OECD LKELERNN SALIK SSTEM GSTERGELER AISINDAN BENZERLK

VE FARKLILIK ANALZ
INTRODUCTION
5:09 a11/p11HE WHO describes a health system as consisting of all the organizations, institutions,
resources, and people whose primary purpose is to improve health. It needs staff, funds,
information, supplies, transport, communications, and overall guidance and direction. And it needs
to provide services that are responsive and financially fair, while treating people decently
(Alva&ark., 2009). Strengthening health systems involves addressing key constraints related to
health worker staffing, infrastructure, health commodities (such as equipment and medicines),
logistics, tracking progress, and effective financing (WHO, 2007).
Salk sistemlerinin iyiletirilmesine ynelik almalar incelendiinde, almalarn etkinlie odakland ancak en iyi olarak gsterilebilecek tek bir yolun bulunmad grlr. Salk sistemi iinde
kullanlan kaynaklar yan sra lkeler aras corafi, kltrel ve demografik farkllklar, gelir
dalm, yaam tarz ve alkanlklar, teknolojik gelimeler ve eitim gibi salk d faktrlerin de
salk sistemleri zerinde etkili olduu bilinmektedir. (Tandon,2005)
The health sector, affects the future of society, has been a particularly important sector made
extensive studies on after 1960 in all countries of the world. New applications and system changes
are made to develop the health systems in many countries in the world (Kocak, 2011). Salk
hizmetine eriim, hakkaniyet, hizmetlerin etkinlii, salk politikalar performans vb. kritik
konularda verilerin tam ve zamannda elde edilmesiyle izleme ve deerlendirme yapmak mmkn
olmaktadr. Bu amala saylar binlerle ifade edilen gstergeler kullanlmaktadr. Hem gstergelerin
teknik eitlilii ve saysnn fazlal, hem de lkelerin salk sistemlerinin birbirinden farkl
olmas deneyimlerin aktarlmasn ve karlatrmay zorlatrmaktadr. So basic health indicators
are widely used in assessing the performance of health systems and the effectiveness of health
spending (Arslanhan, 2010) . This study was conducted in 34 OECD countries with analysis of the
similarities and differences with basic health indicators selected.
MATERIALS AND METHOD
In this study; the level of satisfaction with health services, out of pocket expenditures for health in
total consumption, health expenditure per capita, growth in health expenditures for 1 year, growth in
health expenditures for 5 years, total expenditure on health as a percentage of GDP, general
government expenditure on health as a percentage of total expenditure, neonatal mortality rate (per
1000 live births), life expectancy at birth, density of physicians per 1 000 population, density of
1

magnetic resonance imaging (MRI) units per 1000 000 population and hospital beds per 100 000
population of 34 OECD countries have been chosen and the data of these indicators have been
collected for each country. Dnya Salk rgtnn salk sistemi gstergesi olarak belirlemi
olduu deikenlere ait veriler OECD, Dnya Bankas, Dnya Salk rgtnn yaynlam
olduu istatistik raporlarndan ve eitli makalelerden toplanmtr. (OECD, 2015) (WHO, 2015)
(Kocaman, 2012). Descriptive statistics have been performed by using these indicators and
multidimensional scaling analysis (MDS) has been used to examine the similarities and differences
between countries with SPSS 20.0 software.
FINDINGS
3. The Compare of OECD Countries with Some Indicator of Health Services
Some indicators about health expenditures, health care services satisfaction, health care resources
and mortality of 34 OECD countries have been explained by Turkey basis in this part of the study.
3.1. The Level of Satisfaction with Health Care Services
The level of satisfaction with health care services of the 34 OECD countries has been provided in
the graph 1.

