Türkiye'de kamu ve özel hastanelerin sosyal güvenlik kesimi üzerindeki ekonomik etkileri
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma, Türkiye'de kamu ve özel hastanelerin sosyal güvenlik kesimi üzerindeki ekonomik etkilerini 2014–2024 dönemi aylık veriler üzerinden incelemektedir. Çalışmada kamu, özel ve üniversite hastanelerine ilişkin vaka başı maliyetler, reçete başı maliyetler ve sağlık ödemeleri karşılaştırmalı olarak analiz edilmiştir. Ekonometrik yöntemler kapsamında ADF, PP ve RALS-ADF birim kök testleri ile değişkenlerin durağanlığı sınanmış; uzun dönemli ilişkiler Engle-Granger ve RALS-EG eşbütünleşme analizleriyle değerlendirilmiştir. Ayrıca, uzun dönem katsayı tahminleri FMOLS, DOLS ve CCR yöntemleriyle yapılmıştır. Bulgular hem kamu hem de özel hastanelerde maliyetlerin yıllar içinde artış eğiliminde olduğunu, ancak özel hastanelerin hasta başı maliyetlerinin belirgin şekilde daha yüksek seyrettiğini göstermektedir. Sosyal güvenlik kesiminin kamu hastanelerine yaptığı toplam sağlık ödemeleri mutlak olarak daha yüksek olmakla birlikte, özel sektördeki maliyet yükü birim başına daha ağırdır. COVID-19 pandemisi döneminde mali göstergelerde dikkat çekici dalgalanmalar yaşanmıştır. Çalışma, sağlık hizmetlerinin sürdürülebilir finansmanı için maliyet-etkililik temelli ödeme modellerinin benimsenmesi, kamu hastanelerinin kapasite ve hizmet kalitesinin artırılması, özel hastanelerle yapılan sözleşmelerde şeffaflık ve denetim mekanizmalarının güçlendirilmesi gibi politika önerileri sunmaktadır. Sonuç olarak, sosyal güvenlik kesiminin mali dengelerinin korunabilmesi için hem kamu hem de özel sektörün rolünü dikkate alan bütüncül sağlık politikalarına ihtiyaç duyulduğu vurgulanmaktadır. Anahtar Kelimeler: Sosyal Güvenlik Kesimi, Kamu Hastaneleri, Özel Hastaneler, Sağlık Ödemeleri
This study examines the economic effects of public and private hospitals on the social security sector in Turkey using monthly data from the 2014–2024 period. The study comparatively analyzes per-case costs, per-prescription costs, and health payments for public, private, and university hospitals. Within the scope of econometric methods, the stationarity of the variables was tested using ADF, PP, and RALS-ADF unit root tests; long-term relationships were evaluated using Engle-Granger and RALS-EG cointegration analyses. In addition, long-term coefficient estimates were made using FMOLS, DOLS and CCR methods. The findings show that costs have tended to increase over the years in both public and private hospitals, but that per-patient costs in private hospitals have been significantly higher. Although total health payments made by the social security sector to public hospitals are higher in absolute terms, the cost burden per unit is heavier in the private sector. Notable fluctuations in financial indicators were observed during the COVID-19 pandemic. The study proposes policy recommendations for the sustainable financing of healthcare services, including the adoption of cost-effectiveness-based payment models, increasing the capacity and service quality of public hospitals, and strengthening transparency and oversight mechanisms in contracts with private hospitals. In conclusion, it is emphasized that comprehensive health policies that take into account the role of both the public and private sectors are needed to maintain the financial balance of the social security sector. Keywords: Social Security Sector, Public Hospitals, Private Hospitals, Health Payments
This study examines the economic effects of public and private hospitals on the social security sector in Turkey using monthly data from the 2014–2024 period. The study comparatively analyzes per-case costs, per-prescription costs, and health payments for public, private, and university hospitals. Within the scope of econometric methods, the stationarity of the variables was tested using ADF, PP, and RALS-ADF unit root tests; long-term relationships were evaluated using Engle-Granger and RALS-EG cointegration analyses. In addition, long-term coefficient estimates were made using FMOLS, DOLS and CCR methods. The findings show that costs have tended to increase over the years in both public and private hospitals, but that per-patient costs in private hospitals have been significantly higher. Although total health payments made by the social security sector to public hospitals are higher in absolute terms, the cost burden per unit is heavier in the private sector. Notable fluctuations in financial indicators were observed during the COVID-19 pandemic. The study proposes policy recommendations for the sustainable financing of healthcare services, including the adoption of cost-effectiveness-based payment models, increasing the capacity and service quality of public hospitals, and strengthening transparency and oversight mechanisms in contracts with private hospitals. In conclusion, it is emphasized that comprehensive health policies that take into account the role of both the public and private sectors are needed to maintain the financial balance of the social security sector. Keywords: Social Security Sector, Public Hospitals, Private Hospitals, Health Payments
Açıklama
Anahtar Kelimeler
Ekonomi, Economics
