OECD ÜLKELERİNİN ULUSAL SAĞLIK SİSTEMLERİNİN ZAMANA DAYALI PERFORMANSININ DEĞERLENDİRİLMESİ
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In this study, technical efficiency levels of national health systems in the Organization for Economic Co-operation and Development (OECD) countries and the factors affecting the technical efficiency levels were revealed by Data Envelopment Analysis (DEA) and some panel Tobit regressions for the period of 2000-2016. Four different models were created in DEA. In the first model, only variables related to health systems were used. Among the input variables of the first model, economic indicators and then variables related to behavioral risk factors were added separately and so the second and the third models were created respectively. Finally, the fourth model was created by adding variables related to economic indicators and behavioral risk factors at the same time among the input variables of the first model. In panel Tobit regressions, the effects of economic, sociodemographic, behavioral, physical environmental, social security and health care utilization indicators on the DEA scores were examined. The second stage analyzes were carried out with the panel data belonging 2000-2005, 2006-2011 and 2012-2016 periods, so that the periodic changes could be revealed while measuring the effect of independent variables on the DEA scores. Only the first model was included in the second-stage analyzes due to the high correlation between the DEA models. According to the findings, per capita income by purchasing power parity (in $), the unemployment rate, the ratio of the university graduate population, the proportion of the population benefiting from regular and safely managed sanitation services and the measles vaccination rate statistically significantly and positively affected the technical efficiency levels of health systems (p<0.05). On the other hand, the Gini Coefficient, the 2008 global economic crisis, the proportion of dependent population, the amount of municipal waste per capita (in kg), alcohol consumption, smoking, obesity, out-of-pocket health expenditure (as the percentage of total health expenditure) and the governmental social security contribution (as the percentage of gross domestic product) had a statistically significant and negative effect on the technical efficiency levels of health systems (p<0.05). Governments should take steps to remove the obstacles to the utilization of health care services in times of economic crisis and when income decreases are exprienced. Since the demand for health care services are higher in societies with a high ratio of dependent population, the obstacles to the service demand of these individuals should be removed. Governments should take measures to enable individuals to spend less out-of-pocket health spending. Binge alcohol drinking, smoking and obesity are among the main health problems which many countries encounter. Governments should seek to overcome this problem through community based educational activities. Municipalities should dispose of their waste in a way that does not harm the environment and people's health and should provide sanitation services to the whole society equally. Vaccination is among the important factors affecting the health status of societies. Governments should pay attention to vaccination and take convincing steps against anti-vaccine groups.