Graph 1. The Level of Satisfaction with Health Care Services (2013)

100 94
89 89 88 86
85 85 84 82
90
81 81 80 78
77 77 75 75
80
73 72 72 71 71 70
69 67 67
70
62 60
56 55
60
51 48
50
43
35 35
40
30
20
10
0

The level of satisfaction with health care services of the Turkey is 71 percent. This ratio is the same
as the OECD average. Switzerland is the first rank with the 94% satisfaction level with health care
services. Chile is the worst country in this area with 35% satisfaction level among OECD 34
2

countries. The ratio of Turkey's satisfaction ratio is above the ratio of satisfaction with health care
services of S.Korea, Finland, Spain, Irland, Portugal, Hungary, Slovak Republic, Mexico, Estonia,
Italy, Poland, Greece and Chile.
3.2. Total Health Expenditure Per Capita (PPP)
Total health expenditures per capita of the 34 OECD countries has been provided in the graph 2.
Graph 2. Total Health Expenditure Per Capita (2013) PPP
100009146
9000
8000
6308
6187
7000 6518
5601
6000
4885
4812
4759
4552
4526
4334
4244
4191
5000
3867
3741
3646
3604
3469
3405
3311
3126
4000
2846
2595
2513
2508
2398
2355
2147
3000
1982
1839
1678
1551
1453
2000
1061
1053
1000
0

The health expenditure in terms of per person of Turkey is ranks last in all OECD countries with
1053 USD per year. The avarage of the OECD is 3469 USD per person. This amount is three times
the average in Turkey. Countries with the highest per capita health expenditure respectively are
United States (9146 USD), Luxembourg (6518 USD) and Norway (6308 USD).
3.3. Growth in Health Expenditures (1 year)
The growth rate in the health expenditures per capita of selected countries in 2013 according to
2012 has been shown in the fallowing graph.

Graph 3. Growth in Health Expenditures For 1 year (2013)

10.00
7.79
8.00
6.42
6.29
6.00
4.78
4.42
4.05
4.00
3.93
3.82
3.68
3.68
3.56
3.43
3.35
3.29
4.00
3.15
3.13
2.97
2.91
2.79
2.71
2.55
2.30
2.13
1.74
1.49
1.29
2.00
0.00

-0.09
-0.56
-0.89
-0.86
-1.38
-2.83
-2.78

-2.00
-4.00

Turkey is the first rank in the growth rate in the health expenditures per capita with 7,79% ratio in
2013 according to the 2012. These figures are promising for the development of health services in
Turkey. S.Korea and Greece are the fallowing countries in this area with 6,42% and 6,29% growth
ratio respectively. In 2013, Mexico, Portugal, Italy, Slovenia, Denmark, Spain and Czech Republic
has negative ratio according to 2012 in health expenditures growth. Czech Republic is a country
have most falling off in this area with -2,83% ratio.
3.4. Growth in Health Expenditures (5 years)
The growth rate in the health expenditures per capita of selected countries in 2013 according to
2009 has been shown in the fallowing graph.
Graph 4. Growth in Health Expenditures For 5 years (2013)
40.00
30.00
20.00
10.00
0.00
-10.00
-20.00
-30.00

Netherlands is the first rank country to have biggest health expenditures growth ratio of the in 2013
according to 2009 in all OECD countries with 29,98% growth. Chile and S. Korea are the second
and third ones in this area with 28,01% and 21,06% growth ratio respectively. The growth ratio of
4

Turkey for 5 years is 15,38%. While Greece has one of the biggest growth in 2013 according to the
2012, in 5 years growth rates the country has nagative figures and biggest falling off ratio with
-20,53%. That means, there has been significant developments in Greece since 2012. The avarage
of the OECD is 4,93% growth in 2013 according to the 2009. As well as Greece, United Kingdom,
Czech Republic, Irland, Spain and Portugal have negative growth ratio in this area.
3.5. The Percentage of Out of Pocket Expenditures For Health in Consumption
The percentage of out of pocket health expenditures in total consumption in 34 OECD countries has
been shown in the graph 5.

Graph 5. The Percentage Of Out Of Pocket Expenditures in Consumption (2012)

5 4.7
4.24.24.1
4.5
3.93.83.73.7
4
3.33.23.23.23.1
3.5
3 2.92.92.92.82.82.8
2.72.5
3
2.42.42.22.2
2.5
2 1.91.81.81.8
1.61.5
2
1.31.2
1.5
1
0.5
0

The percentage of out of pocket expenditures in consumption of Turkey is 1,2% in 2012. This ratio
is the lowest one among all OECD countries. The average of OECD is 2,8%. The countries having
most percentage of out of pocket expenditures in consumption countries are S. Korea (4,7%),
Portugal (4,2%) and Hungary (4,2%) respectively.
3.6. Total expenditure on Health as a Percentage of Gross Domestic Product (GDP)
The percentage of total health expenditures in GDP of 34 OECD countries in 2013 has been shown
in the graph 6.

