Health care expenditures and gross domestic product: the Turkish case

Analysis of the coupling coordination between traditional Chinese medicine medical services and economy and its influencing factors in China

Background

The coordinative relationship between medical treatment and the economy is an important part of promoting the sustainable and healthy development of a social economy, and it is conducive to promoting the coordinated development of the two systems.

Methods

Based on constructing a comprehensive evaluation index system for the relationship between traditional Chinese medicine medical services and economic development, the entropy method, coupling coordination model, and Tobit model are used to calculate the comprehensive development level, coupling coordination degree, and influencing factors of the two systems in 31 provinces of China from 2015 to 2021. Suggestions are proposed for the coordinated development of traditional Chinese medicine medical services, and economy.

Results

The results showed that the development level of traditional Chinese medicine was higher than that of social and economic development, the relative development gap between the two systems was gradually narrowed, and the coupling coordination degree increased steadily; however, the regional differences were large. The relative development level and coupling coordination degree of each region show a development pattern of eastern > central > western > northeast; the coupling coordination degree of the two systems in the spatial region was positively correlated and was enhanced year by year. From the perspective of influencing factors, the level of economic development is the decisive factor in the coupling and coordination between traditional Chinese medicine medical treatment and the social economy. Factors such as human capital and health level in traditional Chinese medicine have an inhibitory effect on the coordinated development of the two systems.

Conclusion

So, China should focus on optimizing the regional allocation of traditional Chinese medicine medical personnel, improving the quality of medical services, and enhancing the health level of medical personnel.

The Relationship Between the Health Transformation Program and Health Expenditures: Evidence From an Autoregressive Distributed Lag Testing Approach

OBJECTIVES

As health expenditure increases every year, countries try to provide accessible health services to society and try to protect individuals from the expenses they cannot overcome by investigating the reason for this increase. Especially with the arrangements made in the health systems in developing countries such as Turkey, it has been tried to take the control of dramatic increases in health expenditure. Based on this issue, in this study, we aimed to evaluate the effect of income per capita, annual inflation, and health reform called as Health Transformation Program on the health expenditure per capita in Turkey.

METHODS

This study reflected the effects of income, inflation, and the reform on the total health expenditure through the autoregressive distributed lag. This study covered the years between 1985 and 2016 for Turkey.

RESULTS

As a result of this study, there was a positive relationship between health expenditure and income and a negative relationship with the reform (P < .05).

CONCLUSION

According to the results of this study, it is suggested that health expenditures can be kept under control with improvements such as encouraging individuals to use more primary healthcare services than curative health services and increasing the quality of service without compromising the equity in financing.

Population Aging, Health Investment and Economic Growth: Based on a Cross-Country Panel Data Analysis

With the economic development of various countries and the deepening of population aging, health plays an increasingly important role in the macro-economy. How to meet the growing health needs as well as promote the economy has captured the attention of the world. Therefore, whether health investment can promote economic growth is an important theoretical and practical issue. An extended Mankiw-Romer-Weil model (MRW) with human health capital and population aging is employed to examine the impact on economic growth from population aging and health investment. On the basis of the theoretical model, this paper uses the LSDV and TSLS methods to carry out an empirical study based on cross-country panel data during the period 2000-2016. The empirical results show that health investment plays a significant role in promoting economic growth, and there is an inverted U-shaped relationship between population aging and economic growth. The impacts on economic growth from health investment and population aging can weaken each other. In addition, this paper also finds that health investment structure and the proportion of government health investment to total government spending can affect economic growth.

Differentiation in Healthcare Financing in EU Countries

The main aim of this work was to identify and present the situation and changes in the level of expenditure on healthcare in the European Union in the years 2013–2017. This involved an analysis of the available literature on healthcare financing, data from the EUROSTAT database. For this work, the comparative method was used, dynamics indicators were used, the Gini concentration coefficient was calculated, and the degree of concentration was presented using the Lorenz curve. Pearson’s linear correlation coefficients were also used. A descriptive, tabular and graphic method was used to present the test results that were obtained. A high concentration of expenditure on healthcare was found in the EU countries with the largest population and that are the most economically developed. These results also relate to these expenses on a per capita basis. The main factor differentiating the level of healthcare financing was the level of economic development. This regularity was confirmed in the statement of expenditure per capita, the relationship between this expenditure and the value of GDP and the results obtained when calculating the correlation between expenditure and economic development. In addition to the economic situation, an important factor determining the amount of expenditure on healthcare was the percentage of the country’s population that are older people.

