KAMU SAĞLIK VE SOSYAL HARCAMALARININ SAĞLIK SONUÇLARI ÜZERİNDEKİ ETKİSİ: OECD ÜLKELERİNDE BİR PANEL VERİ ANALİZİ

Yıl 2021, Cilt: 24 Sayı: 3, 469 - 482, 29.09.2021

Seda Aydan , Gamze Bayın Donar , Cengiz Arıkan

Öz

Sağlık hayati önem taşıması nedeniyle, sağlığın geliştirilmesi temel bir hak olarak görülmektedir. Bu nedenle, sağlığım önemli belirleyicilerinden olduğu düşünülen kamu sağlık harcamalarının ve kamu sosyal harcamalarının sağlık sonuçları üzerindeki etkisini ortaya koymak önemlidir. Bu çalışma, OECD ülkelerinin kamu sağlık ve sosyal harcamalarının sağlık sonuçları üzerindeki etkilerini incelemeyi amaçlamaktadır. Çalışma kapsamında, kamu sağlık harcamaları ve sosyal harcamalar, bağımsız değişkenler olarak değerlendirilmiştir. Doğuşta beklenen yaşam süresi, erkek ve kadınlarda doğuşta beklenen yaşam süresi, bebek ölüm hızı ve anne ölüm hızı, çalışmanın bağımlı değişkenleridir. Değişkenlere ilişkin veriler, OECD veri tabanından toplanmıştır ve tüm ülkeler için 2006 ile 2017 yılları arasını kapsamaktadır. Havuzlanmış, sabit ve rastgele etkiler panel veri modelleri tahmin edilmiştir. Çalışmanın bulgularına göre, kamu sağlık ve sosyal harcamaları, doğuşta beklenen yaşam süresi ve bebek ölüm hızı değişkenlerine anlamlı etki etmekte, ancak anne ölüm hızı değişkenine anlamlı etki etmemektedir. Sosyal harcamaların doğuşta beklenen yaşam süresi ve bebek ölüm hızını açıklama katsayıları, sağlık harcamalarına göre daha yüksek bulunmuştur. Doğuşta beklenen yaşam süresini artırmak ve bebek ölüm hızını azaltmak için OECD ülkelerinin sosyal harcamalara önem vermesi önerilmektedir. Hem sağlık hem de sosyal harcamalar ile sağlık sonuçları arasındaki ilişkinin belirlenmesi, sağlık iyileştirmeleri için ulusal politikanın temellerini oluşturur.

Anahtar Kelimeler

Sağlık harcaması, sosyal harcama, sağlık sonuçları, panel veri, OECD ülkeleri

THE EFFECTS OF PUBLIC HEALTH AND SOCIAL SPENDINGS ON HEALTH OUTCOMES: A PANEL DATA ANALYSIS OF OECD COUNTRIES

Öz

Health promotion is seen as a fundamental right, as health is of vital importance. Therefore, it is important to reveal the impact of public health spending and public social spending, which are considered to be important determinants of health, on health outcomes. This study aimed to examine the effects of both public health and social spendings on health outcomes among OECD countries. Public health spending and social spending were evaluated as independent variables and life expectancy at birth, life expectancy at birth for males and females, infant mortality rate and maternal mortality rate were evaluated as the dependent variables. Data were collected from OECD database and it covers the years between 2006 and 2017 for all OECD countries. Panel data analysis was conducted where pooled, fixed and random effect models were estimated. According to findings of the study, public health and social spendings had an impact on life expectancy at birth and infant mortality rate, but not on maternal mortality rate. The coefficients of explaining the life expectancy at birth and infant mortality rate of social spending were higher than health spending. In order to increase life expectancy at birth and reduce the infant mortality rate, it is recommended that OECD countries should attach importance to social spending. Identifying the relationship between both health and social spendings and health outcomes provides foundations for national policy for health improvements.