Graph 6. Total Expenditure on Health as a Percentage of GDP

17.10

18.00
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00

12.90
11.70
11.50
11.30
11.20
11.00
10.90
10.60
10.30
9.809 .709 .709 .709 .609 .409 .409 .209 .159 .109 .109 .10
8 .908 .908.20
8 .007 .707.207 .207 .20
7 .106.70
6.205.705 .60

Turkey has the lowest percentage of total health expenditures in GDP in all 34 OECD countries in
2013 with 5,6% of GDP. The avarage of the OECD is 9,15% GDP. The percentage of Turkey is
below the avarage of the OECD countries. United States is the country dividing the biggest health
expenditures percentage of GDP in 2013. Netherlands is in the second position with 12,90% of
GDP and France is in the third position with 11,7% of GDP just before Switzerland.
3.7. General Government Expenditure on Health as a Percentage of Total Health Expenditure
The percentage of general government health expenditures in total health expenditures of 34 OECD
countries in 2013 has been shown in the graph 7.
Graph 7. General Government Expenditure on Health as a Percentage of Total Expenditure (2013)
85.4
83.7
83.5
83.38382.1
9085.5
81.5
80.5
79.87877.9
77.5
77.4
76.8
75.8
75.7
75.3
72.11
80
71.6
70.47069.8
69.6
69.5
67.7
67.56664.7
63.6
70
59.1
53.4
52.9
60
51.7
47.4
50
40
30
20
10
0

The general government health expenditures in total health expenditures of Turkey is 77,4 percent,
That means The Government in Turkey meets 77 percent of every hundred pound in health care.
The avarage of OECD is 72,11 and not so far away the Turkeys one. While United States, Mexico
and Chile have the lowest goverment back up in health sector with the ratio respectively 52,9%,
6

51,7% and 47,4% in all OECD countries, Norway, Denmark and Luxembourg are the countries
having the biggest support in the health sector from their goverments with respectively 85,5 percent,
85,4 percent and 83,7 percent.
3.8. Life Expectancy At Birth
The life expectancy at birth of 34 OECD countries in 2013 has been shown in the graph 8.
Graph 8. Life Expectancy at Birth (2013)
86 84
83 83 83 83
84
82 82 82 82 82 82 82 82 82
81 81 81 81 81 81 81 81
82
80.41
80 80 80 80
79
80
78
77 77
78
76
75 75 75
76
74
72
70

Due to the improvement of the living conditions, it has been a great increase in expectations life in
many OECD countries over the past 50 years. While the life expectancy in Turkey was 48,3 in
1960, now it has been increased in 75 years. In spite of this increasing, the life expectancy at birth
in Turkey still one of the lowest level among the OECD countries. The avarage of OECD was 68,5
in 1960, now it has been reached to 80,4 years. Japan has the longest life expectancy at birth with
84 years.
3.9. Health Care Services Resources and Indicators I
The density of physicians per 1 000 population and hospital beds per 100 000 population WHO
2011 in selected OECD countries in 2011 have been shown graph 9.

Graph 9. Health Care Services Resources

1600
1390
1400
1200
860
1000
768
719
684
800 656
655
620
614
552
537
531
485
484 466
463
600
398
370
364
356
350
348
340
338
327
326
326
325
296
295
274 296 309231 278 253
272
400 316
230250 272
210
207
170
170219 210
105
200
0

Density of physicians

Hospital Beds

When we investigate some health care services reseources of Turkey; While the density of
physicians per 1000 person is 170 physicians and the hospital beds per 100 000 person is 235 beds.
But these figures are fairly under the OECD avarage. The avarage of OECD in physicians density is
330 physicians per 1000 person and the avarage of the hospital beds per 100 000 person is 540.
3.10. Health Care Services Resources and Indicators II
The density of magnetic resonance imaging (MRI) units per 1000 000 population and neonatal
mortality rate per 1000 live births in 2011 in selected OECD countries has been shown in graph 10.

