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Ulaştırma ve Lojistik Kongreleri

alphanumeric journal

The Journal of Operations Research, Statistics, Econometrics and Management Information Systems

The Determinants of Turkey Household Catastrophic Health Expenditures: A Different Approach by Data Mining

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Uğur Ercan, Ph.D.


Abstract

This study aims to determine socioeconomic, demographic, and household characteristics that affect Turkish household catastrophic health expenditure (CHE). Data gathered by TurkStat belonging to 40,033 households for the years 2009-2012 were used in the analysis. In the study, CHE was defined as household health expenditures that were 40% (or above) greater than the capacity pay of the household. CHAID analysis was used to determine characteristics affecting Turkish household CHE. According to the CHAID analysis; income, presence of a sick/disabled person, residential area, household size, age, education level and gender of the household head, presence of individuals aged 65+, presence of people between the ages of zero and five, and access to health institutions have been observed to affect CHE, while the marital status, age, and employment status of the head of the household, or the household type do not affect CHE. The proportion of households exposed to CHE was 0.62%, and the proportion of households making out-of-pocket health expenditure (OOPHE) was 62.71%. It was especially observed that households with low income, with sick/disabled individuals, and those with difficult access to healthcare facilities are more likely to be exposed to CHE. None of the households exposed to CHE has supplementary health insurance.

Keywords: CHAID Analysis, Catastrophic Health Expenditure, Household budget survey, Out-of-pocket Health Expenditure, Turkey

Jel Classification: C46

Suggested citation

Ercan, U. (). The Determinants of Turkey Household Catastrophic Health Expenditures: A Different Approach by Data Mining. Alphanumeric Journal, 9(2), 229-246. http://dx.doi.org/10.17093/alphanumeric.940744