Health expenditure and growth dynamics in the SADC region: evidence from non-stationary panel data with cross section dependence and unobserved heterogeneity

This paper investigates the long run relationship between health care expenditure and economic growth, using panel data for 14 Southern African Development Community (SADC) member countries over the period 1995-2012. The non-stationarity and cointegration properties between health expenditure per capita and GDP per capita were examined, controlling for cross section dependence and heterogeneity between countries. Our results suggest that health expenditure and GDP per capita are non-stationary and cointegrated. These findings seem to confirm the notion that health expenditure is non-discretionary-health is a necessary good-in the SADC region. The estimated income elasticity is below unity but higher than what was obtained for the OECD regional grouping. The policy implication of our result is that adequate health care service provision should be a key objective of governmental intervention in the SADC region.

Convergence and determinants of health expenditures in OECD countries

This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.

The dynamic relationship between health expenditure and economic growth: is the health-led growth hypothesis valid for Turkey?

The well-known health-led growth hypothesis claims a positive correlation between health expenditure and economic growth. The aim of this paper is to empirically investigate the health-led growth hypothesis for the Turkish economy. The bound test approach, autoregressive-distributed lag approach (ARDL) and Kalman filter modeling are employed for the 1975-2013 period to examine the co-integration relationship between economic growth and health expenditure. The ARDL model is employed in order to investigate the long-term and short-term static relationship between health expenditure and economic growth. The results show that a 1 % increase in per-capita health expenditure will lead to a 0.434 % increase in per-capita gross domestic product. These findings are also supported by the Kalman filter model's results. Our findings show that the health-led growth hypothesis is supported for Turkey.

Variation in tonsillectomy rates by health care system type

OBJECTIVE

To analyze variation in tonsillectomy procedure rates between health care system types around the world.

STUDY DESIGN

International database analysis.

METHODS

The 2015 Organization for Economic Co-operation and Development (OECD) Health Statistics surgical procedures database was used to ascertain tonsillectomy procedure volumes for 31 countries. Each country's health system type and structure were classified by overall system type, and by health care regulation, financing, and provision methods. Each system type and structure variable were compared using the rate of tonsillectomy procedures per 100,000 citizens.

RESULTS

10.5 million tonsillectomy procedures completed between 1993 and 2014 were analyzed. Overall, social health insurance system types had higher total tonsillectomy rates versus other health care system types (p < 0.05 for each comparison). Health systems with private care provision had a higher procedure rate versus state provided care (159.1 vs. 131.1 per 100,000 citizens; p = 0.002). Health care systems with societal regulation and financing had a higher procedure count versus state regulated or financed care (regulation 193.3 vs. 139.7 per 100,000 citizens, p < 0.0001; financing 168.2 vs. 135.0 per 100,000 citizens, p = 0.0004).

CONCLUSIONS

The volume of tonsillectomy procedures is associated with a health care system's overall structure, regulation, financing, and provision methods. International health care systems with state mediated provision, regulation, and financing had lower tonsillectomy rates versus systems with private provision, and societal regulation or financing. Further study is needed to determine differences in indications for tonsillectomy between countries, but these results underscore potential variation in health care delivery in different systems.

Is income relevant for health expenditure and economic growth nexus?

This paper examines the relationship between health expenditure and economic growth using panel data consisting low and high-income countries. Using dynamic panel data methodology, we analyze twenty five high-income and nineteen low-income economies for the periods of 1995-2012 and 1997-2009, respectively. We find reciprocal relationship between health expenditure and economic growth in the short run and one-way causality from economic growth to public health expenditure in the long-run. In high-income countries, there is a two-way causality for both private and public health expenditures in the short-run, while in the long-run there is a one-way causality between economic growth and private health expenditures. The crucial finding of this study is that private health expenditures have negative influence on economic growth while public health expenditures have both negative and statistically significant effect.

Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system

This paper analyzes the effects of the pay for performance (PFP) system on the efficiencies of public and private hospitals in Turkey. In order to evaluate these effects, we examine the relationship between hospital efficiency and health care costs in Turkey, and address the impact of the PFP system on the efficiencies of public and private hospitals. In an effort to analyze the efficiencies of public and private hospitals, this study uses data envelopment analysis. The Malmquist Productivity Index is also used to analyze the patterns of efficiency change for the study years from 2001 to 2008. This study shows that health care costs and hospital efficiency are negatively correlated for private hospitals, while they are positively correlated for public hospitals. In other words, increased health care costs might reduce efficiency in private hospitals in contrast to public hospitals. Our findings also indicate that average efficiencies of public hospitals tend to increase, particularly during the implementation period of PFP system. The efficiency trend of private hospitals, conversely, decreased in the latter periods of the PFP system. Suggestions for improvement are provided to the health care policy makers regarding the impact of health care reforms on public and private hospitals.

