Araştırma Makalesi


DOI :10.26650/JEPR1227842   IUP :10.26650/JEPR1227842    Tam Metin (PDF)

G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz

Resul TelliZehra Vildan Serin

Son dönemde sağlık sisteminden yararlanmak için özellikle yüksek gelirli ülkelerden Türkiye’ye gelen turist sayısında dikkat çekici bir artış görülmektedir. Türk sağlık sektörüne yönelik artan bu talep, bizi Türkiye’nin sağlık harcamalarının verimliliğini yüksek düzeyde sanayileşmiş ülkelerle karşılaştırmaya yöneltmiştir. COVID-19 süreci, dünyada her ülke için sağlık sektöründe etkinliğin ne kadar önemli olduğunu bir kez daha göstermiştir. Sağlık harcamalarının etkinliği, minimum sağlık girdisi kullanarak maksimum sağlık sonuçlarına ulaşılmasıdır. Bu makale, 2000 ile 2018 yılları arasında G8 ülkeleri ve Türkiye’nin sağlık harcama verimliliğini değerlendirmektedir. Çalışmada Veri Zarflama Analizi (VZA) kullanılarak sağlık harcamalarının verimlilik değerleri ölçülmüştür. Ülkelerin sağlık harcamalarındaki verimlilik değişimleri yıllara göre Malmquist İndeksi (Mİ) ile belirlenmiştir. Çalışmada Türkiye’nin Teknik Etkinlik Değişimi (TEC) değerinde ortalama %1,7’lik bir artışla girdilerini optimum şekilde kullanmayı başararak tüm yıllar boyunca teknik olarak en verimli ülke olduğu tespit edilmiştir. Teknolojik Değişim (TD) değerinde ise Türkiye, İtalya’dan sonra ikinci sırada en etkin ülke olarak tespit edilmiştir. Toplam Faktör Verimlilik Endeksi (Mİ) sonucunda sağlık harcamalarında verimli olan ilk üç ülke sırasıyla İtalya, Türkiye ve Fransa olarak belirlenmiştir. Türkiye’de sağlık reformları ile gerçekleştirilen yapısal dönüşüm programları sonucunda araştırma dönemi içinde etkin üretim çizgisine ulaşmadaki başarı diğer ülkelere göre çok daha fazla artmıştır. Bu iyileştirmelerin sürdürülebilirliği, Türkiye’nin sağlık teknolojilerinden yararlanma kapasitesinin geliştirilmesine ve gerçekleştirilmesine bağlıdır. 

JEL Classification : C14 , D57 , H51
DOI :10.26650/JEPR1227842   IUP :10.26650/JEPR1227842    Tam Metin (PDF)

A Comparative Analysis on Healthcare Spending Efficiency Among the G-8 Countries and Turkey

Resul TelliZehra Vildan Serin

Recently, there has been a remarkable increase in the number of people coming to Turkey from high-income countries to benefit from the healthcare system. This increasing demand for Turkish healthcare-related services has led us to compare the efficiency of the country’s healthcare spending to highly industrialized countries. Specifically, COVID-19 has indicated the important of every country reaching healthcare efficiency. The efficiency of healthcare expenditure facilitates reaching maximum healthcare outcomes with minimum healthcare inputs. This paper evaluates the cross-country healthcare spending efficiency ranking across the countries of the Group of Eight (G8) and Turkey between 2000 and 2018. We measured the efficiency values of healthcare spending using the Data Envelopment Analysis (DEA). We also evaluated the fluctuations in healthcare spending of the studied countries on a yearly basis via the Malmquist Index. The findings indicate that Turkey has been the most technically efficient across all years. Turkey managed the optimal use of its inputs by an average increase of 1.7% on the Technical Efficiency Exchange (TEC) value. Furthermore, the results reveal that Turkey follows Italy in total productivity growth in healthcare expenditures. Turkey has managed to increase its success in reaching an efficient production line much more than other countries during the research period. The sustainability of these improvements depends on Turkey’s development of the capacity and realization to benefit from healthcare technology.

