Journals / Çankırı Karatekin Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi / 2026 / Cilt: 16 Sayı: 3

Some Public Expenditures and Their association with Healthcare Utilization

Bazı Kamu Harcamaları ve Sağlık Hizmetlerinden Yararlanma ile İlişkisi

Gülizar Gülcan Şeremet(ÇANKIRI KARATEKİN ÜNİVERSİTESİ)0000-0002-5790-2780
Pages
973–1004
Publication Date
2026-09-23
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

The allocation of public resources is closely associated with access to healthcare, with healthcare utilization showing a positive association with health expenditures, no significant association with education spending, and a negative association with military expenditures.These findings underscore the importance of prioritizing investments in human capital over defense in public budgeting.

📌 3 Key Takeaways

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Objective & Hypothesis:This study examines the effects of government expenditures on education, health, and military sectors—measured as shares of gross domestic product (GDP)—along with the Health Transformation Program (HTP), on the number of physician consultations per capita, which serves as a key indicator of healthcare utilization.
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Key Findings & Data:The study employed an Autoregressive Distributed Lag (ARDL) model using annual data from 1978 to 2022.
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Conclusion & Impact:The allocation of public resources is closely associated with access to healthcare, with healthcare utilization showing a positive association with health expenditures, no significant association with education spending, and a negative association with military expenditures.These findings underscore the importance of prioritizing investments in human capital over defense in public budgeting.
🔬Design:Modeling & Simulation
📍Scope:2022 Verileri
⚙️Variables:Sağlıkta Dönüşüm Programı · kamu harcamaları · doktor muayeneleri

Abstract

This study examines the effects of government expenditures on education, health, and military sectors—measured as shares of gross domestic product (GDP)—along with the Health Transformation Program (HTP), on the number of physician consultations per capita, which serves as a key indicator of healthcare utilization. The study employed an Autoregressive Distributed Lag (ARDL) model using annual data from 1978 to 2022. Explanatory variables include the shares of military, education, and health spending in GDP, as well as a Health Transformation Program (HTP) dummy (coded 0 for 1978–2002 and 1 for 2003–2022). Cointegration was tested, and an Error Correction Model (ECM) was applied to capture both short-run dynamics and long-run relationships. The allocation of public resources is closely associated with access to healthcare, with healthcare utilization showing a positive association with health expenditures, no significant association with education spending, and a negative association with military expenditures.These findings underscore the importance of prioritizing investments in human capital over defense in public budgeting.

Özet

Bu çalışma, gayrisafi yurt içi hasıla (GSYİH) içindeki payları esas alınarak ölçülen eğitim, sağlık ve askerî harcamalar ile Sağlıkta Dönüşüm Programı’nın (SDP) kişi başına düşen doktor muayenesi sayısı üzerindeki etkisini incelemektedir. Çalışmada, 1978–2022 dönemine ait yıllık veriler kullanılarak Otoregresif Dağıtılmış Gecikme (ARDL) modeli kullanılmıştır. Açıklayıcı değişkenler arasında GSYİH'deki askeri, eğitim ve sağlık harcamalarının payları ile Sağlıkta Dönüşüm Programı (SDP) kukla değişkeni (1978-2002 için 0 ve 2003-2022 için 1 olarak kodlanmıştır) yer almaktadır. Eşbütünleşme test edilmiş ve hem kısa vadeli dinamikleri hem de uzun vadeli ilişkileri yakalamak için Hata Düzeltme Modeli (ECM) uygulanmıştır. Sonuçlar, kamu kaynaklarının sektörel dağılımının sağlık hizmeti kullanımını anlamlı biçimde etkilediğini göstermektedir. Sağlık harcamaları pozitif, askerî harcamalar negatif etki yaratırken, eğitim harcamalarının anlamlı bir etkisi bulunmamıştır. Bu bulgular, kamu bütçelerinde savunmaya kıyasla insan sermayesine yapılan yatırımlara öncelik verilmesinin önemini vurgulamaktadır.

