KAMU SAĞLIK HARCAMALARININ ÖZEL SEKTÖR SAĞLIK HARCAMALARINA YÖNELİK DIŞLAMA VE DESTEKLEME ETKİSİ: TÜRKİYE İÇİN AMPİRİK BİR ANALİZ

Bu çalışma, Türkiye’de kamu sağlık harcamalarının, özel sektör sağlık harcamalarına yönelik dışlama ve destekleme etkisini belirlemeyi amaçlamaktadır. Analizlerde, VECM (Vektör Hata Düzeltme) modelinden yararlanılmıştır. Analiz verileri 1999q1-2018q4 dönemlerini kapsamaktadır. Modelin değişkenleri özel sektör sağlık harcamaları, kamu toplam sağlık yatırımları, kamu cari sağlık harcamaları, gayri safi yurtiçi hasıla, tüketici fiyat endeksi ve faiz oranından oluşmaktadır. Değişkenlere ilişkin analiz sonuçlarına göre, kısa ve uzun dönemde, kamu toplam sağlık yatırımlarının, özel sektör sağlık harcamalarına yönelik dışlama etkisi oluşturduğu, kamu cari sağlık harcamalarının, özel sektör sağlık harcamalarına yönelik destekleme etkisine neden olduğu sonucuna varılmıştır. Kısa dönemde, kamu toplam sağlık yatırımlarının dışlama etkisi, kamu cari sağlık harcamalarının destekleme etkisine göre daha büyükken, uzun dönemde, kamu cari sağlık harcamalarının destekleme etkisinin, kamu toplam sağlık yatırımlarının dışlama etkisine göre daha büyük olduğu sonucu bulunmuştur.

Anahtar Kelimeler:

Dışlama Etkisi, Destekleme Etkisi, Kamu Sağlık Harcamaları, Özel sektör Sağlık Harcamaları, Türkiye

CROWDING OUT AND CROWDING IN EFFECT OF PUBLIC HEALTH EXPENDITURES ON PRIVATE HEALTH EXPENDITURES: AN EMPIRICAL ANALYSIS FOR TURKEY

This study aims to determine the crowding-out and crowding-in effect of public health expenditures on private sector health expenditures in Turkey. In the analyzes, VEC (Vector Error Correction) model was used. Analysis data covers the period between 1999q1-2018q4. The variables of the model are private sector health expenditures, public total health investments, public current health expenditures, gross domestic product, consumer price index and interest rate. According to the analysis results of the variables, it is concluded that, in the short and long term, public total health investments have an crowding-out effect on private sector health expenditures, while public current health expenditures have an crowding-in effect on private sector health expenditures. While the crowding-out effect of total public health investments in the short run is greater than the crowding-in effect of public current health expenditures, it is found that in the long run, the crowding-in effect of public current health expenditures is greater than the crowding-out effect of public total health investments

Keywords:

Crowding-out, Crowding-in, Public Health Expenditures, Private Health Expenditures, Turkey,