JEL Classification : C14 , D57 , H51

GENİŞLETİLMİŞ ÖZET


Effectiveness in healthcare expenditures relates to achieving maximum healthcare outcomes using minimum healthcare inputs. This paper evaluates the healthcare expenditure efficiency of the Group of Eight (G8) countries and Turkey between 2000 and 2018. In this study, the efficiency values of healthcare expenditures were measured via Data Envelopment Analysis (DEA). The productivity changes in the healthcare expenditures of the countries were determined by the Malmquist Index (MI). After the reforms initiated in the healthcare sector in Turkey, many studies have been conducted on the effectiveness of the Turkish healthcare sector since 2013. This study was prepared in accordance with the literature. The variables used in the study were inspired by those found in the literature. 

The method of the study was determined as DEA-based Malmquist Index (MI). With the research method, productivity in healthcare status was measured at the macro level for the Decision Making Units (DMUs) covered by this study. The study aims to make some contributions to the literature. Suggestions are presented firstly, to measure the effectiveness of healthcare services, secondly, to identify inefficient DMUs in healthcare services, and thirdly, to activate these DMUs with the help of reference DMUs. Another contribution of this paper is determination of the amount of wasted or inactive input. In the present study, the G8 countries and Turkey were determined as Decision Making Units. The choice of which DMU to be used in practice in non-parametric methods is shown with three different formulas in the literature. 

DEA models were established under the assumption of either the constant return of scaleCRS assumption developed by Charnes, Cooper, and Rhodes (CCR) or the variable return to scale-VRS hypothesis put forward by Banker, Charnes, and Cooper (BCC) These models can be implemented as input (Input-I) or output (Output-O), or as both input (I) and output (O) oriented simultaneously. With the MI method, productivity changes between periods can be calculated. The MI method calculates the ratio of Technical Efficiency Change (TEC), Technological Efficiency Change (TC), and Total Factor Efficiency Change (TFEC) of DMUs. According to the findings obtained in the study, the countries with an increase in technical efficiency change (TEC) on average are: the USA, France, England, Russia, and Turkey. These five countries managed to increase their power in reaching an average effective production line during the analysis period. A TEC greater than 1 is also accepted as an indication that resources are used effectively in the production unit in question or that resources are not wasted. It is particularly striking that Turkey ranks first among all DMUs in terms of TEC increase rate, with an average of 1.7%. With this aspect, Turkey has managed to increase its power to reach an effective production line much more than all other countries throughout the period.

Considering the change in technological efficiency, the country that benefited most from technological innovations during the whole period was Italy, followed by Turkey. Accordingly, these two countries have reached a production level that can achieve more output with the same amount of input by increasing the effective production line. On the other hand, it was determined that Japan and Russia could not benefit from technology to the desired extent. Since Japan and Russia could not move up their efficient production line (with TC<1), they could not reach the production level that could achieve more output with the same input amount. For this reason, these countries are considered to be technologically inefficient. When all DMUs were evaluated in terms of TFEC values, an average of 70% efficiency was found, while 30% was inefficient. DMUs with a TFEC value greater than 1 are Germany, USA, France, England, Italy, Canada, and Turkey. Among these countries, Italy ranks first in productivity growth. Although Turkey’s average TEC (1.7%) and TC (4.4%) values are not very high separately, the TFEC value obtained by multiplying the two has increased significantly as a result of the increasing value of both. This situation is the result of Turkey increasing its power to reach an effective production line throughout the period and, at the same time, to reach a higher production line where it can reach more output with equal inputs. Another remarkable detail is the stability (TEC=1) in Turkey’s TEC values, especially during the period of 2011 to 2018 compared to the previous period. Accordingly, Turkey’s power to reach the effective production line has neither increased nor decreased every year in the last seven years of the analysis period compared to the previous period. The increase in TEC, which will be formed as a result of the plans and policies to be made to overcome this situation, will further increase the efficiency of Turkey’s healthcare expenditures. 