Graph 10. MRI and Neonatal Mortality

50.00
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00

Neonatal mortality

Density of MRI

While the density of magnetic resonance imaging (MRI) units per 1000 000 population in Turkey is
6,14 and neonatal mortality rate per 1000 live births is 11,2. The figure of neonatal mortality rate is
fairly above the OECD avarage. The avarage of OECD is just 2,83. The best OECD country in this
area is Iceland and Luxembourg with 0,90 ratio per 1000 live births. Turkey has worst avarage of
this area among the 34 OECD countries.
4. The Result of Multivariate Analysis
The data was evaluated by the correlation analysis in order to examine the direction of reciprocal
linear relationship and degree between variables. The results obtained from the correlation analysis
are shown in Table 1.
Table 1. The Correlation Analysis of the Selected Indicators
OECD
Satisfactio
n
2014
OECD
Satisfaction
2014

PearsonCorrelation

Out of Pocket
Ex. in Comp.
2013

PearsonCorrelation

Health Ex. Per

Capita 2013

PearsonCorrelation

Health Ex. in
GDP
2013

PearsonCorrelation

Goverment Ex.
in total health
Ex.
2013
Neonatal
Mortality

Life Expec.

1,00

Sig. (2-tailed)

Sig. (2-tailed)

Sig. (2-tailed)

Sig. (2-tailed)
PearsonCorrelation
Sig. (2-tailed)

Out of
Pocket Ex.
in Comp.
2013

Health Ex.
Per Capita
2013

Health Ex.
in GDP
2013

Goverment
Ex. in total
health Ex.
2013

Neonatal
Mortality

Life Expec.

Density of
Physicians

-,346**

,645*

,459*

,434*

-,236

,375**

,033

0,04

0,00

0,00

0,00

0,173

0,02

0,855

-,143

-,054

-,655*

,058

,045

,033

0,419

0,763

0,00

0,743

0,800

0,855

,807*

,191

-,327

,477*

,153

0,00

0,271

0,055

0,00

0,396

,037

-,233

,396**

,215

0,833

0,177

0,02

0,229

,311

,233

,301

0,06

0,184

0,08

-,639*

-,378**

0,00

0,03

1,00

1,00

1,00

1,00

PearsonCorrelation
1,00
Sig. (2-tailed)
PearsonCorrelation

,281

1,00

Sig. (2-tailed)
Density of
Physicians

0,113

PearsonCorrelation

1,00

Sig. (2-tailed)

* Correlation is sinnificant at the 0.01 level (2-tailed)

** Correlation is sinnificant at the 0.05 level (2-tailed)

The significant pozitive relationships have been determined between satisfaction level with health
care services of OECD countries and health expenditures per capita, the percentage of health
expenditures in GDP, the percentage of general government health expenditures in total health
expenditures, life expectancy at birth, density of physicians as a results of correlation analysis. Also
9

significant negative relationships have been detected between satisfaction level from health care
services of OECD countries and the percentage of out of pocket expenditures in total consumption,
neonatal mortality rates of countries. In addition, When the relationship between other indicators
examined one another, significant relationships have been found as a results of analysis and shown
in the correlation table.
5. The Results of Multidimensional Scaling (MDS)
MDS is a statistical analysis which reveals relationships between objects by benefiting from the
distance between them in cases the relationship between objects unknown but can be calculated.
(Kalayc, 2014). The effectiveness of multidimensional scaling analysis is measured by Kruskal
stress statistics. Kruskal stress statistics is calculated by taking the square root the ratio of difference
between the estimated size of the configuration to distance of configuration with the configuration
size (Ersz, 2008).
Iteration was continued as far as it is less than 0.001 for k=2 stress statistics. Iteration was stopped
in fourth iteration when the 0,00022 result was reached. Stress is a moderate level of alignment and
statistics 0,19. The comformity of configuration distance with the original away from the
configuration according to the size of their value; The stress, poor comformity 0.20, 0,10 < stress
moderate comfirmatory, stress=0,05 ise good, stress=0,00 is considered complete or perfect
comfirmatory (Ersz, 2008). The stress solutions value which is close to size 0 is solutions desired
or considered as appropriate in MD. Stress value has been calculated according to Kruskal's formula
and found 0.86267. That means, stress value, for k = 2 dimensions, are explained 0.86 percent of
data. If stress values desired to examine with different sizes, k=1.2.3.4 chart, it is preferred that high
stress valuable dimension by checking stress values (Kalayc, 2014).
Multidimensional scaling analysis was carried out in two dimensions in our analysis. According to
this, the coordinates determined by the variable of OECD countries are shown in the stimulus
coordinates table.
Table 2. Stilumus Coordinates
Stimulus Number
1
2
3
4
5
6
7
8