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Cite This Article

Şeremet, G. G. (2026). Some Public Expenditures and Their association with Healthcare Utilization. Çankırı Karatekin Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, Cilt: 16 Sayı: 3, 973–1004. https://doi.org/10.18074/ckuiibfd.1897785

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References (109)

  1. Avşar, Z., Öğütoğulları, E., and Öğütoğulları, Ö. (2012). Sosyal güvenlik kurumu’nun kurumsal iletişimi ve halkla ilişkiler faaliyetlerinin önemi. Akdeniz Üniversitesi İletişim Fakültesi Dergisi, (16), 120-131.
  2. Abbasov, R. (2025). The Effectiveness of performance-based budgeting in the public sector: An empirical analysis and policy implications. iBusiness https://doi.org/10.4236/ib.2025.171003
  3. Ak, S. (2023). Health transformation program in Turkish health system reforms and policy processes. Journal of Health Sciences and Management, 3(3), 71-78. https://doi.org/10.29228/JOHESAM.28
  4. Akbulut, Y., Sarp, N., and Ugurluoglu, E. (2007). Reform of the health care system in Turkey: A review of universal health insurance. World Hospitals and Health Services, 43(1), 13.
  5. Akdağ, R. (2008). Türkiye’de sağlıkta dönüşüm programı ve temel sağlık hizmetleri Kasım 2002-2008, Alma Ata’nın 30. yılı hatırası. TC Sağlık Bakanlığı, (770).
  6. Akinci, F., Mollahaliloğlu, S., Gürsöz, H., and Öğücü, F. (2012). Assessment of the Turkish health care system reforms: A stakeholder analysis. Health Policy, 107(1), 21-30.
  7. Ali Jadoo, S. A., Aljunid, S. M., Sulku, S. N., and Nur, A. M. (2014). Turkish health system reform from the people’s perspective: a cross sectional study. BMC Health Services Research, 14(1), 30.
  8. Alper, Y. (2007). Kurumsal yapıda “tek çatı” hayata geçti. Sosyal Siyaset Konferansları Dergisi, (53), 141-171. Anand, V., Nizamani, M. Q., and Nizamani, F. Q. (2019). Macroeconomic determinants of inclusive growth in Pakistan: An ARDL approach. Global Economics Review, 4(2), 105-118.
  9. Arthur, E., and Oaikhenan, H. E. (2017). The effects of health expenditure on health outcomes in Sub‐Saharan Africa (SSA). African Development Review, 29(3), 524-536. https://doi.org/10.1111/1467-8268.12287
  10. Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I.,. and Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382(9886), 65-99.
  11. Avsar, T. S., Erdem, R., and Akkas, E. (2017). Evaluation of the healthcare transformation programme in Turkey as a strategy for better health. Journal of International Health Sciences and Management, 3(4), 11-19.
  12. Aytemiz, L., Sart, G., Bayar, Y., Danilina, M., and Sezgin, F. H. (2024). The long-term effect of social, educational, and health expenditures on indicators of life expectancy: An empirical analysis for the OECD countries. Frontiers in Public Health, 12, 1497794. https://doi.org/10.3389/fpubh.2024.1497794
  13. Baffo, I., Leonardi, M., D’alberti, V., and Petrillo, A. (2024). Optimizing public investments: A sustainable economic, environmental, and social investment multi-criteria decision model (SEESIM). Regional Science Policy & Practice, 16(11), 100140. https://doi.org/10.1016/j.rspp.2024.100140
  14. Baldacci, E., Guin‐Siu, M. T., and Mello, L. D. (2003). More on the effectiveness of public spending on health care and education: a covariance structure model. Journal of International Development: The Journal of the Development Studies Association, 15(6), 709-725. https://doi.org/10.1002/jid.1025
  15. Barasa, E. W., Maina, T., and Ravishankar, N. (2017). Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. International Journal for Equity in Health, 16(1), 31.
  16. Başkavak, G., Şahinol, M., and Kılıçtepe, Ş. (2024). Interplay of global technological dynamics and local realities: Digital healthcare transformatıon in Turkey. Trakya Üniversitesi Sosyal Bilimler Dergisi, 26(1), 91-118. https://doi.org/10.26468/trakyasobed.1369225
