Tıbbi Tanı ve Tedavi Cihazlarının Sağlık Harcamaları Üzerindeki Etkisi

Yıl 2024, Cilt: 15 Sayı: 41, 181 - 193, 28.02.2024

Taner Abiş , Haşim Çapar

https://doi.org/10.21076/vizyoner.1261886

Öz

Tıbbi tanı cihazlarının sağlık harcamalarını arttırmadığı buna karşın tıbbi tedavi cihazlarının ise sağlık harcamalarını arttırdığı gerçeği ile bu çalışmanın amacı, OECD düzeyinde sağlık teknolojileri olan tıbbi tanı ve tedavi cihazlarının sağlık harcamalarına etkisini incelemek ve bu etkiden elde edilen veriler ile politikacılara kanıt sağlamaktır. Bu çalışma, panel veri analizi yöntemlerinden biri olan Driscoll-Kraay tahmincisi ile tamamlanmıştır. 11 OECD ülkesinin 2009-2016 yıllarına ait verileri ile analiz yapılmıştır. Elde edilen bulgulara göre Bilgisayarlı Tomografi (CT) ve Radyoterapi (RT) cihaz sayılarındaki 1 birimlik artış kişi başı sağlık harcaması yükünü (EXP) sırasıyla 50,478 ve 296,123 birim arttırmaktadır. Yatak Sayısı (BED) ve Mamografi (MAM) teknolojisine yapılan yatırımlardaki 1 birimlik artış ise kişi başı sağlık harcaması yükünü (EXP) sırasıyla 127,158 ve 8,697 birim azaltmaktadır. Sonuç olarak, tedavide kullanılan teknolojiler, sağlık harcamalarının yükünü arttırmaktadır. Dolayısı ile sağlık teknolojisi yatırımlarının birincil korunmaya dönük yapılması, tedavi edici sağlık hizmetlerine olan talebin azalmasına neden olacaktır. Bu durum, sağlık politikacılarının tıbbi tanı ve tedavi cihazlarının hastanelerdeki düşük payının yüksek bir harcama oranı ile ilişkili olduğu gerçeğini unutmadan kanıta dayalı politikalar üretmesini gerekli kılmaktadır.

Anahtar Kelimeler

Tıbbi Tanı Cihazları, Tedavi Tıp Cihazları, Sağlık Harcaması, Sağlık Teknolojileri

The Impact of Medical Diagnostic and Therapeutic Devices on Health Expenditures

Öz

It is stated that medical diagnostic devices do not increase health expenditures, whereas medical treatment devices increase health expenditures. The study aims to examine the effect of medical diagnosis and treatment devices, which are health technologies at the OECD level, on health expenditures and to provide evidence to politicians with the data obtained from this effect. The study is completed with one of the panel data analysis methods, namely the Driscoll-Kraay estimator. Analysis is conducted with data from 11 OECD countries for the 2009-2016 period. According to the findings, a 1-unit increase in the number of Computed Tomography (CT) and Radiotherapy (RT) devices, increases the per capita health expenditure burden (EXP) by 50.478 and 296.123 units, respectively. A 1-unit increase in investments in the Number of Beds (BED) and Mammography (MAM) technology, reduces the per capita health expenditure burden (EXP) by 127.158 and 8.697 units, respectively. Therefore, investing in health technology for primary prevention would reduce the demand for therapeutic health services. This situation requires health politicians to produce evidence-based policies without forgetting the fact that the low share of medical diagnostic and treatment devices in hospitals is associated with a high spending rate.

Anahtar Kelimeler

Medical Diagnostic Devices, Therapeutic Medicine Devices, Health Expenditure, Health Technologies

