Sağlık sistemlerinin iktisadi analizi: Latin Amerika örneği

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Thesis Type: Doctorate

Institution Of The Thesis: Yildiz Technical University, Graduate School of Social Sciences, Economy, Turkey

Approval Date: 2024

Thesis Language: Turkish

Student: NİHAT ÇAĞRI YAZAR

Supervisor: Tolga Aksoy

Abstract:

The 2008 global crisis and the rise in global public indebtedness following the Covid-19 crisis have turned attention to health expenditures, one of the most important items of the public budget, and increasing efficiency in health systems has become one of the most important policy issues of today. Eliminating systemic inefficiencies will lead to better health outcomes with the same resources. Research in this field generally classifies countries' health systems and tries to guide policymakers in resource allocation through efficiency analysis to determine which policies and institutions produce more successful outcomes. The related literature has focused on OECD countries, but there is a gap in this area for Latin American countries, and my thesis is an attempt to fill this gap. In the second and third parts of my thesis, general information on health system classifications in the literature and Latin American health systems is given. In the fourth part, a hierarchical agglomerative clustering analysis was performed through 13 system indicators (policies) that I calculated for 21 Latin American countries based on the data of the OECD Health System Characteristics survey in 2018, and two main country groups were identified. The most important policies that differentiated the groups were the right to choose suppliers, gatekeeping practices, budget discipline, and Health Technology Assessment practices. This section also compares the policies of Latin American countries with those of OECD countries. In the fifth section, technical efficiency is calculated and ranked for these Latin American countries using Stochastic Frontier Analysis (Pitt and Lee, 1981 model) and panel data (2000-2019). "Life expectancy at birth" and "infant mortality rates" are used to represent the outputs (health outcomes) of the health production process. Two different models were created based on these variables and the results were confirmed in this way. Among the input variables, per capita health expenditures, specialist-assisted birth rates and the level of financial protection of citizens were significant in both models. Costa Rica and Chile share the first two places in the country ranking in both models. It is believed that the more efficient use of health resources in these countries is due to their higher overall institutional quality rather than the health policies implemented. On average, at the same level of inputs, if all countries were at the production frontier, there is potential for a 6% improvement in life expectancy (4.8 years) and a 48% improvement in infant survival rate (7.4 babies saved before the age of one per 1,000 live births).