Comparative Analysıs of Out-Of-Pocket Health Expenditure Across Countries of Different Income Groups

Yıl 2024, Cilt: 13 Sayı: 2, 635 - 645, 29.06.2024

İlknur Arslan Aras , Seyhan Çil Koçyiğit

https://doi.org/10.37989/gumussagbil.1367045

Öz

The objective of this study is to conduct a comparative analysis of the proportion of out-of-pocket health expenditures (OOPHE) in total health expenditure for countries across various income groups. The study utilizes data from the World Bank database between 2010 and 2019, compiled and analyzed in Excel. In 2019, there was a 4% increase in the low-income group, an 18% increase in the lower middle-income group, a 63% increase in the upper middle-income group, and a 36% increase in the high-income group when compared to the year 2010. When OOPHE per capita is analysed separately, we can observe that the high-income countries group has the highest expenditure (14%), but it is the group with the lowest share in total health expenditures. Given higher levels of out-of-pocket health expenditures in low- and lower-middle-income countries, significant disparities are apparent among income groups. To ensure more equitable access to healthcare, countries must reduce financial burdens on individuals by understanding the distinctions and implementing appropriate policies.

Anahtar Kelimeler

Health Expenditures, Out-of-Pocket Health Expenditures, Country Income Groups.

Cepten Sağlık Harcamalarının Ülke Gelir Gruplarına Göre Karşılaştırılması

Öz

Bu çalışmanın amacı cepten sağlık harcamalarının (CSH) toplam sağlık harcaması içindeki paylarını farklı gelir gruplarındaki ülkeler bakımından karşılaştırılmalı bir analizini gerçekleştirmektir. Çalışma kapsamında analize tabi tutulacak olan veriler 2010-2019 tarihleri arasında Dünya Bankası veri tabanından elde edilerek, Excel programında derlenmiş ve karşılaştırmalı analize tabi tutulmuştur. Kişi başına yapılan CSH’ler de 2019 yılında 2010 yılına oranla düşük gelir grubunda %4’lük, alt orta gelirli grubunda %18’lik, üst orta gelirli grubunda %63’lük ve yüksek gelirli grubunda %36’lık bir artış meydana gelmiştir. Kişi başına yapılan CSH tek başına incelendiğinde en yüksek harcamanın yüksek gelirli ülkeler (%14) grubunda olduğu görülse de toplam sağlık harcamaları içinde payı en az olan ülke grubudur. Cepten sağlık harcamaları, düşük ve alt-orta gelirli ülkelerde daha yüksek düzeylerde olduğu gözlendiğinden, gelir grupları açısından önemli farklılıklar göstermektedir. Ülkeler, bu farklılıkları anlayarak ve uygun politikaları uygulayarak, bireyler üzerindeki mali yükü azaltmak ve sağlık hizmetlerine daha adil erişim sağlamak için çalışmalıdır.