Anahtar Kelimeler

Health spending, social spending, health outcomes, panel data, OECD countries

Kaynakça

• Afonso, A., Schuknecht, L., & Tanzi, V. (2008). Income distribution determinants and public spending efficiency. Frankfurt: European Central Park, Workin Paper Series.
• Babazono, A. & Hillman, A. L. (1994). A comparison of international health outcomes and health care spending. International Journal of Technology Assessment in Health Care, 10, 376-381.
• Barlow, R. & Vissandjée, B. (1999). Determinants of national life expectancy. Canadian Journal of Development Studies, 20, 9-29.
• Bein, M. A., Unlucan, D., Olowu, G., & Kalifa, W. (2017). Healthcare spending and health outcomes: evidence from selected east african countries. African Health Sciences, 17, 247-254.
• Bradley, E. H., Canavan, M., Rogan, E., Talbert-Slagle, K., Ndumele, C., Taylor, L., & Curry, L. A. (2016). Variation in health outcomes: the role of spending on social services, public health, and health care, 2000–09. Health Affairs, 35, 760-768.
• Bradley, E. H., Elkins, B. R., Herrin, J., & Elbel, B. (2011). Health and social services expenditures: associations with health outcomes. BMJ Qual Saf., 20, 826-831.
• Busetto, L., Luijkx, K., & Vrijhoef, B. (2017). Development of the COMIC Model for the comprehensive evaluation of integrated care interventions. 17th International Conference on Integrated Care, Dublin.
• Crémieux, P. Y., Meilleur, M. C., Ouellette, P., Petit, P., Zelder, M. & Potvin, K. (2005). Public and private pharmaceutical spending as determinants of health outcomes in Canada. Health Economics, 14, 107-116.
• Çevik, S. (2013). The effect of public spending on the improvement of healthcare services: a comparative study. Journal of Political Sciences, 48, 113-133.
• Çevik, S. & Taşar, M. O. (2013). Public spending on health care and health outcomes: a cross-country comparison. Journal of Business, Economics & Finance, 2, 82-100.
• Çukur, A. & Bekmez, S. (2011). The relationship between income, income inequality and health in turkey: evidence from panel data analysis. Gaziantep University Journal of Social Sciences, 10, 21-40.
• Dhrifi, A. (2018). Public health expenditure and child mortality: does institutional quality matter? Journal of the Knowledge Economy, 11, 692-706.
• Duba, J., Berry, J., Fang, A., & Baughn, M. (2018). The effects of health care expenditures as a percentage of gdp on life expectancies. Research in Applied Economics, 10, 50-65.
• Dutton, D. J., Forest, P. G., Kneebone, R. D., & Zwicker, J. D. (2018). Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study. CMAJ, 190, E66-71.
• Edney, L. C., Haji Ali Afzali, H., Cheng, T. C., & Karnon, J. (2018). Mortality reductions from marginal increases in public spending on health. Health Policy, 122, 892-899.
• Exworthy, M., Powell, M., & Glasby, J. (2017). The governance of integrated health and social care in England since 2010: great expectations not met once again? Health Policy, 121, 1124-1130.
• Filmer, D. & Pritchett, L. (1999). The impact of public spending on health: does money matter? Social Science & Medicine, 49, 1309-1323.
• Gilbride, J. A., Amella, E. J., Breines, E. B., Mariano, C., & Mezey, M. (1998). Nutrition and health status assessment of community-residing elderly in New York City: a pilot study. J Am Diet Assoc., 1998, 98, 554-558.
• Hlafa, B., Sibanda, K., & Hompashe, D. M. (2019). The impact of public health expenditure on health outcomes in south africa. International Journal of Environmental Research and Public Health, 16, 2993.
• Keon, W. J. & Pépin, L. (2009). The standing senate committee on social affairs, science and technology final report of senate subcommittee on population health. Canada; 2009. Available at: https://sencanada.ca/content/sen/Committee/402/popu/rep/rephealth1ju n09-e.pdf [accessed 10.10.19].
• Kim, T. K. & Lane, S. R. (2013). Government health expenditure and public health outcomes: a comparative study among 17 countries and ımplications for US health care reform. American International Journal of Contemporary Research, 3, 8-13.