Turkish health system reform from the people's perspective: a cross sectional study

Background

Since 2003, Turkey has implemented major health care reforms to develop easily accessible, high-quality, efficient, and effective healthcare services for the population. The purpose of this study was to bring out opinions of the Turkish people on health system reform process, focusing on several aspects of health system and assessing whether the public prefer the current health system or that provided a decade ago.

Methods

A cross sectional survey study was carried out in Turkey to collect data on people’s opinions on the healthcare reforms. Data was collected via self administered household’s structured questionnaire. A five-point Likert-type scale was used to score the closed comparative statements. Each statement had response categories ranging from (1) “strongly agree” to (5) “strongly disagree.” A total of 482 heads of households (response rate: 71.7%) with the mean age of (46.60 years) were selected using a multi stage sampling technique from seven geographical regions in Turkey from October 2011 to January 2012. Multiple logistic regressions were performed to identify significant contributing factors in this study.

Results

Employing descriptive statistics it is observed that among the respondents, more than two third of the population believes that the changes have had positive effects on the health system. A vast majority of respondents (82.0%) believed that there was an increase in accessibility, 73.7% thought more availability of health resources, 72.6% alleged improved quality of care, and 72.6% believed better attitude of politician/mass media due to the changes in the last 10 years. Indeed, the majority of respondents (77.6%) prefer the current health care system than the past. In multivariate analysis, there was a statistically significant relationship between characteristics and opinions of the respondents. The elderly, married females, perceived themselves healthy and those who believe that people are happier now than 10 years ago have a more positive opinion of the changes. While, the single unemployed from rural region who perceived themselves as unhealthy and believe that people are unhappy now compare to ten years ago showed less positive opinions.

Conclusions

Hence, we conclude that from the people’s perspective overall the health system reforms were most likely successful.

Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: the case of public hospitals in Turkey

OBJECTIVE

This paper empirically analyzes the effects of efficiency and structural quality on patient satisfaction in Turkish public hospitals. It also investigates the controversial relationship between hospital efficiency and structural quality for small, medium and large size hospitals in a comparative perspective.

METHODS

Data envelopment analysis (DEA) is used to analyze the efficiencies of hospitals. Data concerning 523 public hospitals is obtained from Turkish Ministry of Health. Due to the missing data of some hospitals, the sample of this study is composed of the remaining 348 observations. Multiple regression analysis is used to evaluate the relationship between patient satisfaction as a dependent variable and structural quality, hospital efficiency and institutional factors as independent variables. Furthermore, stepwise process multiple regression analysis is used to analyze the moderator effects of hospital efficiency on the form of the relationship between quality and satisfaction.

FINDINGS

The findings indicate that hospital efficiency changes the form of the relationship between structural quality and patient satisfaction as a moderator variable. The trade-off between quality and efficiency is found to vary depending on the hospital size. Negative correlation is found between quality and efficiency for small-size hospitals. However, positive correlation between efficiency and quality is found significant as indicated by Total Quality Management (TQM) approach for large-size hospitals. This study also provides the empirical evidence on the negative relationship between patient satisfaction and hospital size.

CONCLUSIONS

The effect of hospital efficiency on patient satisfaction might be improved for inefficient small and medium size hospitals by taking successful large hospitals as role models.

The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals

This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals.

Is health care a luxury or a necessity or both? Evidence from Turkey

This study investigates the effect of per capita income on per capita health expenditures in Turkey over the period 1975-2007 by using ARDL bounds test approach to the cointegration considering both demand and supply side variables. Since we reject the null hypothesis that there is no cointegration among the series, we estimate long run and short run elasticities. The results show that while income has no effect on health expenditures in the long run, it is a necessity good in the short run that is a 1% increase in per capita income creates an 0.75% increase in per capita health expenditures. On the other hand, by examining the coefficient of demand and supply side variables, we found that average length of stay and number of physicians has negative effect, percentage of older people has positive effect and infant mortality rate has no effect on health expenditures in both short and long runs.