  17. Behera, D. K., and Dash, U. (2020). Is health expenditure effective for achieving healthcare goals? Empirical evidence from South-East Asia Region. Asia-Pacific Journal of Regional Science, 4(2), 593-618. https://doi.org/10.1007/s41685-020-00158-4
  18. Boerma, T., Eozenou, P., Evans, D., Evans, T., Kieny, M. P., and Wagstaff, A. (2014). Monitoring progress towards universal health coverage at country and global levels. PLoS Medicine, 11(9), e1001731. https://doi.org/10.1371/journal.pmed.1001731
  19. Bostan, S., and Ağaç, G. (2019). Kamu hastaneleri birliği yapılanmasının sağlık hizmeti sunum süreçlerine etkisinin yönetici ve çalışan açısından değerlendirilmesi. İşletme Bilimi Dergisi, 7(1), 151-174. https://doi.org/10.22139/jobs.483566
  20. Caner, A., and Cilasun, S. M. (2019). Health care services and the elderly: Utilization and satisfaction in the aftermath of the Turkish Health Transformation Program. Gerontology and Geriatric Medicine, 5, 2333721418822868. https://doi.org/10.1177/2333721418822868
  21. Chen, E., and Zhang, H. (2025). The relationship between public health expenditure and urban economic resilience. Frontiers in Public Health, 13, 1550528. https://doi.org/10.3389/fpubh.2025.1550528
  22. Coombs, N. C., Campbell, D. G., and Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22(1), 438. https://doi.org/10.1186/s12913-022-07829-2
  23. Cubi-Molla, P., Mott, D., Henderson, N., Zamora, B., Grobler, M., and Garau, M. (2023). Resource allocation in public sector programmes: Does the value of a life differ between governmental departments?. Cost Effectiveness and Resource Allocation, 21(1), 96. https://doi.org/10.1186/s12962-023-00500-5
  24. Cutler, D. M., and Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence. (NBER Working Paper No. 12352). National Bureau of Economic Research. https://doi.org/10.3386/w12352
  25. Das, D. (2017). Public expenditure and healthcare utilization: The case of reproductive health care in India. International Journal of Health Economics and Management, 17(4), 473-494. https://doi.org/10.1007/s10754-017-9219-7
  26. Dhungana, B. R. (2023). Government health expenditure and policy for public health outcomes: A systematic literature review. MedS Alliance Journal of Medicine and Medical Sciences, 3(6), 84-91. https://orcid.org/0000-0002-0728-1226
  27. Dickey, D. A., and Fuller, W. A. (1981). Likelihood ratio statistics for autoregressive time series with a unit root. Econometrica: Journal of the Econometric Society, 1057-1072.
  28. Dunne, J. P., and Tian, N. (2016). Military expenditure and economic growth, 1960–2014. The Economics of Peace and Security Journal, 11(2). https://doi.org/10.15355/epsj.11.2.50
  29. Dursun, B., Cesur, R., and Mocan, N. (2018). The impact of education on health outcomes and behaviors in a middle-income, low-education country. Economics & Human Biology, 31, 94-114. https://doi.org/10.1016/j.ehb.2018.07.004
  30. Espinosa-González, A. B., and Normand, C. (2019). Challenges in the implementation of primary health care reforms: A qualitative analysis of stakeholders’ views in Turkey. BMJ Open, 9(7), e027492. https://doi.org/10.1136/bmjopen-2018-027492
  31. Fan, H., Liu, W., and Coyte, P. C. (2018). Do military expenditures crowd-out health expenditures? Evidence from around the world, 2000–2013. Defence and Peace Economics, 29(7), 766-779. https://doi.org/10.1080/10242694.2017.1303303
  32. Farahani, M., Subramanian, S. V., and Canning, D. (2009). The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis. Social Science & Medicine, 68(11), 1918-1925.
  33. Fletcher, J. M., and Frisvold, D. E. (2009). Higher education and health investments: Does more schooling affect preventive health care use? Journal of Human Capital, 3(2), 144-176.
  34. Garcia-Diaz, R. (2022). Effective access to health care in Mexico. BMC Health Services Research, 22(1), 1027. https://doi.org/10.1186/s12913-022-08417-0