PDF Görünüm

Referanslar

  • Akal, Z. (1992). İşletmelerde performans ölçüm ve denetimi. MPM Yayınları, Ankara, 21, 64. google scholar
  • Artan, S., Hayaloğlu, P., & Demirel, S. K. (2017). BRICS Ülkelerinde Kamu Sağlık Harcamaları Etkinliğinin Belirleyicileri. SGD-Sosyal Güvenlik Dergisi, 7(1), 9-30. google scholar
  • Bal, V. (2010). The measurement of the effects of information systems on the performance of health enterprises by data envelopment analysis: A study in state hospitals in Turkey. (Doctoral dissertation, Social Sciences). google scholar
  • Banker, R. D., Cooper, W. W., Seiford, L. M., Thrall, R. M., & Zhu, J. (2004). Returns to scale in different DEA models. European Journal of Operational Research, 154(2), 345-362. google scholar
  • Banker, R.D., Charnes, A., & Cooper, W.W. (1984). Some models for estimating technical and scale inefficiencies in data development analysis. Management science, 30(9), 1078-1092. google scholar
  • Bayyurt, N., & Serin, Z. V. (2017). The Non-Linear Relation between Governance and Efficiency: Evidence from Agriculture. google scholar
  • Beraldo, S., Montolio, D., & Turati, G. (2009). Healthy, educated and wealthy: a primer on the ımpact of public and private welfare expenditures on economic growth, The Journal of Socio-Economics, 38(1), 946-956. google scholar
  • Bilsel, M., & Davutyan, N. (2014). Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case. Annals of Operations Research, 221(1), 73-88. google scholar
  • Bolukçu, F. (2020). Evaluation of technical efficiency levels of social security expenditures of turkey and european union countries: data envelopment analysis applications (Doctoral dissertation, Ankara Yıldırım Beyazıt University Health Sciences Institute). google scholar
  • Bulgurcu, B., & Özdemir, P. (2015). Geçiş ekonomilerinde sağlık harcamalarının etkinliği üzerine bir inceleme. Ege Academic Review, 15(4), 523-537. google scholar
  • Caves, D. W., Christensen, L. R., & Diewert, W. E. (1982a). Multilateral comparisons of output, input, and productivity using superlative index numbers. The economic journal, 92(365), 73-86. google scholar
  • Caves, D. W., Christensen, L. R., & Diewert, W. E. (1982b). The economic theory of index numbers and the measurement of input, output, and productivity. Econometrica: Journal of the Econometric Society, 13931414. google scholar
  • Coelli, T. J., Rao, D. S. P., O’Donnell, C. J., & Battese, G. E. (2005). An introduction to efficiency and productivity analysis. Springer science & business media. google scholar
  • Cooper, W. W., Seiford, L. M., & Tone, K. (2006). Introduction to data envelopment analysis and its uses: with DEA-solver software and references. Springer Science & Business Media. google scholar
  • Cooper, W. W., Seiford, L. M., & Zhu, J. (2011). Data envelopment analysis: History, models, and interpretations. In Handbook on data envelopment analysis,1-39. Springer, Boston, MA. google scholar
  • Çakmak, M., Öktem, K., & Ömürgönülşen, U. (2009). The efficiency problem of turkish public hospitals: The measurement of technical efficiency of maternity hospitals by data envelopment analysis. Hacettepe Journal of Health Administration. 12(1), 1-36. google scholar
  • Depren, Ö. (2008). Veri zarflama analizi ve bir uygulama. Yüksek Lisans Tezi, Yıldız Teknik Üniversitesi Fen Bilimler Enstitüsü İstatistik Anabilim Dalı, İstanbul. google scholar
  • Dirik, C., & Şahin, S. (2020). Türkiye’deki sağlık hizmetlerinin etkinlik ve verimlilik analizi: radyal ve radyal olmayan VZA ve MVE modellerinin karşılaştırması. Süleyman Demirel Üniversitesi Vizyoner Dergisi, 11(28), 790-814. google scholar
  • Dyson, R. G., Allen, R., Camanho, A. S., Podinovski, V. V., Sarrico, C. S., & Shale, E. A. (2001). Pitfalls and protocols in DEA. European Journal of Operational Research, 132(2), 245-259. google scholar
  • Ecevit, E., & Çiftci, F. (2008). The relationship between health and economic growth in terms of cointegration and causality tests: the case of Turkey, 1960-2005. International Sustainable Development Strategies, 17-19. google scholar
  • Farrell, M. J. (1957). The measurement of productive efficiency. Journal of the Royal Statistical Society: Series A (General), 120(3), 253-281. google scholar
  • Gök, M. S., & Sezen, B. (2013). Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: the case of public hospitals in Turkey. Health policy, 111(3), 290-300. google scholar
  • Grifell-Tatjé, E., & Lovell, C. K. (1995). A note on the Malmquist productivity index. Economics letters, 47(2), 169175. google scholar