PDF

___

Agyei, S.K. (2019). Assessing the bi-causal relationship between private investment and public investment in SSA: Evidence from panel vector autoregression approach, Journal of Economics and Sustainable Development, 10(12), 8-19. https://doi.org/10.7176/JESD.
Ahmed, H. & Miller S.M. (2000). Crowding out and crowding in effects of the components of government expenditure. Contemporary Economic Policy, 18(1), 124-133.https://doi.org/10.1111/j.1465-7287.2000.tb00011.x.
Akdur, R. (2005, Ağustos 8). Türkiye’de sağlık hizmetleri ve Avrupa topluluğu ülkeleri ile kıyaslanması. http://www.recepakdur.com/upload/ab_turkiye_kiyaslamasi.pdf.
Awaworyi, S., Yew S.L. & Uğur M. (2015). Effects of government education and health expenditures on economic growth: A meta-analysis. Greenwich Paper In Political Economy, No: GPERC21.
Bahal, G., Raissi, M. & Tulin V. (2018). Crowding-out or crowding-in? Public and private investment in India. World Development, 109, 323-333. https://doi.org/10.1016/j.worlddev.2018.05.004.
Bakırtaş, İ. (2015). Kamu harcamalarının temel makroekonomik göstergelerle ilişkisi ve nedenselliği (1983-2000 Türkiye Örneği). Dumlupınar Üniversitesi Sosyal Bilimler Dergisi, 9(9), 41-46.
Barwick, P.J., Li, S., Rao D. & Zahur, N.B. (2018). The morbidity cost of air pollution: Evidence from consumer spending in China (No. W24688). National Bureau of Economic Research, Working Paper 24688. http://dx.doi.org/10.2139/ssrn.2999068.
Bernell, S. (2016). Health Economics : Core Concepts and Essential Tools. Health Administration Press.
Boyce, T. & Brown, C. (2019). Economic and Social Impacts and Benefits of Health Systems. WHO Regional Office for Europe.
Bulut, E. & Coşkun, Ç. (2015). Doğrudan yabancı sermaye yatırımlarının yerli yatırımlar üzerine etkileri: Türkiye uygulaması. Ömer Halisdemir Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 8(4), 1-27.
Chen, T., Liu, L.X. & Zhou, L.A. (2015). The crowding-out effects of real estate shocks–evidence from China. SSRN eLibrary, Available at SSRN 2584302. https://dx.doi.org/10.2139/ssrn.2584302.
Choi, J.W., Park, E.C., Yoo, K.B., Lee, S.G., Jang, S.I. & Kim, T.H. (2015). The effect of high medical expenses on household income in South Korea: A longitudinal study using propensity score matching. BMC Health Services Research, 15(1), 369. https://doi.org/10.1186/s12913-015-1035-5.
Cogan, J.F., Cwik, T., Taylor J.B. & Wieland V. (2010). New Keynesian versus old Keynesian government spending multipliers. Journal of Economic Dynamics and Control, 34(3), 281-295.https://doi.org/10.3386/w14782.
Çelik, Y. (2013). Sağlık Ekonomisi (Gözden Geçirilmiş 2. baskı). Siyasal Kitabevi.Dhrifi, A. (2018). Health-care expenditures, economic growth and infant mortality: Evidence from developed and developing countries. CEPAL Review, No:125.https://doi.org/10.18356/02c1a26c-en.
Fonseca, F., Gómez-Zaldívar, M. & Ventosa-Santaulària, D. (2019). Public investment and economic activity in Mexico, 1925-1981. Economics Discussion Papers, 14(2020-6), 1-24. https://doi.org/ 10.5018/economics ejournal.ja.2020-6.
Gruber, J. & Simon, K. (2008). Crowd-out 10 years later: Have recent public ınsurance expansions crowded out private health insurance? Journal of Health Economics, 27(2), 201-217.https://doi.org/10.3386/w12858.
Hassett, K.A. (2009). Why fiscal stimulus ıs unlikely to work. International Finance, 12(1), 75-91.https://doi.org/10.1111/j.1468-2362.2009.01237.x.
Hayran, O. & Sur, H. (1998). Sağlık ve Hastalık Kavramları: Sağlık Hizmetleri El Kitabı (1. baskı). Hiperlink.
Hussain, A., Muhammad, S.D., Akram, K. & Lal, I. (2009). Effectiveness of government expenditure crowding-in or crowding-out: Empirical evidence in case of Pakistan. European Journal of Economics, Finance and Administrative Sciences, 16, 143-149.
Hossain, S. (2012, Haziran 1). Impuse response function. youtube.com/watch?v=uPyRD3uu_ww.
Hossain, S. (2014, Haziran 1). Variance decomposition in VAR.youtube.com/watch?v=BwxnMBSEu4o.
Kalantary, R.R., Jamshidi, A., Mofrad, M.M.G., Jafari, A.J., Heidari, N., Fallahizadeh, S., Arani, M.H. & Torkashvand, J. (2021). Effect of covid-19 pandemic on medical waste management: A case study. Journal of Environmental Health Science and Engineering, 1-6. https://doi.org/10.1007/s40201-021-00650-9.
Katsaitis, O. (1987). The crowding out debate. Journal of Post Keynesian Economics, 9(3), 473-476.
Keho, Y. (2019). Impact of government spending on private consumption: Evidence from ecowas countries”, Modern Economy, 10(03), 600-614. https://doi.org/10.4236/me.2019.103041.
Kruse, I., Pradhan, M. & Sparrow, R. (2012). Marginal benefit incidence of public health spending: Evidence from Indonesian sub-national data. Journal of Health Economics, 31(1), 147-157. https://doi.org/10.1016/j.jhealeco.2011.09.003.