  35. Golkhandan, A. (2019). Effect of military expenditure on health status in developing countries. Health Research Journal, 4(1), 47-54.
  36. Gordienko, L., Pasichnyk, Y., and Smakovskaya, Y. (2021). The effect of education and health care expenditure on GDP in EU countries. Journal of European Economy, 20(3), 424-441. https://doi.org/10.35774/jee2021.03.423
  37. Granger, C. W. J. and Newbold, P. (1974). Spurious regressions in econometrics. Journal of Econometrics, 2(2), 111–120.
  38. Gujarati, D. N. (2012). Basic Econometrics 4th ed.
  39. Gupta, S., Verhoeven, M., and Tiongson, E. R. (2002). The effectiveness of government spending on education and health care in developing and transition economies. European Journal of Political Economy, 18(4), 717-737. https://doi.org/10.1016/S0176-2680(02)00116-7
  40. Gürsoy, K. (2015). An overview of Turkish healthcare system after health transformation program: Main successes, performance assessment, further challenges, and policy options. Sosyal Güvence, (7), 83-112.
  41. Gürsoy, K. (2016). An analysis of public pharmaceutical policy, pricing and spending in Turkey. Sosyal Güvenlik Dergisi, 6(1), 225-243.
  42. Harris, R., and Sollis, R. (2003). Applied Time Series Modelling and Forecasting. Wiley.
  43. Hashtarkhani, S., Schwartz, D. L., and Shaban-Nejad, A. (2024). Enhancing health care accessibility and equity through a geoprocessing toolbox for spatial accessibility analysis: Development and case study. JMIR Formative Research, 8, e51727. https://doi.org/10.2196/51727
  44. Hone, T., Gurol-Urganci, I., Millett, C., Başara, B., Akdağ, R., and Atun, R. (2017). Effect of primary health care reforms in Turkey on health service utilization and user satisfaction. Health Policy and Planning, 32(1), 57-67. https://doi.org/10.1093/heapol/czw098
  45. Ifeagwu, S. C., Yang, J. C., Parkes-Ratanshi, R., and Brayne, C. (2021). Health financing for universal health coverage in Sub-Saharan Africa: A systematic review. Global Health Research and Policy, 6(1), 8. https://doi.org/10.1186/s41256-021-00190-7
  46. Ikegami, M., and Wang, Z. (2023). Does military expenditure crowd out health-care spending? Cross-country empirics. Quality & Quantity, 57(2), 1657-1672. https://doi.org/10.1007/s11135-022-01412-x
  47. Isiaka, A., Mihailov, A., and Razzu, G. (2025). Government spending reallocations and inequality: Evidence from middle-income countries. Empirical Economics, 69, 1229–1257. https://doi.org/10.1007/s00181-025-02768-3
  48. Khandelwal, V. (2015). Impact of energy consumption, GDP & fiscal deficit on public health expenditure in India: An ARDL bounds testing approach. Energy Procedia, 75, 2658-2664. https://doi.org/10.1016/j.egypro.2015.07.652
  49. Kilci, E. N. (2021). A study on financial sustainability of healthcare indicators for Turkey under the health transformation program. The International Journal of Health Planning and Management, 36(4), 1287-1307. https://doi.org/10.1002/hpm.3182
  50. Konca, M. (2024). The effect of universal health coverage on health outcomes: The case of Türkiye. Alanya Akademik Bakış, 8(2), 490-502. https://doi.org/10.29023/alanyaakademi.1342126
  51. Konca, M., and Yildirim, H. H. (2021). How can Turkey create fiscal space for its health care system? A qualitative approach. International Journal of Healthcare Management, 14(4), 940-947. https://doi.org/10.1080/20479700.2020.1721749
  52. Kundu, A. (2017). The effectiveness of public spending on education and health care in ındian economy. The Indian Economic Journal, 65(1-4), 140-158. https://doi.org/10.1177/001946621772788
  53. Loef, B., Meulman, I., Herber, G. C. M., Kommer, G. J., Koopmanschap, M. A., Kunst, A. E.,. and Uiters, E. (2021). Socioeconomic differences in healthcare expenditure and utilization in The Netherlands. BMC Health Services Research, 21(1), 643. https://doi.org/10.1186/s12913-021-06694-9