Kaynakça

• Abdel-Wahab, M., Gondhowiardjo, S. S., Rosa, A. A., Lievens, Y., El-Haj, N., Polo Rubio, J. A., ... ve Gospodarowicz, M. (2021). Global radiotherapy: Current status and future directions—white paper. JCO Global Oncology, 7, 827-842.
• Anderson, G. F., Frogner, B. K., ve Reinhardt, U. E. (2007). Health spending in OECD countries in 2004: An update. Health Affairs (Project Hope), https://pubmed.ncbi.nlm.nih.gov/17848460/ adresinden 17 Şubat 2023 tarihinde alınmıştır.
• Abernethy, A. L., Adams, M., Barrett, C., Bechtel, P., Brennan, A., Butte, J., Faulkner, E., Fontaine, S., Friedhoff, J., Halamka, M., Howell, K., Johnson, P. Lee, P., Long, D., McGraw, R., Miller, J., Perlin, D., Rucker, L., Sandy, L., Savage, L., Stump, P., Tang, E., Topol, R. ve Tuckson, K. V. (2022). The promise of digital health: Then, now, and the future. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202206e.
• Baltagi, B. H. (1998). Panel data methods. Handbook of applied economic statistics içinde (s. 311-323). CRC Press.
• Chambers, J. D., Silver, M. C., Berklein, F. C., Cohen, J. T. ve Neumann, P. J. (2022). Are medical devices cost-effective? Applied health economics and health policy. https://pubmed.ncbi.nlm.nih.gov/34820784/ adresinden 17 Şubat 2023 tarihinde alınmıştır.
• Calcoen, P., Boer, A, Van De Ven, W. P. M. M. (2017). Should new health technology be available only for patients able and willing to pay?. J Mark Access Health Policy, 5(1), 1315294. https://doi.org/10.1080/20016689.2017.1315294
• Driscoll, J. C. ve Kraay. A. C. (1998). Consistent covariance matrix estimation with spatially dependent panel data. Review of Economics and Statistics, 80(4), 549-560.
• Dökmen, G. (2012). Yolsuzlukların vergi gelirleri üzerindeki etkisi: dinamik panel veri analizi. Doğuş Üniversitesi Dergisi, 13(1), 41–51.
• European Commission. (2019). Health and food safety. Task shifting and health system design report of the expert panel on effective ways of investing in health (EXPH). https://commission.europa.eu/about-european-commission/departments-and-executive-agencies/health-and-food-safety_en adresinden 26 Mart 2023 tarihinde alınmıştır.
• Eastman, R. C., Leptien, A. D. ve Chase, H. P. (2003). Cost-effectiveness of use of the GlucoWatch Biographer in children and adolescents with type 1 diabetes: A preliminary analysis based on a randomized controlled trial. Pediatr Diabetes, 4(2), 82-86. https://doi.org/10.1034/j.1399-5448.2003.00011.x
• Ekman, M., Sjögren, I. ve James, S. (2006). Cost-effectiveness of the Taxus paclitaxel-eluting stent in the Swedish healthcare system. Scandinavian Cardiovascular Journal, 40(1), 17-24. https://doi.org/10.1080/14017430500296323
• Farebrother, R. W. (1981). The Durbin-Watson test for serial correlation when there is no intercept in the regression. Econometrica, 49(1), 277. https://doi.org/10.2307/1911150
• Ferguson, M., Kim, M., Patel, P. ve Stockwell, B. (2014). The impact of medical device use on hospital costs. Value in Health, 17(3), A2.
• Gelijns Annetine, C. ve Ethan A. H. (1991). The diffusion of new technology: Costs and benefits to health care. National Academies Press (US), https://www.ncbi.nlm.nih.gov/books/NBK234309/ adresinden 17 Şuabt 2023 tarihinde alınmıştır.
• Giraldes, M. R. (2010). Evaluation of new technologies pet/ct nuclear ımaging. Acta Medica Portuguesa, 23(2), 291–310.
• Hachamovitch, R., James, R., Johnson, M. A. Hlatky vd. (2009). The study of myocardial perfusion and coronary anatomy ımaging roles in cad (sparc): Design, rationale, and baseline patient characteristics of a prospective, multicenter observational registry comparing PET, SPECT, and CTA for resource utilization and clinical outcomes. Journal of Nuclear Cardiology, 16(6), 935–948.