References

  • Ahmed, S., Szabo, S., & Nilsen, K. (2018). Catastrophic healthcare expenditure and impoverishment in tropical deltas: Evidence from the Mekong Delta region. International Journal for Equity in Health, 17:53, 1–13.
  • Akhtar, A., Ahmad, N., & Chowdhury, I. R. (2020). Socio-economic inequality in catastrophic health expenditure among households in India: A decomposition analysis. Indian Economic Review, 55, 339-369.
  • Arsenijevic, J., Pavlova, M., & Groot, W. (2013). Measuring the catastrophic and impoverishing effect of household health care spending in Serbia. Social Science & Medicine, 78, 17–25.
  • Barros, A. J. D., Bastos, J. L., & Dâmaso, A. H. (2011). Catastrophic spending on health care in Brazil: Private health insurance does not seem to be the solution. Cad. Saude Publica, 27, 254–262.
  • Berry, M. J. A. and Linoff, G. S. (2004). Data Mining Techniques For Marketing, Sales, and Customer Relationship Management (Second Edition). Indianapolis, Indiana: Wiley Publishing Inc.
  • Choi, J. W., Choi, J. W., Kim, J. H., Yoo, K. B., & Park, E. C. (2015). Association between chronic disease and catastrophic health expenditure in Korea. BMC Health Services Research, 15:26, 1–8.
  • Cleopatra, I., & Eunice, K. (2018). Household Catastrophic Health Expenditure : Evidence from Nigeria. Microeconomics and Macroeconomics, 6(1), 1–8.
  • Dalui, A., Banerjee, S., & Roy, R. (2020). Determinants of out-of-pocket and catastrophic health expenditure in rural population: A community-based study in a block of Purba Barddhaman, West Bengal. Indian Journal of Public Health, 64, 223–228
  • Falconi, D. P., & Bernabé, E. (2018). Determinants of catastrophic healthcare expenditure in Peru. International Journal of Health Economics and Management, 18, 425–436.
  • Gehrke, J. (2003). Decision Trees, (Ed.) Ye, N. In The Handbook of Data Mining (1st Edition). New Jersey: CRC Press.
  • Goryakin, Y., & Suhrcke, M. (2014). The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries : a methodological commentary. International Journal for Equity in Health, 13:107, 1–5.
  • Han, J., Kamber, M., & Pei, J. (2011). Data Mining Concepts and Techniques Third Edition. The Morgan Kaufmann Series In Data Management Systems. USA, Waltham: Elsevier.
  • Kang, J. H., & Kim, C. W. (2018). Relationship Between Catastrophic Health Expenditures and Income Quintile Decline, Osong Public Health and Research Perspectives, 9(2), 73–80.
  • Kantardzic, M. (2019). Data Mining Concepts, Models, Methods, and Algorithms Third Edition. New Jersey: John Wiley & Sons, Inc.
  • Kass, G. V. (1980). An Exploratory Technique for Investigating Large Quantities of Categorical Data. Applied Statistics, 29(2), 119-127.
  • Knaul, F. M., Wong, R., Arreola-Ornelas, H., Méndez, O., & The Network on Health Financing and Social Protection in Latin America and the Caribbean (LANET) (2011). Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Salud Pública de México, 53(2), 85–95.
  • Li, X., Shen, J. J., Lu, J., Wang, Y., Sun, M., Li, C., Chang, F., & Hao, M. (2013). Household catastrophic medical expenses in eastern China: Determinants and policy implications. BMC Health Services Research, 13:506, 1-9.
  • Memişoğlu, D., & Durgun, A. (2011). 2008 Ekonomi̇k Kri̇zi̇ ve Türki̇ye’de Sağlık Sektörü Üzeri̇ne Etki̇leri̇. Süleyman Demirel Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 1(13), 81–100.
  • Narcı, H. Ö., Şahin, İ., & Yıldırım, H. H. (2015). Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey. The European Journal of Health Economics, 16(3), 255–270.
  • Nisbet, R., Miner, G., & Yale, K. (2018). Handbook of Statistical Analysis and Data Mining Applications (Second Edition). London: Academic Press, Elsevier Inc.
  • Njagi, P., Arsenijevic, J., & Groot, W. (2018). Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review. Systematic Reviews, 7:136, 1-23.
  • O’Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Analyzing Health Equity Using Household Survey Data A Guide to Techniques and Their Implementation, Washington, DC: The World Bank.
  • OECD (2019). Health at a Glance 2019: OECD Indicators. OECD Publishing, Paris.
  • Pehlivan, G. (2006). CHAID Analizi ve Bir Uygulama, Yüksek Lisans Tezi, Yıldız Teknik Üniversitesi, Fen Bilimleri Enstitüsü, İstanbul.
  • Piroozi, B., Moradi, G., Nouri, B., Bolbanabad, A. M., & Safari, H. (2016). Catastrophic health expenditure after the implementation of health sector evolution plan: A case study in the west of Iran. International Journal of Health Policy and Management, 5(7), 417–423.
  • Sutton, C. D., (2005). Classification and Regression Trees, Bagging, and Boosting, (Ed.) Rao, C. R., Wegman, E. J., & Solka, J. L. In Data Mining and Data Visualization, Handbook of Statistics, Vol. 24, (pp. 303-329). The Netherlands: Elsevier B.V.