• Kofi Boachie, M., Ramu, K., & Põlajeva, T. (2018). Public health expenditures and health outcomes: new evidence from ghana. Economies, 6, 1-25.
• Krieger, J. & Higgins, D. L. (2002). Housing and health: time again for public health action. American Journal of Public Health, 92, 758-768.
• Leigh, A. & Jenks, C. (2007). Inequality and mortality: Long-run evidence from a panel of countries. Journal of Health Economics, 26, 1–24.
• Lobb, A. (2009). Health care and social spending in OECD nations. American Journal of Public Health, 99, 1542-1543.
• Marmot, M. (2002). The influence of income on health: views of an epidemiologist. Health Aff., 21, 31-46.
• Narayan, L. (2017). Are better health outcomes related to social sector public expenditure? – evidences from a panel data study of Indian states. International Journal in Management and Social Science, 5, 399-409.
• Navarro, V., Muntaner, C., Borrell, C., Benach, J., Quiroga, Á., Rodríguez-Sanz, M., Verges, N., & Pasarin, M. I. (2006). Politics and health outcomes. Lancet, 368, 1033-1037.
• Nixon, J. & Ulmann, P. (2006). The relationship between health care expenditure and health outcomes. Eur J Health Econom., 7, 7–18.
• OECD. (2009). Health at a glance 2010: OECD indicators. Paris: OECD Publishing.
• OECD. (2010). Health care systems: getting more value for money. OECD Economics Department Policy Notes, No. 2. Available at: http://www.oecd.org/economy/growth/46508904.pdf [accessed 10.10.19].
• OECD. (2019). OECD data. Available at: https://data.oecd.org/ [accessed 10.05.19].
• Papanicolas, I, Woskie, L. R., Orlander, D., Orav, E. J., & Jha, A. K. (2019). The relationship between health spending and social spending in high-income countries: how does the us compare? Health Affairs, 38(9),1567-1575.
• Patel, N., Gunjana, G., Patel, S., Thanvi, R., Sathvara, P., & Joshi, R. (2015). Nutrition and health status of school children in urban area of Ahmedabad, India: Comparison with Indian Council of Medical Research and body mass index standards. J Nat Sci Biol Med., 6, 372–377.
• Preston, S. H. (1975). The changing relation between mortality and level of economic development. Population Studies, 29, 231-248.
• Prichett, L. & Summers, L. H. (1996). Wealthier is healthier. The Journal of Human Resources, 31, 841-868.
• Rahman, M. M., Khanam, R., & Rahman, M. (2018). Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region. Globalization and Health, 14, 113.
• Rana, R. H., Alam, K., & Gow, J. (2018). Health expenditure, child and maternal mortality nexus: a comparative global analysis. BMC International Health and Human Rights, 18, 29.
• Rezapour, A., Mousavi, A., Lotfi, F., Movahed, M. S., & Alipour, S. (2019). The Effects of Health Expenditure on Health Outcomes Based on the Classification of Public Health Expenditure: A Panel Data Approach. Shiraz E-Med J., 20, e88526.
• Robert Wood Johnson Foundation Commission. (2011). Housing and health. Available at: https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html [accessed 10.10.19].
• Rodgers, G. B. (1979). Income and inequality as determinants of mortality: an international cross-section analysis. Population Studies, 33, 343-351.
• Rubin, J., Taylor, J., Krapels, J., Sutherland, A., Felician, M., Liu, J., Davis, L., & Rohr, C. (2016). Are better health outcomes related to social expenditure? UK: RAND Corporation.
• Sango-Coker, E. Y. & Bein, M. A. (2018). The impact of healthcare spending on life expectancy: evidence from selected West African countries. African Journal of Reproductive Health, 22, 64-71.
• Schanzenbach, D., Mumford, M., Nunn, R., Bauer, L. (2016). Money lightens the load. Advancing opportunity, prosperity, and growth. The Hamilton Project.
• Swain, G. R. (2016). How does economic and social disadvantage affect health? Focus, 33, 1-6.
• Tatoğlu FY. (2018). Panel data econometrics stata applied. İstanbul: Beta Publishing.
• Van den Heuvel, W. J. A. & Olaroiu, M. (2017). How important are health care expenditures for life expectancy? A comparative, european analysis. JAMDA, 18, 276.e9e276.e12.
• Wilkonson, R. G. (1992). Income distribution and life expectancy. BMJ, 304, 165-8.