Stimulus Name
UNITED STATES
SWITZERLAND
GERMANY
FRANCE
ICELAND
BELGIUM
GREECE
PORTUGAL

1. Dimension
1,3247
1,1024
,9603
,7939
,3646
,4852
-,3708
-,2011

2. Dimension
-2,1279
-,5617
-,2669
-,1830
,5062
-,5137
2,5431
1,2880

10

9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

CANADA
NORWAY
AUSTRALIA
AUSTRIA
NETHERLANDS
SWEDEN
DENMARK
ITALY
NEW ZEALAND
HUNGARY
UNITED KINGDOM
SPAN
JAPAN
LUXENBOURG
TURKEY
CZECH Republic
IRLAND
MEXICO
POLAND
SLOVAK Republic
S. KOREA
ESTONIA
ISRAEL
CHILE
SLOVENIA
FINLAND

,1641
,9957
,2298
1,0717
1,0659
,3951
,7748
,1471
,4737
-1,4263
,3019
,1548
1,7294
1,1674
-2,8034
-,0206
-,1462
-2,3839
-1,2700
-,9841
-,8488
-,9252
-,4297
-2,1542
,1419
,1196

-,5047
-,0890
-,2147
,2969
-1,1301
-,2058
,5678
1,1606
-,3091
-,2324
,5562
1,2949
-,9763
,2487
-1,6263
1,4032
,3717
,0129
,0273
,1523
-1,5630
,7829
,0644
-1,1686
,3939
,0020

According to the stimulus coordinates table, United States, Switzerland, Austria, Netherlands,
Japan and Luxembourg have both pozitive and above 1 value. It is seen that thesee countries have
been perceived similar in terms of primary twelve variable. So thesee countries are the most
important separator in dimension 1. Other values are fairly close to the zero. The nagative values of
Portugal, Greece, Hungary, Turkey, Czech Republic, Irland, Mexico, Poland, Slovak Republic,
S.Korea, Estonia, Israel, Chile are an other remarkable situation in dimension 1.From thesee
countries; Mexico, Chile, Portugal and Turkey have nagative values above 2. Greece has negative
value above 3. That means, Greece is the most separate country in dimension 1. So thesee countries
are not important in this dimension.
In the dimension 2. Portugal, Italy, Spain, Czech Republic have both pozitive and above 1 value.
But the most important value is Greece with 2,5431. Other values are again so close to the zero. So
Greece is the most important separator country in this dimension. When the negative values
examined in second dimension, it is seen that, United States, Switzerland, Germany, France,
Belgium, Canada, Norway, Australia, Netherlands, Sweden New Zealand, Hungary, Japan, Turkey,
11

S.Korea and Chile have negative values. United States has the negative value above 2 so it is the
most separate country in dimension 2. The countries which have negative values are not important
in this dimension.
Differences matrix have been obtained from data after stimulus coordinates. The differences matrix
shows the similar or separate OECD countries each other. Since the matrix extremely huge, only
some part of it have been shown in table 3.
Table 3. Differences Matrix*
UNITED

SWITZERLAN

GERMAN

STATES

FRANCE

ICELAND

-------

UNITED

0,000

STATES
SWITZERLAN

1,792

0,000

D
GERMANY
FRANCE
ICELAND
BELGIUM
GREECE
PORTUGAL
CANADA
NORWAY
AUSTRALIA
AUSTRIA
NETHERLAND

2,370
2,262
2,801
2,058
3,945
2,954
1,789
2,409
2,211
2,510
2,026

1,076
1,179
1,281
,591
2,946
1,793
1,089
,861
,549
,747
1,353

0,000
0,000
1,186
,718
2,865
2,136
1,069
,883
,946
,337
,793

0,000
,976
,788
2,896
1,916
,579
,841
,729
,707
,715

0,000
,854
2,012
1,136
,930
,587
,493
1,194
1,761

.....
.....
.....
.....
.....
.....
.....
.....

S
SWEDEN
DENMARK
ITALY
NEW

2,461
2,591
3,185
2,737

1,032
1,489
1,969
1,387

1,167
1,167
1,753
,410

,920
,846
1,431
,077

,152
1,049
1,006
,915

.....
.....
.....
.....