  • Kutlar, A., & Kartal, M. (2004). Efficiency analysis of Cumhuriyet University: An application with data envelopment method at faculties level. Kocaeli University Journal of Social Sciences, (8), 49-79. google scholar
  • Li, J., Zhao, M., & Jiang, K. (2009, November). Empirical analysis of the determinants of health care expenditure in China based on co-integration and error-correction model. In 2009 IEEE International Conference on Grey Systems and Intelligent Services (GSIS 2009) (pp. 1710-1714). IEEE. google scholar
  • Liu, W., Xia, Y., & Hou, J. (2019). Health expenditure efficiency in rural China using the super-SBM model and the Malmquist productivity index. International journal for equity in health, 18(1), 1-13. google scholar
  • Malmquist, S. (1953). Index numbers and indifference surfaces. Trabajos de Estadística, 4(2), 209-242. google scholar
  • Masri, M. D., & Asbu, E. Z. (2018). Productivity change of national health systems in the WHO Eastern Mediterranean region: application of DEA-based Malmquist productivity index. Global health research and policy, 3(1), 1-13. google scholar
  • Mirmirani, S. (2008). Health care efficiency in transition economies: an application of data envelopment analysis. International Business & Economics Research Journal, 7(2), 47-56. google scholar
  • Mirmirani, S., & Lippmann, M. (2004). Health care system efficiency analysis of G12 countries. International Business & Economics Research Journal (IBER), 3(5). google scholar
  • Mutlu, A., & Işık, A.K. (2005). Sağlık ekonomisine giriş, Ekin Yayınları, Bursa. google scholar
  • Önder, B. (2013). Türk sağlık reformları kapsamında sağlıkta dönüşüm programının incelenmesi (Master’s thesis, Adnan Menderes Üniversitesi, Sosyal Bilimler Enstitüsü). google scholar
  • Özgen, Narcı, H., Özcan, Y. A., Şahin, İ., Tarcan, M., & Narcı, M. (2015). An examination of competition and efficiency for hospital industry in Turkey. Health care management science, 18(4), 407-418. google scholar
  • Özyakışır, D. (2011). Beşeri sermayenin ekonomik kalkınma sürecindeki rolü: teorik bir değerlendirme. Girişimcilik ve Kalkınma Dergisi, 6(1), 46-71. google scholar
  • Popescu, C., Asandului, L., & Fatulescu, P. (2014). A data development analysis for evaluating Romania’s health system. Procedia-Social and Behavioral Sciences, 109, 1185-1189. google scholar
  • Rao, D. P., & Coelli, T. J. (2004). Catch-up and convergence in global agricultural productivity. Indian Economic Review, 123-148. google scholar
  • Ruggiero, J., & Bretschneider, S. (1998). The weighted Russell measure of technical efficiency. European Journal of Operational Research, 108(2), 438-451. google scholar
  • Sajadi, H. S., Goodarzi, Z., Takian, A., Mohamadi, E., Olyaeemanesh, A., Hosseinzadeh Lotfi, F., ... & Majdzadeh, R. (2020). Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis. Cost Effectiveness and Resource Allocation, 18, 1-11. google scholar
  • Seiford, L. M. (1997). A bibliography for data envelopment analysis (1978-1996). Annals of Operations Research, 73, 393-438. google scholar
  • Şahin, B., & İlgün, G. (2019). Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis. Health care management science, 22, 437-446. google scholar
  • Talluri, S. (2000). Data envelopment analysis: models and extensions. Decision Line, 31 (3), 8-11. google scholar
  • Telli, R., & Kan, E. (2022). Measuring agricultural production efficiency in G8 countries and Turkey. Current Researches in Social Sciences II. 17-28. google scholar
  • Temiz, D., & Korkmaz, S. (2007). Türkiye’de sağlık ve ekonomik büyüme ilişkisi: 1965-2005. TUIK 16’ncı İstatistik Araştırmaları Sempozyumu, 266–278. google scholar
  • Temur, Y. (2008). An analysis of the health organization in Turkey: A dea application. Journal of Social Sciences. (3), 261-82. google scholar
  • Uluç, C. İ., & Ferman, M. (2016). A comparative analysis of user insights for e-health development challenges in Turkey, Kingdom of Saudi Arabia, Egypt and United Arab Emirates. Journal of Management Marketing and Logistics, 3(2), 176-189. google scholar
  • Yayla, Z., & Çavlin, A. (2019). Bebek ölümlerindeki MERNİS kayıtlarının tamlık yüzdesi: illerin insani gelişme düzeyi farklılığı açıklar mı?. Türkiye Halk Sağlığı Dergisi, 17(3), 279-293. google scholar
  • Yeşilyurt, Ö., & Salamov, F. (2017). Türk devletleri sağlık sistemlerinde etkinliğin ve etkinliğe etki eden faktörlerin süper etkinlik ve tobit modelleriyle değerlendirilmesi. In III. IBANESS Congress Series-Edirne/Türkiye, 852863. google scholar
  • Zhang, L., Cheng, G., Song, S., Yuan, B., Zhu, W., He, L., ... & Meng, Q. (2017). Efficiency performance of China’s health care delivery system. The International journal of health planning and management, 32(3), 254-263. google scholar