Anahtar Kelimeler

Sağlık Harcamaları, Cepten Sağlık Harcamaları, Ülke Gelir Grupları

Kaynakça

• 1. Chandrakar, A, Soni, G, Sinha, A, Jain, K, Panda, P. and Pradhan, S. (2017). “Estimation of Out of Pocket Expenditure Under Janani Shishu Suraksha Karayakram (JSSK) in Rural Block of Chhattisgarh: A Community Based Cross-Sectional Study”. National Journal of Community Medicine, 8 (02), 84-89.
• 2. Ensor, T. and Witter, S. (2001). “Health Economics in Low İncome Countries: Adapting To The Reality Of The Unofficial Economy”. Health Policy, 57 (1), 1-13.
• 3. Xu, K, Evans, D.B, Carrin, G, Aguilar-Rivera, A.M, Musgrove, P. and Evans, T. (2007). “Protecting Households From Catastrophic Health Spending”. Health Affairs, 26 (4), 972-983.
• 4. World Health Organization. (2010). “World Health Statistics 2010”. World Health Organization.
• 5. Kaiser Family Foundation, KFF (2022). "Key Facts About The Uninsured Population”. https://www.kff.org/Uninsured/issue-Brief/Key-Facts-About-The-Uninsured-Population/#:~:Text=Key%20Details%3A,of%20the%20totalandText=More%20than%20eight%20in%20ten,The%20total%20nonelderly%20uninsured%20population. (Erişim tarihi: 09.09.2023)
• 6. Lagarde, M. and Palmer, N. (2008). “The İmpact of User Fees on Health Service Utilization in Low-And Middle-income Countries: How Strong İs The Evidence?”. Bulletin of the World Health Organization, 86 (11), 839-848C.
• 7. Yildirim, H.H, Yildirim, T. ve Erdem, R. (2011). “Sağlık Hizmetleri Finansmanında Kullanıcı Katkıları: Genel Bir Bakış ve Türkiye İçin Bir Durum Değerlendirmesi”. Amme İdaresi Dergisi, 44 (2), 71-98.
• 8. World Bank. (2020). “Databank: Metadata Glossary”. Metadata Glossary Of The World Bank - Indicator: Out-Of-Pocket Health Expenditure, Code: SH.XPD.OOPC.ZS Https://Databank.Worldbank.Org/Metadataglossary/World-Development-Indicators/Series/SH.XPD.OOPC.Z
• 9. Çelik, Y. (2011). “Sağlık Ekonomisi”. Siyasal Kitabevi, Ankara.
• 10. Kara, O. ve Kurutkan, M.N. (2018). “Mikro İktisadi Açıdan Sağlık Hizmetleri Piyasasının Analizi”. Nobel Bilimsel Eserler, (113).
• 11. Özgen, H, Şahin, B, Belli, P, Tatar, M. and Berman, P. (2010). “Predictors of Informal Health Payments: The Example From Turkey”. Journal of Medical Systems, 34 (3), 387-396.
• 12. Cohen, N. (2012). “Informal Payments For Health Care–The Phenomenon and its Context”. Health Economics, Policy And Law, 7 (3), 285-308. 13. Vian, T, Grybosk, K, Sinoimeri, Z. and Hall, R. (2006). “Informal Payments in Government Health Facilities in Albania: Results of A Qualitative Study”. Social Science & Medicine, 62 (4), 877-887.
• 14. Özgen, H. ve Tatar, M. (2008). “Sağlık Hizmetleri Finansmanında İnformal Ödemeler”. Hacettepe Sağlık İdaresi Dergisi, 11 (1), 103-132.
• 15. Belli, P. (2002). “Formal and Informal Household Spending on Health: A Multi-Country Study in Central and Eastern Europe”. Harvard School of Public Health.
• 16. Baji, P, Pavlova, M, Gulácsi, L. and Groot, W. (2012). “Changes in Equity in Out-of-Pocket Payments During the Period of Health Care Reforms: Evidence from Hungary”. International Journal for Equity in Health, 11 (1), 1-11.
• 17. Creese, A. (1997). “User Fees”. BMJ: British Medical Journal, 315 (7102), 202.
• 18. Saltman, R.B. and Figueras, J. (1997). “European Health Care Reform: Analysis of Current Strategies”. World Health Organization. Regional Office for Europe.
• 19. Austvoll‐Dahlgren, A, Aaserud, M, Vist, G.E, Ramsay, C, Oxman, AD, Sturm, H and Vernby, Å. (2008). “Pharmaceutical Policies: Effects of Cap and Co‐Payment on Rational Drug Use”. Cochrane Database of Systematic Reviews, (1).
• 20. World Health Organization. (2019). “Global Spending on Health: A World in Transition (No. WHO/HIS/HGF/Hfworkingpaper/19.4)”. World Health Organization.
• 21. Sirag, A. and Mohamed Nor, N. (2021). “Out-Of-Pocket Health Expenditure And Poverty: Evidence From A Dynamic Panel Threshold Analysis”. In Healthcare 9 (5), 536. MDPI.