ZEALAND
HUNGARY
UNITED

3,105
2,923

2,255
1,977

2,131
1,220

2,234
,700

1,798
,836

.....
.....

KINGDOM
SPAN
JAPAN
LUXENBOURG
TURKEY
CZECH

3,147
3,586
2,956
4,438
3,751

1,938
2,350
1,673
4,044
2,516

1,990
1,309
1,094
3,586
1,748

1,602
1,425
,906
3,468
1,612

1,276
2,304
1,028
3,623
1,682

.....
.....
.....
.....
.....

Republic
IRLAND
MEXICO
POLAND
SLOVAK

2,424
3,585
3,426
2,966

1,438
3,148
2,698
2,202

1,565
3,404
2,040
1,757

1,192
3,225
1,907
1,722

,577
2,866
1,815
1,438

.....
.....
.....
.....

12

Republic
S. KOREA
ESTONIA
ISRAEL
CHILE
SLOVENIA
FINLAND

3,333
3,749
2,884
3,350
2,814
2,487

2,007
2,719
1,418
3,071
1,836
1,206

2,310
1,878
1,594
3,332
2,266
,786

2,394
1,768
1,402
3,100
,835
,535

2,071
1,407
1,065
2,885
1,164
,320

.....
.....
.....
.....
.....
.....

*Due to table size, only some part have been shown here but the similarities have been explained in the text.

According to the matrix; The most similar and the most separate countries are seen in term of
twelve health variable. While the values close to zero represents similiarity of countries, the values
above 1 stands for dissimilarity. According to this; Germany and New Zealand, France and New
Zealand, Iceland and Australia, Iceland and Sweden, Iceland and Finland, Greece and Finland,
Portugal and Spain, Canada and Australia, Canada and Finland, Norway and Sweden, Australia and
Israel, Australia and Finland, Sweden and Finland, Italy and Spain, New Zealand and Finland,
Hungary and Slovak Republic, Irland and Finland, Poland and Slovak Republic, Poland and Estonia
are similiar countries with each other due to their values are close to zero.
Another case pointed out in the differences matrix is Turkey. The dissimilarity value of Turkey with
each country is above 3. So Turkey is the most separate country from other OECD countries.
Especially, United States (4,438), Switzerland (4,044), Portugal (4,160), Austria (4,018), Spain
(4,062) and Japan (4,418) are the most separate countries from Turkey in terms of twelve health
indicators.
After stilumus coordinates table and differences matrix table, euclidean distance model have been
shown in this part of the study.
It has been shown that OECD countries perceived to be most similar collected together in this
graph. According to the multidimensional scaling analysis, Turkey, Mexico, Poland, Chile,
Hungary, Slovak Republic, S.Korea, Estonia, Greece, United States and Japan are different from
general trend in terms of twelve health variables discussed in this study. From thesee countries;
Turkey, Chile, Mexico can be evaluated together as a subgroup. Poland, Hungary, Slovak Republic,
S.Korea, Estonia and Greece can be thought together as a an other subgroup. But Japan and United
States are completely different from each other and thesee countries. So their tendency is
completely diversy.

13

Graph 11. Euclidean Distance Model (For Cases)1

After explaining the similarities and differences relations between the countries, euclidean distance
model has been created according to the twelve health variables so as to see which variables make
similarity

and

which

variables give rise to

perception of
difference between OECD countries.
Graph 12. Euclidean Distance Model (For Variables)2

1 Note: VAR1: UNITED STATES, VAR2: SWITZERLAND, VAR3: GERMANY, VAR4: FRANCE, VAR5:
ICELAND, VAR6: BELGIUM, VAR7: GREECE, VAR8: PORTUGAL, VAR9: CANADA, VAR10: NORWAY,
VAR11: AUSTRALIA, VAR12: AUSTRIA, VAR13: NETHERLANDS, VAR14: SWEDEN, VAR15: DENMARK,
VAR16: ITALY, VAR17: NEW ZEALAND, VAR18: HUNGARY, VAR19: UNITED KINGDOM, VAR20: SPAN,
VAR21: JAPAN, VAR22: LUXENBOURG, VAR23: TURKEY, VAR24: CZECH Republic, VAR25: IRLAND,
VAR26: MEXICO, VAR27: POLAND, VAR28: SLOVAK Republic, VAR29: S. KOREA, VAR30: ESTONIA, VAR31:
ISRAEL, VAR32: CHILE, VAR33: SLOVENIA, VAR34: FINLAND.