  • Rashad, A. S., & Sharaf, M. F. (2015). Catastrophic and impoverishing effects of out-of-pocket health expenditure: New evidence from Egypt. American Journal of Economics, 5(5), 526–533.
  • Rokach, L., & Maimon, O. (2008). Data Mining With Decision Trees Theory and Applications. Singapore: World Scientific Publishing Co. Pte. Ltd.
  • Rokach, L., & Maimon, O. (2010). Classification Trees. (Ed.) Maimon, O. & Rokach, L., In Data Mining and Knowledge Discovery Handbook Second Edition, (pp. 149-174), New York: Springer, 149-174.
  • Rokach, L., & Maimon, O. (2015). Data Mining With Decision Trees Theory and Applications (2nd Edition). Singapore: World Scientific Publishing Co. Pte. Ltd.
  • Si, Y., Zhou, Z., Su, M., Wang, X., Lan, X., Wang, D., Gong, S., Xiao, X., Shen, C., Ren, Y., Zhao, D., Hong, Z., Bian, Y., & Chen, X. (2019). Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: Two waves’ cross-sectional study. BMJ Open, 9, 1–9.
  • T.C. Maliye Bakanlığı, (2010). Merkezi Yönetim Kapsamındaki İdareler, Sosyal Güvenlik Kurumları ve Mahalli İdareler 2009 Yılı Genel Faaliyet Raporu, Ankara.
  • Tapkan, P., Özbakır, L., & Baykasoğlu, A. (2011). Weka İle Veri Madenciliği Süreci ve Örnek Uygulama. Endüstri Mühendisliği Yazılımları ve Uygulamaları Kongresi, 30 Eylül-02 Ekim 2011, İzmir. (pp. 247–262).
  • Thu Thuong, N. T. , Berg, Y. V. D., Huy, T. Q., Tai, D. A., & Anh, B. N. H. (2021). Determinants of Catastrophic Health Expenditure in Vietnam. The International Journal of Health Planning and Management, 36, 316–333.
  • Tokatlıoğlu, Y., & Tokatlıoğlu, İ. (2018). Türkiye’de Katastrofik Sağlık Harcamaları ve Bu Harcamaları Belirleyen Faktörler: 2002-2014 Dönemi. Sosyoekonomi, 26(35), 59–78.
  • TurkStat, (2009). Turkey Household Budget Survey-2009, Ankara.
  • TurkStat, (2010). Turkey Household Budget Survey-2010, Ankara.
  • TurkStat, (2011). Turkey Household Budget Survey-2011, Ankara.
  • TurkStat, (2012). Turkey Household Budget Survey-2012, Ankara.
  • UN, (2015). United Nations, Transforming Our World: The 2030 Agenda For Sustainable Development, A/RES/70/1.
  • Vahedi, S., Rezapour, A., Khiavi, F. F., Esmaeilzadeh, F., Javan-Noughabi, J., Almasiankia, A., & Ghanbari, A. (2020). Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran. Clinical Epidemiology and Global Health, 8, 437–441.
  • Wagstaff, A., Flores, G., Hsu, J., Smitz, M. F., Chepynoga, K., Buisman, L. R., van Wilgenburg, K., & Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health, 6(2), 169–179.
  • Wagstaff, A., & van Doorslaer, E. (2003). Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Economics, 12, 921–934.
  • WHO. (2019). Global Spending on Health: A World in Transition 2019. Geneva: World Health Organization
  • WHO, & UNICEF. (2018). A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF).
  • World Bank. (2021a). Out-of-pocket (health) expenditure per capita (current US$). https://data.worldbank.org (access date: 18.08.2020).
  • World Bank. (2021b). Current health expenditure per capita (current US$) https://data.worldbank.org (access date: 18.08.2020).
  • Xu, K., Evans, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., & Evans, T. (2007). Protecting households from catastrophic health spending. Health Affairs, 26(4), 972–983.
  • Xu, K. (2005). Distribution of health payments and catastrophic expenditures methodology. Geneva: World Health Organization, Discussion Paper, Number 2, EIP/HSF/DP.05.2.
  • Xu, K., Evans, D. B., Carrin, G., & Aguilar-Rivera, A. M. (2005). Designing Health Financing Systems to Reduce Catastrophic Health Expendıtiure, Geneva: World Health Organization, Technical Briefs for Policy-Makers, Number 2, WHO/EIP/HSF/PB/05.02.
  • Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. L. (2003). Household catastrophic health expenditure: a multicountry analysis. The Lancet, 362, 111–117.
  • Yardim, M. S., Cilingiroglu, N., & Yardim, N. (2010). Catastrophic health expenditure and impoverishment in Turkey. Health Policy, 94, 26–33.
  • Yereli, A. B., Köktaş, A. M., & Selçuk, I. Ş. (2014). Türkiye’de Katastrofik Sağlık Harcamalarını Etkileyen Faktörler. Sosyoekonomi, 2, 273–296.
  • Zhao, Y., Oldenburg, B., Mahal, A., Lin, Y., Tang, S., & Liu, X. (2020). Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016. Tropical Medicine and International Health, 25(2), 236–247.

Volume 9, Issue 2, 2021

2021.09.02.OR.03

alphanumeric journal

Volume 9, Issue 2, 2021

Pages 229-246

Received: May 21, 2021

Accepted: July 13, 2021

Published: Dec. 31, 2021

Full Text [510.9 KB]

2021 Ercan, U.

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