• 22. Azzani, M, Roslani, AC. and Su, TT. (2019). “Determinants of Household Catastrophic Health Expenditure: A Systematic Review”. The Malaysian Journal of Medical Sciences: MJMS, 26 (1), 15.
• 23. Cylus, J, Thomson, S. and Evetovits, T. (2018). “Catastrophic Health Spending in Europe: Equity And Policy İmplications of Different Calculation Methods”. Bulletin Of The World Health Organization, 96 (9), 599.
• 24. Devadasan, N, Criel, B, Van Damme, W, Ranson, K. and Van Der Stuyft, P. (2007). “Indian Community Health İnsurance Schemes Provide Partial Protection Against Catastrophic Health Expenditure”. BMC Health Services Research, 7 (1), 1-11.
• 25. Kutzin, J. (2008). “Health Financing Policy: A Guide For Decision-Makers”. Health Financing Policy Paper. Copenhagen, WHO Regional Office For Europe, 24. 26. Morgan, R, Ensor, T. and Waters, H. (2016). “Performance of Private Sector Health Care: İmplications for Universal Health Coverage”. The Lancet, 388 (10044), 606-612.
• 27. Çelik, Y, Khan, M. and Hikmet, N. (2017). “Achieving Value for Money in Health: A Comparative Analysis of OECD Countries and Regional Countries”. The International Journal of Health Planning and Management, 32 (4), E279-E298.
• 28. Sağlık Bakanlığı. (2006). “Türkiye Ulusal Sağlık Hesapları Hanehalkı Sağlık Harcamaları 2002-2003”. RSHMB, Hıfzıssıhha Mektebi Müdürlüğü, Yayın No: 601, Alban Tanıtım Organizasyon, Ankara.
• 29. Karan, A.C. and Garg (2005). “Socio-Economic Determinants of Out-of-Pocket and Catastrophic Expenditure in India: A Multivariate Analysis”. 11-13th July, 5. IHEA World Congress of Health Economics, 345. Barselona.
• 30. Stephanie, V, Scholder H.K, Xu K, Aguilar-Rivera, A.M. and Evans, D. (2005). “Health Service Utilization and Catastrophic Health Expenditures in Armenia; 1999 And 2001”. 11-13th July, 5. IHEA World Congress of Health Economics, 135-137. Barselona.
• 31. Başara, B.B. and Şahin, İ. (2008). “Türkiye’de Cepten Yapilan Sağlik Harcamalarini Etkileyen Etmenler”. Hacettepe Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 26 (2), 319-340.
• 32. İpek, E. (2019). “Türkiye’de Cepten Yapılan Sağlık Harcamalarının Belirleyicileri: Koşulsuz Kantil Regresyon”. Eskişehir Osmangazi Üniversitesi İktisadi Ve İdari Bilimler Dergisi, 14 (2), 409-420.
• 33. Łyszczarz, B. and Abdi, Z. (2021). “Factors Associated with Out-Of-Pocket Health Expenditure in Polish Regions”. In Healthcare, 9 (12), 1750.
• 34. Lagarde, M. and Palmer, N. (2008). “The Impact of User Fees on Health Service Utilization in Low-And Middle-income Countries: How Strong Is The Evidence?”. Bulletin of The World Health Organization, 86 (11), 839-848C. 35. Sari, N, Langenbrunner, J. and Lewis, M. (2000). “Affording Out-Of-Pocket Payments For Health-Services: Evidence from Kazakhstan”. Eurohealth-London, 6 (2), 37-39.
• 36. Eregata, G.T, Hailu, A, Geletu, Z.A, Memirie, S.T, Johansson, K.A, Stenberg, K. ... and Norheim, O.F. (2020). “Revision of The Ethiopian Essential Health Service Package: An Explication of The Process And Methods Used”. Health Systems and Reform, 6 (1), E1829313.
• 37. Rahman, M.M, Khanam, R. and Rahman, M. (2018). “Health Care Expenditure and Health Outcome Nexus: New Evidence from The SAARC-ASEAN Region”. Globalization and Health, 14 (1), 1-11.
• 38. OECD. (2021). “Health Statistics 2021 Definitions, Sources and Methods”. https://www.OECD.org/Els/Health-Systems/Table-of-Content-Metadata-OECD-Health-Statistics-2021.Pdf. (Erişim tarihi: 20.04.2023).
• 39. World Bank. (2023). “World Bank Country and Lending Groups”.https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. (Erişim tarihi:02.09.2023).
• 40. Şeremet, G.G. and Uçakkuş, P. (2023). “Sağlıkta Yeni Bir Yönetim Anlayışı: Holakratik Yönetim”. Avrasya Sağlık Bilimleri Dergisi, 6 (2), 60-66.