  54. Maddala, G. S., and Lahiri, K. (1992). Introduction to Econometrics (Vol. 2, p. 525). New York: Macmillan.
  55. Manavgat, G., and Demirci, A. (2020). Decentralization matter of healthcare and effect on regional healthcare efficiency: Evidence from Turkey. Sosyoekonomi, 28(44), 261-281. https://doi.org/10.17233/sosyoekonomi.2020.02.12
  56. Meulman, I., Uiters, E., Cloin, M., Polder, J., and Stadhouders, N. (2024). Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage. BMJ Open, 14(3), e080559. https://doi.org/10.1136/bmjopen-2023-080559
  57. Mohapatra, S. (2019). Public health expenditure and its effect on health outcomes: A new methodological approach in the Indian context. Great Lakes Herald, 13(1), 148.
  58. Mulcahy, P., Mahal, A., McPake, B., Kane, S., Ghosh, P. K., and Lee, J. T. (2021). Is there an association between public spending on health and choice of healthcare providers across socioeconomic groups in India? Evidence from a national sample. Social Science & Medicine, 285, 114149. https://doi.org/10.1016/j.socscimed.2021.114149
  59. Narayan, P. K. (2005). The saving and investment nexus for China: Evidence from cointegration tests. Applied Economics, 37(17), 1979-1990.
  60. OECD (2008). OECD Reviews of Health Systems: Turkey. OECD Publishing. https://www.oecd.org/content/dam/oecd/en/publications/reports/2009/02/oecd-reviews-of-health-systems-turkey-2008_g1gh980b/9789264051096-en.pdf
  61. OECD (2025). https://www.oecd.org/en/data.html (Access date: 10.09.2025)
  62. Organisation for Economic Co-operation and Development (OECD) (2021). Government at a glance 2021: Public finance and economics. OECD Publishing. https://doi.org/10.1787/1c258f55-en (Access date: 10.10.2025)
  63. Orhan, F., Yılık, P., Gökçe, A., and Beylik, U. (2025). Sağlıkta dönüşüm programı kapsamında türkiye’de 112 acil sağlık hizmetleri: Durum analizi ve politika önerileri. Türkiye Sağlık Araştırmaları Dergisi, 6(1), 26-43.
  64. Ozcan, Y. A., and Khushalani, J. (2017). Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform. Central European Journal of Operations Research, 25(2), 325-343. https://doi.org/10.1007/s10100-016-0440-0
  65. Öcek, Z. A., Çiçeklioğlu, M., Yücel, U., and Özdemir, R. (2014). Family medicine model in Turkey: A qualitative assessment from the perspectives of primary care workers. BMC Family Practice, 15(1), 38.
  66. Ökem, Z. G., and Çakar, M. (2015). What have health care reforms achieved in Turkey? An appraisal of the “health transformation programme”. Health Policy, 119(9), 1153-1163. https://doi.org/10.1016/j.healthpol.2015.06.003
  67. Park, J. Y. (1992). Canonical cointegrating regressions. Econometrica: Journal of the Econometric Society, 119-143.
  68. Peña-Sánchez, A. R., Ruiz-Chico, J., and Jiménez-García, M. (2021, March). Dynamics of public spending on health and socio-economic development in the european union: An analysis from the perspective of the sustainable development goals. In Healthcare (Vol. 9, No. 3, p. 353). MDPI. https://doi.org/10.3390/healthcare9030353
  69. Pérez-Cárceles, M. C. (2025). Is defence expenditure a guarantee of human development? A panel data approach in the group of twenty. Applied Economics, 57(20), 2569-2580.
  70. Pesaran, M. H., Shin, Y., and Smith, R. J. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16(3), 289-326. https://doi.org/10.1080/00036846.2024.2326531
  71. Phillips, P. C., and Hansen, B. E. (1990). Statistical inference in instrumental variables regression with I (1) processes. The review of Economic Studies, 57(1), 99-125.
  72. Rachely, B., Bashir, A., and Rohima, S. (2023). The effect of public expenditure and economic complexity on ıncome disparity in indonesia. AFEBI Economic and Finance Review, 8(1), 63-74.
  73. Raghupathi, V., and Raghupathi, W. (2020). The influence of education on health: An empirical assessment of OECD countries for the period 1995–2015. Archives of Public Health, 78(1), 20. https://doi.org/10.1186/s13690-020-00402-5