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According to the graph; Neonatal mortality rate per 1000 live births, Growth in health expenditures
for 1 year cause Turkey's to be perceived differently from other countries. Density of physicians
per 1 000 population, life expectancy at birth, total expenditure on health as a percentage of GDP
and health expenditure per capita are variables perceived countries to be similar to each other.
General government expenditure on health as a percentage of total expenditure is the variables
causes United Statess to be perceived differently from other countries.

2 Neonatalmortality: Neonatal mortality rate per 1000 live births, Growth1: Growth in health expenditures
for 1 year, Growth5: Growth in health expenditures for 5 years, Pocketexpenditures: Out of pocket
expenditures for health in consumption, Physicians: Density of physicians (per 1 000 population), HEin
GDP: Total expenditure on health as a percentage of GDP, HEpercapita2013: health expenditure per capita,
Beds: Hospital beds per 100 000, govermentexpenditure: General government expenditure on health as a
percentage of total expenditure
15

Graph 13. Euclidean Distance Model (For Eliminated Cases)

If we eliminate the variables cause Turkey to be perceived differently from other countries and
examine the similiarity and differenties between countries again to see the reasons of differenties
more clear, as it is seen in the fallowing graph, we can see that countries are more closer to each
other and density is more in the new graphics than the previous one. The position of Turkey is more
close to the general tendency. No it is easy to say that the neonatal mortality rate per 1000 live
births, growth in health expenditures for 1 year cause perceived Turkey to be different form the
other OECD countries.

16

DISCUSSION AND CONCLUSION

lkelerin salk sistemlerinde mkemmele ulaabilmesi iin kendi modellerini denemelerinin
yannda birbirlerinin deneyimlerinden de yararlanmalar nemli yer tutmaktadr. Salk
sistemlerinin ve spesifik politika uygulamalarnn outcomelar asndan karlatrmal analizlerin
yeri gittike artmakta ve yeni yeni analitik yntemler gelitirilmektedir. Bu almada da belirtilen
34 OECD yesi lkenin Dnya Salk rgtne gre salk sistemi gstergesi olarak
deerlendirilen baz gstergelere gre benzerlik ve farkllk analizi gerekletirilmitir. Salk
sistemi gstergeleri seilirken daha doru bir sonuca ulamak iin, tm lkelere ait ulalabilen
gstergeler analiz kapsamna alnm ve genel olarak salk sisteminin btnn ele alan, makro
deikenler vastasyla alma gerekletirilmitir. Bu dorultuda OECD lkelerin seilmi salk
gstergeleri bakmndan birbirlerine gre benzerliklerin ya da farkllklarn ortaya konulmas,
benzerliklerini/farkllklarn temel alarak iki ya da daha fazla gruplar halinde blnmesi ve bu
benzerlik/farklla neden olan deikenlerin hangilerinin olduunun tespit edilmesi hedeflenmitir.
Yaplan ok boyutlu lekleme analizi sonucunda Trkiye, Meksika, ili ve Gney Kore
Cumhuriyetinin 12 salk deikeni asndan benzer alglandklar grlmektedir. Yunanistan
(4,538), United States (4,438), Switzerland (4,044), Portugal (4,160), Austria (4,018), Spain (4,062)
and Japonya ise bu 12 salk gstergesi asndan Trkiyenin farkllnn en fazla olduu
lkelerdir. Amerika ve Japonya dier 32 OECD lkesinden belirtilen 12 salk gstergesi asndan
nemli derecede ayrlmaktadr. Trkiye ve Yunanistan seilmi salk gstergeleri asndan
birbirine en uzak olan lkelerdir. 2008 ylnda Ersz tarafndan yaplan benzerlik ve farkllk
almasnda, OECD lkelerinin salk dzeyleri ve salk harcamalarnn analizi yaplmtr. Bu
almada Trkiyeye en benzer olduu lkenin Meksika olduu, Trkiye ile farklln en fazla
olduu lkelerin ise Avusturya, Almanya ve Norve olduu tespit edilmitir. Rehimli ve ark (2008)
tarafndan gerekletirilen baka bir almada ise maternal lm oran, yeni doan lm oran ve
dk arlkl yeni doan oran gstergeleri bakmndan Trkiye ve Meksikann dier OECD
lkelerinden ayrldklar, Trkiye ve Meksikann dier lkelerden genel olarak mortalite oran,
dk arlkl yeni doan oran ve yeni doan lm oran bakmndan farkl olduklar tespit
edilmitir (Sakine Rehimli, 2008). almamzda da baz gstergeler farkl olsa bile Trkiyenin
benzer ve farkl olduu lkeler neredeyse ayndr. Trkiyenin OECD lkelerinden ayrlmasna
neden olan en nemli gstergelere baktmzda ise bunlar neonatal bebek lm hz ve salk
17