• Hoechle, D. (2007). Robust standard errors for panel regressions with cross-sectional dependence. The Stata Journal, 7(3), 281-312.
• Hadian, M., Alireza J., Elaheh, M. ve Marziyeh, N. (2021). What is the impact of clinical guidelines on imaging costs?. Journal of Education and Health Promotion, 10.
• Hashmi, R. ve Alam, K. (2019). Dynamic relationship among environmental regulation, innovation, CO2 emissions, population, and economic growth in OECD countries: A panel investigation. Journal of Cleaner Production, 231, 1100-1109.
• Jonsson, E. ve David, B. (1999). Management of health technologies: An international view. BMJ : British Medical Journal, 319(7220), 1293.
• Jing, R., Xu, T., Lai, X., Mahmoudi, E. ve Fang, H. (2019). Technical efficiency of public and private hospitals in beijing, China: A comparative study. International Journal of Environmental Research and Public Health, 17(1), 82. https://doi.org/10.3390/ijerph17010082
• Krämer, W. (2011). Durbin–watson test. M. Lovric (Ed.) International encyclopedia of statistical science. Springer. https://doi.org/10.1007/978-3-642-04898-2_219
• Kumar, R. K. (2011). Technology and healthcare costs. Annals of Pediatric Cardiology, 4(1), 84–86.
• Konak, A. ve Demir, M. A. (2019). Türkiye'nin BRICS ülkeleri ile ticaretinin analizi: Çekim modeli uygulaması. Uluslararası Bankacılık Ekonomi ve Yönetim Araştırmaları Dergisi, 2(2), 43-70.
• Karagöz, H. ve Şener, S. (2023). Sanayi sektörü önemini yitirdi mi? İhracat ve rekabet gücü ekseninde bir inceleme. İstanbul İktisat Dergisi, 73(1), 307-331.
• Kane, J. M. (2014). Technology-based interventions in health care. Epidemiol Psychiatr Sci, 23(4), 323-6. https://doi.org/10.1017/S2045796014000444
• Le, T. H., Le, H. C. ve Taghizadeh-Hesary, F. (2020). Does financial inclusion impact CO2 emissions? Evidence from Asia. Finance Research Letters, 34, 101451.
• Lim, C. T. (2020). Future of healthdiagnostics. View, 1, e3. https://doi.org/10.1002/viw2.3.
• Luitel, N. P., Jordans, M. J. D., Subba, P. ve Komproe, I. H. (2020). Perception of service users and their caregivers on primary care-based mental health services: A qualitative study in Nepal. BMC Family Practice, 21, 1-11. https://doi.org/10.1186/s12875-020-01266-y.
• Marino, A. ve Luca, L. (2019). The impact of technological advancements on health spending - a literature review. (OECD Health Working Paper No. 113 / JT03450328). OECD. https://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=DELSA/HEA/WD/HWP(2019)6&docLanguage=En
• Mason, P. (2020). Tourism impacts, planning and management (4th ed.). Routledge. https://doi.org/10.4324/9780429273544
• Meyer, M., Nance Jr, J. W., Schoepf, U. J., Moscariello, A., Weininger, M., Rowe, G. W., ... ve Henzler, T. (2012). Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease. European Journal of Radiology, 81(12), 3719-3725.
• Ming, J., He, Y., Yang, Y., Hu, M., Zhao, X., Liu, J., ... ve Chen, Y. (2022). Health technology assessment of medical devices: Current landscape, challenges, and a way forward. Cost Effectiveness and Resource Allocation, 20(1), 1-9.
• Newhouse, J. P. (1992). Medical care costs: How much welfare loss?. Journal of Economic Perspectives, 6(3), 3-21.
• Newman-Toker, D. E., Kathryn, M., McDonald, M. ve David, O. M. (2013). How much diagnostic safety can we afford, and how should we decide? A health economics perspective. BMJ Quality & Safety, 22(Suppl 2), ii11-ii20.
• OECD. (2016). Scoping paper on health system efficiency measurement (cooperation between the OECD and EC in promoting efficiency in health care). https://www.oecd.org/els/health-systems/Scoping-Paper-Measuring-efficiency-in-health-system.pdf adresinden 3 Aralık 2023 tarihinde alınmıştır.