  74. Rahman, M. M., Khanam, R., and Rahman, M. (2018). Health care expenditure and health outcome nexus: New evidence from the SAARC-ASEAN region. Globalization and Health, 14(1), 113. https://doi.org/10.1186/s12992-018-0430-1
  75. Rasu, R. S., Bawa, W. A., Suminski, R., Snella, K., and Warady, B. (2015). Health literacy impact on national healthcare utilization and expenditure. International Journal of Health Policy and Management, 4(11), 747. https://doi.org/10.15171/ijhpm.2015.151
  76. San, S. (2020). Türkiye'de sağlıkta dönüşüm programı ve hasta memnuniyeti üzerine etkileri. Ankara Sağlık Bilimleri Dergisi, 9(2), 55-66. https://doi.org/10.46971/ausbid.762740
  77. Sönmez, S., and İlgün, G. (2018). Türkiye’de ilaç fiyatlandırma ve geri ödeme politikalarının AB ülkeleri ile karşılaştırılması. Sayıştay Dergisi, (108), 99-121.
  78. Srinivasan, P., Kumar, P. S., and Ganesh, L. (2012). Tourism and economic growth in Sri Lanka: An ARDL bounds testing approach. Environment and Urbanization Asia, 3(2), 397-405.
  79. Stock, J. H., and Watson, M. W. (1993). A simple estimator of cointegrating vectors in higher order integrated systems. Econometrica: Journal of the Econometric Society, 783-820.
  80. Stokes, J., Gurol–Urganci, I., Hone, T., and Atun, R. (2015). Effect of health system reforms in Turkey on user satisfaction. Journal of Global Health, 5(2), 020403. https://doi.org/10.7189/jogh.05.020403
  81. Stronks, K., and Gunning-Schepers, L. J. (1993). Should equity in health be target number 1?. The European Journal of Public Health, 3(2), 104-111.
  82. Strulik, H. (2011). Health and education: Understanding the gradient (No. 487). Leibniz Universität Hannover, Wirtschaftswissenschaftliche Fakultät. https://hdl.handle.net/10419/73105
  83. Sulku, S. N. (2012). The health sector reforms and the efficiency of public hospitals in Turkey: Provincial markets. The European Journal of Public Health, 22(5), 634–638. https://doi.org/10.1093/eurpub/ckr163.
  84. Şenol, V., Elmali, F., Çetinkaya, F., Naçar, M., and Yalap, R. (2023). Change in utilization of health services and its affecting factors in Kayseri city center: A comparative population-based cross-sectional study in 2004 and 2017. Turkiye Klinikleri Journal of Medical Sciences, 43(1). https://doi.org/10.5336/medsci.2022-91590
  85. Tanaka, T., Okamoto, S., and Canning, D. (2022). National health spending, health-care resources, service utilization, and health outcomes. American Journal of Epidemiology, 191(3), 386-396. https://doi.org/10.1093/aje/kwab179
  86. Tatar, M., Mollahaliloğlu, S., Şahin, B., Aydın, S., Maresso, A., Hernández-Quevedo, C. (2011). Turkey Health System Review. Health Systems in Transition.13(6).
  87. The Turkish Government Gazette. (2005). The law regarding the transfer of health units of some public institutions and organizations to the Ministry of Health. https://www.resmigazete.gov.tr/eskiler/2005/01/20050119M1-1.htm
  88. The Turkish Government Gazette. (2010). The law regarding university and health staff working full time and amending some laws. https://www.resmigazete.gov.tr/eskiler/2010/01/20100130-1.htm (Access date: 19.10.2025)
  89. The Turkish Government Gazette. (2011). Declaration on the organization and duties of the Ministry of Health and its affiliates. https://www.resmigazete.gov.tr/eskiler/2011/11/20111102M1-3.htm (Access date: 10.10.2025)
  90. The Turkish Social Security Institution. (2011). General Health Insurance System in Turkey. The Turkish Social Security Institution Publishing.
  91. Tran, L. D., Zimmerman, F. J., and Fielding, J. E. (2017). Public health and the economy could be served by reallocating medical expenditures to social programs. SSM-Population Health, 3, 185-191. https://doi.org/10.1016/j.ssmph.2017.01.004