harcamalarndaki bir yllk bymedir. Salk harcamalarndaki bir yllk bymenin dier
lkelerden fazla olmas, lkemizin salk sisteminin gelecei asndan mit verici olarak
deerlendirilebilir. Ancak bebek lm hznn dier lkelerin ortalamasnn yaklak 4 kat olmas
lkemizin salk sistemi asndan zerinde durulmas gereken en nemli noktalardan birisidir.
Son yllarda DS, Dnya Bankas gibi uluslararas salk kurulularnn ncl ile salk
politikalarnda ve salk sistemlerinde reform abalarna girmemi lke neredeyse yoktur. Bu
sayede gnmzde standart ltler asndan karlatrmalar yaplabilmekte ve deneyim paylam
iin bir zemin bulunmaktadr. alma sonucuna gre incelenen baz ltler asndan elde edilen
sonularda baz ortak sorunlarn varl dikkat ekmektedir. Salk sistemi iin yaplan yatrmlarn
her geen gn artt lkemizde, OECD lkeleri ile salk gstergeleri asndan nemli farkllklar
ortadan kaldrmak ve salk sisteminin daha etkin ve verimli almasn iin bir takm nlemlerin
alnmas gereklidir. Bebek lm oranlarnn ykseklii, kii bana den salk harcamas, toplam
salk harcamalarnn GSYH iindeki oran, 1000 kiiye den doktor ve 100 000 kiiye den
yatak saylar asndan Trkiye OECD lkelerinden geridedir. zellikle bebek lm oranlarnn
dier OECD lkelerinin yaklak drt kat olmas olduka dikkat ekicidir. Dnya Salk rgt
2012 ylnda yaynlam olduu raporunda bebek lm oranlarna dikkat ekmitir. Dnya Salk
rgt ve UNICEF bebek lm oranlarn drmek iin doumdan sonraki ilk haftalarda
profesyonel salk ekiplerinin evlere yapaca ziyaretleri tavsiye etmektedir (WHO, 2012). Bunun
yan sra bebek lm oranlarn azaltmak iin salk hizmetlerinin yannda genel eitim dzeyinin
ve anne eitim ve bilincinin artrlmas, lkedeki gelir dalmnn daha adil bir hale getirilmesi,
sigortal birey say ve orannn artrlmas nerilmektedir (Barlas ve ark., 2014). Bebek lm
oranlarnn drlmesine ynelik politikalarn yan sra, lkemizde salk profesyonellerinin
saysnn arttrlmasna ihtiya olduu aktr. Gnmzde toplamda 650 bin olan salk sektrnde
alan says 2015te 715 bine, 2019da 853 bine, 2023te ise 1 milyon 100 bine ulamas
hedeflenmitir. Javier Martnez & Tim Martineaua gre salk sektrndeki insan kayna
sorununu geni apl makroekonomik politikalar olmadan zmek zordur (Martinez&Martineau,
2012). Trkiyede son yllarda yaplan almalara baktmzda aklanan hedefler ve politikalar
sevindiricidir. Ancak nemli olan nokta say olarak art salarken bunu insan kaynann kalitesini
drmeden yapmaktr. Son olarak kii bana salk harcamas ve salk harcamalarnn GSMH
iindeki paynn OECD orannn ok gerisinde olmas zerinde tartlmas gereken konulardandr.
lkenin kaynaklarnn boa harcanmamas iin gereken makroekonomik nlemlerin alnmasnn
faydal olaca dnlmektedir.

18

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