Kurt, S. (2015). Government health expenditures and economic growth: A feder-ram approach for the case of Turkey. International Journal of Economics and Financial Issues, 5(2), 441-447.
Lavoie, M. (2009). Introduction to Post-Keynesian Economics. Palgrave Macmillan.
Mahmoudzadeh, M., Sadeghi S. & Sadeghi, S. (2017). Fiscal spending and crowding out effect: A comparison between developed and developing countries. Institutions and Economies, 5(1), 31-40.
Makuyana, G. & Odhiambo, N.M. (2019). Public and private investment and economic growth in
Malawi: An ARDL-bounds testing approach. Economic Research-Ekonomska Istraživanja, 32(1), 673-689. https://doi.org/10.1080/1331677X.2019.1578677.
Mankiw, N.G. & Taylor, M.P. (2011). Economics. Cengage Learning.
Masten, I. & Gnip, A.G. (2019). Macroeconomic Effects of public ınvestment in South-East Europe. Journal of Policy Modeling, 41(6), 1179-1194. https://doi.org/10.1016/j.jpolmod.2019.05.005.
Michl, T.R. (2015). Macroeconomic Theory: A Short Course. Routledge.
Moreno-Luna, L., Robina-Ramírez, R., Sánchez, M.S.O. & Castro-Serrano, J. (2021). Tourism and sustainability in times of covid-19: The case of Spain. International Journal of Environmental Research and Public Health, 18(4), 1859. https://doi.org/10.3390/ijerph18041859.
Rees, H. (2017). Managerial Economics. Library Press.
Semercigil, N. (2015). Ülke gelirleri sağlık harcamalarını etkiliyor mu? Dirim Tıp Gazetesi, 305, 28-31.
Siami-Namini, S. (2018). Healthcare expenditure, economic growth, and inflation in The G7 Countries: A panel cointegration approach. Research Journal of Economics, 2(2), 1-8.
Sloan, F.A. & Norton, E.C. (1997). Adverse selection, bequests, crowding out, and private demand for insurance: Evidence from the long-term care insurance market. Journal of Risk and Uncertainty, 15(3), 201-219. https://doi.org/10.1023/A:1007749008635.
Strupat, C. & Klohn, F. (2018). Crowding out of solidarity? Public Health ınsurance versus informal transfer networks in Ghana. World Development, 104, 212-221. https://doi.org/10.1016/j.worlddev.2017.11.004.
Şen, H. & Kaya, A. (2014). Crowding-out or crowding-in? Analyzing the effects of government spending on private investment in Turkey. Panoeconomicus, 61(6), 631-651. https://doi.org/10.2298/PAN1406631S.
Şimşek, M. (2003). Kamu harcamalarının özel yatırımlara etkileri, 1970-2001. C.Ü. İktisadi ve İdari Bilimler Dergisi, 4(2), 1-20.
T.C. Sağlık Bakanlığı Sağlık İstatistik Yıllıkları (2019, 15 Aralık), yıllara göre katastrofik sağlık harcaması, (%). https://www.saglik.gov.tr/TR,11588/istatistik-yilliklari.html.
The Organisation for Economic Co-operation and Development [OECD] (2020, 5 Şubat),https://data.oecd.org/healthres/health-spending.html.
The World Bank (2020, Kasım 1), Current Health Expenditure, (% of GDP).https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS.
Tülümce, S. & Buyrukoğlu, S. (2013). Türkiye’de kamu ve özel yatırımlar arasındaki ilişkinin ampirik analizi: Dışlama etkisi (1980-2010). İstanbul Serbest Muhasebeci Mali Müşavirler Odası Mali Çözüm Dergisi, 119, 59-77.
Türkiye İstatistik Kurumu [TÜİK] (2020, 1 Aralık), Sağlık harcamaları istatistikleri, 2019. http://www.tuik.gov.tr/PreTablo.do?alt_id=1084.
Umoru, D. & Yaqup, J.O. (2013). Private and public health capital expenditures in Nigeria: An empirical test of the relationship. American Academic & Scholarly Research Journal, 5(1), 83.
United Nation [UN] (2020, 5 Şubat), Life expectancy at birth for both sexes combined (years).http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3A68.
Ünsal, M.E. (2020). Crowding-out effect: Evidence from OECD countries. İstanbul İktisat Dergisi, 70(1), 1-16. https://doi.org/10.26650/ISTJECON2020-0001.
Van der Ploeg, F. (2005). Back to Keynes? CESifo Economic Studies, 51(4), 777-822. https://doi.org/10.1093/cesifo/51.4.777.
Wellay, T., Gebreslassie, M., Mesele, M., Gebretinsae, H., Ayele, B., Tewelde, A. & Zewedie, Y. (2018). Demand for Health care service and associated factors among patients in The Community of Tsegedie District, Northern Ethiopia. BMC Health Services Research, 18(1), 697. https://doi.org/10.1186/s12913-018-3490-2.
World Health Organization [WHO] (2020, 10 Ekim), Global health expenditure database.https://apps.who.int/nha/database/Select/Indicators/en.
Yalçıner, K. & Coşkun, Y. (2014). İpotekli konut finansmanı sisteminin gelişme koşulları: Türkiye için ampirik bir analiz. İktisat İşletme ve Finans, 29(340), 27-68.https://doi.org/10.3848/iif.2014.339.3839.
Ying, Y.H. & Chang, K. (2020). The effect of national health insurance on private health expenditure in Taiwan: Crowd in or crowd out? Journal of the Asia Pacific Economy,25(2), 371-385.https://doi.org/10.1080/13547860.2019.1665327