan, S. (2019). Expenditure on health care, tobacco, and alcohol: Evidence from household surveys in rural Puducherry. Journal of Family Medicine and Primary Care, 8(3), 909-913.doi: 10.4103/jfmpc.jfmpc_91_19
93. Wang, Z. (2009). The determinants of health expenditures: evidence from US state-level data. Applied Economics, 41(4). 429-435.
94. Xu, X., Shrestha, S. S., Trivers, K. F., Neff, L., Armour, B. S., & King, B. A. (2021). US healthcare spending attributable to cigarette smoking in 2014. Preventive medicine, 150, 106529.
95. Yap, K. W., & Selvaratnam, D. P. (2018). Empirical analysis of factors influencing the public health expenditure in Malaysia/Yap Kok Wooi and Doris Padmini Selvaratnam. Journal of Emerging Economies and Islamic Research, 6(3), 1-14.
96. Yetim, B., İlgün, G., Çilhoroz, Y., Demirci, Ş., & Konca, M. (2021). The socioeconomic determinants of health expenditure in OECD: An examination on panel data. International Journal of Healthcare Management, 14(4), 1265-1269..doi: 10.1080/20479700.2020.1756112
97. Yildirim, J., Yilmaz, E., & Korucu, N. (2011). The determinants of out-of-pocket payments: evidence from selected hospitals in Ankara, Turkey. Applied Economics Letters, 18(12), 1159-1162.doi: 10.1080/13504851.2010.528351
98. You, X., & Kobayashi, Y. (2011). Determinants of out-of-pocket health expenditure in China: analysis using China Health and Nutrition Survey data. Applied health economics and health policy, 9, 39-49.
99. Zhao, J., & Zhong, H. (2015). Medical expenditure in urban China: a quantile regression analysis. International Journal of Health Economics and Management, 15, 387-406.
100. Zhou, L., Ampon-Wireko, S., Asante Antwi, H., Xu, X., Salman, M., Antwi, M. O., & Afua, T. M. N. (2020). An empirical study on the determinants of health care expenses in emerging economies. BMC Health Services Research, 20, 1-16.