  92. Tutuncu, O., Cobaner, A. A., Guzelgoz, O., Cetin, A., Malkoc, M., and Mollahaliloglu, S. (2014). The effects of health transformation program on patient–healthcare personnel communication and interaction in Turkey. Quality & Quantity, 48(6), 3433-3446. https://doi.org/10.1007/s11135-013-9965-7
  93. TÜİK (Turkish Statistical Institute). (2024). İstatistiklerle Çocuk, 2024. https://www.tuik.gov.tr
  94. Tüzün, H., Özkan, S., Dikmen, A. U., Aksakal, N. B., Çalışkan, D., Taşçı, Ö., and Ünal, S. C. (2023). How health literacy associates with healthcare utilization and health promotion behaviours in Turkey? Contributions to discussions concerning the Anderson model and ecological models. The International Journal of Health Planning and Management, 38(4), 986-998. https://doi.org/10.1002/hpm.3640
  95. Ullah, I., Ullah, A., Ali, S., Poulova, P., Akbar, A., Haroon Shah, M.,. and Afridi, F. E. A. (2021). Public health expenditures and health outcomes in Pakistan: Evidence from quantile autoregressive distributed lag model. Risk Management and Healthcare Policy, 3893-3909. https://doi.org/10.2147/RMHP.S316844
  96. Ünal, E., and Yılmaz, S. (2025, March). Healthcare sector dynamics in Turkey (2002–2022): Trends, breakpoints, and policy ımplications (Privatization in the hospital sector). Healthcare, 13(6). https://doi.org/10.3390/healthcare13060622
  97. Wagner, A. K., Graves, A. J., Reiss, S. K., LeCates, R., Zhang, F., and Ross-Degnan, D. (2011). Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey. Health Policy, 100(2-3), 151-158. https://doi.org/10.1016/j.healthpol.2010.08.004
  98. Wagstaff, A. (2009). Social health insurance vs. tax-financed health systems-evidence from the OECD. World Bank Policy Research Working Paper, (4821).
  99. World Bank. (2023). World Development Indicators: Health expenditure (% of GDP), Turkey. World Bank Open Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=TR. (Access date: 20.10.2025)
  100. World Bank. (2025). World Bank Open Data. https://data.worldbank.org/.(Access date: 20.09.2025)
  101. Xin, Y., and Ren, X. (2023). Determinants of province-based health service utilization according to Andersen’s Behavioral Model: A population-based spatial panel modeling study. BMC Public Health, 23(1), 985. https://doi.org/10.1186/s12889-023-15885-4
  102. Yakışık H., & Çetin A. (2014). The impact of education, health and level of technology on economic growth: ARDL bounds test approach. Sosyoekonomi, 21, 169–186
  103. Yardim, M. S., Cilingiroglu, N., and Yardim, N. (2014). Financial protection in health in Turkey: The effects of the Health Transformation Programme. Health Policy and Planning, 29(2), 177-192. https://doi.org/10.1093/heapol/czt002
  104. Yasar, G. Y. (2011). ‘Health Transformation Programme’in Turkey: An assessment. The International Journal of Health Planning and Management, 26(2), 110-133.
  105. Yıldız, M. S. (2017). Türkiye’de 2002-2015 yılları arasında hastane yatak kullanımının değerlendirilmesi: Pabon Lasso metodu uygulaması. Hacettepe Sağlık İdaresi Dergisi, 20(3), 347-356.
  106. Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I.,. and Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382(9886), 65-99.
  107. Loef, B., Meulman, I., Herber, G. C. M., Kommer, G. J., Koopmanschap, M. A., Kunst, A. E.,. and Uiters, E. (2021). Socioeconomic differences in healthcare expenditure and utilization in The Netherlands. BMC Health Services Research, 21(1), 643. https://doi.org/10.1186/s12913-021-06694-9
  108. Ullah, I., Ullah, A., Ali, S., Poulova, P., Akbar, A., Haroon Shah, M.,. and Afridi, F. E. A. (2021). Public health expenditures and health outcomes in Pakistan: Evidence from quantile autoregressive distributed lag model. Risk Management and Healthcare Policy, 3893-3909. https://doi.org/10.2147/RMHP.S316844
  109. World Bank. (2023). World Development Indicators: Health expenditure (% of GDP), Turkey. World Bank Open Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=TR. (Access date: 20.10.2025)