Atıflar

Biçimlendirilmiş bir atıfı kopyalayıp yapıştırın veya seçtiğiniz biçimde dışa aktarmak için seçeneklerden birini kullanın


DIŞA AKTAR



APA

Telli, R., & Serin, Z.V. (2023). G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz. İktisat Politikası Araştırmaları Dergisi, 10(1), 281-302. https://doi.org/10.26650/JEPR1227842


AMA

Telli R, Serin Z V. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz. İktisat Politikası Araştırmaları Dergisi. 2023;10(1):281-302. https://doi.org/10.26650/JEPR1227842


ABNT

Telli, R.; Serin, Z.V. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz. İktisat Politikası Araştırmaları Dergisi, [Publisher Location], v. 10, n. 1, p. 281-302, 2023.


Chicago: Author-Date Style

Telli, Resul, and Zehra Vildan Serin. 2023. “G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz.” İktisat Politikası Araştırmaları Dergisi 10, no. 1: 281-302. https://doi.org/10.26650/JEPR1227842


Chicago: Humanities Style

Telli, Resul, and Zehra Vildan Serin. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz.” İktisat Politikası Araştırmaları Dergisi 10, no. 1 (Feb. 2024): 281-302. https://doi.org/10.26650/JEPR1227842


Harvard: Australian Style

Telli, R & Serin, ZV 2023, 'G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz', İktisat Politikası Araştırmaları Dergisi, vol. 10, no. 1, pp. 281-302, viewed 21 Feb. 2024, https://doi.org/10.26650/JEPR1227842


Harvard: Author-Date Style

Telli, R. and Serin, Z.V. (2023) ‘G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz’, İktisat Politikası Araştırmaları Dergisi, 10(1), pp. 281-302. https://doi.org/10.26650/JEPR1227842 (21 Feb. 2024).


MLA

Telli, Resul, and Zehra Vildan Serin. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz.” İktisat Politikası Araştırmaları Dergisi, vol. 10, no. 1, 2023, pp. 281-302. [Database Container], https://doi.org/10.26650/JEPR1227842


Vancouver

Telli R, Serin ZV. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz. İktisat Politikası Araştırmaları Dergisi [Internet]. 21 Feb. 2024 [cited 21 Feb. 2024];10(1):281-302. Available from: https://doi.org/10.26650/JEPR1227842 doi: 10.26650/JEPR1227842


ISNAD

Telli, Resul - Serin, ZehraVildan. G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir Analiz”. İktisat Politikası Araştırmaları Dergisi 10/1 (Feb. 2024): 281-302. https://doi.org/10.26650/JEPR1227842



ZAMAN ÇİZELGESİ


Gönderim01.01.2023
Kabul16.01.2023
Çevrimiçi Yayınlanma31.01.2023

LİSANS


Attribution-NonCommercial (CC BY-NC)

This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.


PAYLAŞ




İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.