• Otawova, R., Vojtech, K., Pavla, H. ve Vladimir, R. (2015). Cost-effectiveness studies on medical devices: Application in cardiology. In bioinformatics and biomedical engineering. Francisco Ortuño and Ignacio Rojas, eds, Springer International Publishing, 163–174.
• Otawova, R., Kamensky, V., Hasenohrlova, P. ve Rogalewicz, V. (2015). Cost-effectiveness studies on medical devices: Application in cardiology. Bioinformatics and Biomedical Engineering: Third International Conference, IWBBIO 2015 (s. 163-174). Granada, Spain, April 15-17, 2015, Proceedings, Part I 3. Springer International Publishing.
• Pammolli, F., Massimo, R., Claudia, O. vd. (2005). Medical devices competitiveness and impact on public health expenditure. MPRA Paper. https://mpra.ub.uni-muenchen.de/16021/ adresinden 17 Şubat 2023 tarihinde alınmıştır.
• Polisena, J., Dinsie, W. ve Oriana C. (2020). Health technology assessment of medical devices. E. Iadanza (Ed.), Clinical engineering handbook (Second Edition) içinde (s. 795–798). Academic Press.
• Rohr, U. P., Binder, C., Dieterle, T., Giusti, F., Messina, C. G. M., Toerien, E., ... ve Schäfer, H. H. (2016). The value of in vitro diagnostic testing in medical practice: A status report. PloS one, 11(3), e0149856.
• Sharma, A., Harrington, R. A., McClellan, M. B., Turakhia, M. P., Eapen, Z. J., Steinhubl, S., ... ve Peterson, E. D. (2018). Using digital health technology to better generate evidence and deliver evidence-based care. Journal of the American College of Cardiology, 71(23), 2680-2690. https://doi.org/10.1016/j.jacc.2018.03.523
• Sargan, J. D. (1958). The estimation of economic relationships using ınstrumental variables. Econometrica, 26(3), 393. https://doi.org/10.2307/1907619.
• Sarafidis ve Wansbeek, T. (2012). Cross-sectional dependence in panel data analysis. Econometric Reviews, 31(5), 483-531.
• Sertkaya, A., Rebecca, D., Amber, J. ve Trinidad, B. (2022). Estimated cost of developing a therapeutic complex medical device in the US. JAMA Network Open, 5(9), e2231609–e2231609.
• Smith-Bindman, R., Kwan, M. L., Marlow, E. C., Theis, M. K., Bolch, W., Cheng, S. Y., ... ve Miglioretti, D. L. (2019). Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016. Jama, 322(9), 843-856.
• Sorenson, C., Michael, D. ve Beena, B. K. (2013). Medical technology as a key driver of rising health expenditure: Disentangling the relationship. ClinicoEconomics and Outcomes Research: CEOR, 5, 223–234. Tabanchnick, B. G. ve Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson Education Inc.
• Vasudevan, S., Saha, A., Tarver, M. E. ve Patel, B. (2022). Digital biomarkers: convergence of digital health technologies and biomarkers. NPJ Digital Medicine, 5(1), 36. https://doi.org/10.1038/s41746-022-00583-z
• Van Der Pol, S., Paula Rojas, G., Fernando Antoñanzas, V., Maarten, J. P. ve Van Asselt Antoinette, D. I. (2021). Health-economic analyses of diagnostics: Guidance on design and reporting. Pharmaco Economics, 39(12), 1355–1363.
• Wang, F. (2018). The roles of preventive and curative health care in economic development. PLoS ONE, 13(11), e0206808.
• Wong, E., Mavondo, F. ve Fisher, J. (2020). Patient feedback to improve quality of patient-centred care in public hospitals: A systematic review of the evidence. BMC Health Services Research, 20(1), 530. https://doi.org/10.1186/s12913-020-05383-3
• Wurcel, V., Cicchetti, A., Garrison, L., Kip, M. M. A., Koffijberg, H., Kolbe, A. ve Zamora, B. (2019). The value of diagnostic information in personalised healthcare: A comprehensive concept to facilitate bringing this technology into healthcare systems. Public Health Genomics, 1–8. https://doi.org/10.1159/000501832.
• Yerdelen Tatoğlu, F. (2018), Panel veri ekonometrisi: Stata uygulamalı (4. Baskı). Beta Yayınevi.