The impact of public and private health investment expenditures on the health system in Türkiye: Causality analysis using the Toda-Yamamoto method for the period 2002-2022

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Türkiye's healthcare system has undergone substantial changes since 2002, driven by public and private sector investments aimed at expanding capacity, improving service quality, and enhancing health outcomes. This study examined the causal effects of these investments on healthcare indicators such as hospital capacity, patient satisfaction, and mortality rates from 2002 to 2022 using data from the Ministry of Health, the World Bank, and TURKSTAT. Seventeen models were analyzed through the Toda-Yamamoto causality approach, focusing on variables like hospital beds, healthcare personnel, patient satisfaction, and economic factors such as GDP and the Consumer Confidence Index (CCI). Public health investments significantly increased beds in public hospitals (χ²=10.14, p=0.04), while private investments had a strong impact on beds in private hospitals (χ²=24.29, p<0.01). GDP also positively influenced the number of beds in both public (χ²=56.13, p<0.01) and private hospitals (χ²=59.01, p<0.01). Private investments were associated with increased healthcare personnel in the private sector (χ²=39.34, p<0.01), whereas public investments had no significant impact on public-sector personnel (χ²=1.06, p=0.59). GDP had a positive effect on patient satisfaction with public health services (χ²=22.31, p<0.01), and private investments correlated with higher satisfaction in private healthcare (χ²=24.29, p<0.01). Additionally, GDP significantly reduced infant mortality (χ²=34.70, p<0.01) and under-five mortality (χ²=41.55, p<0.01). Health investments were linked to lower mortality rates from cardiovascular disease, cancer, diabetes, and chronic kidney disease (χ²=32.39, p<0.01). The findings highlight the essential role of both public and private investments in enhancing Türkiye's healthcare system. Private-sector investment is especially critical for expanding capacity and improving satisfaction. Policies integrating economic growth with healthcare improvements and continuous investments in infrastructure and human resources are vital for sustaining progress.