G-8 Ülkeleri ile Türkiye Arasında Sağlık Harcamaları Verimliliği Üzerine Karşılaştırmalı Bir AnalizResul Telli, Zehra 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.
A Comparative Analysis on Healthcare Spending Efficiency Among the G-8 Countries and TurkeyResul Telli, Zehra 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.
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.