Evaluating Health Financing Typologies Through Healthy Life Expectancy and Infant Mortality: Evidence from OECD Countries and Türkiye

Abstract

Highlights: What are the main findings? High-Public-Spending systems achieved an 81.2% success rate in top-quartile health performance, whereas Moderate/Emerging systems exhibited only 8.3% success, with Türkiye ranking 36th of the 38 countries (TOPSIS score = 24.8, 45% below cluster average). Sex-disaggregated analysis revealed that low-resource systems magnify gender disparities (HALE gap 3.43 vs. 1.66 years; male excess infant mortality 1.04 vs. 0.53 per 1000), with Türkiye exhibiting the third-highest male infant mortality gap globally. What are the implications of the main findings? Robust public financing (>USD 3500 per capita, >7% GDP) is necessary and nearly sufficient for superior outcomes—81% of High-Public-Spending systems achieve top performance versus only 8% of low-resource systems, demonstrating that adequate financing is non-negotiable. Türkiye requires fundamental increases in public investment (at minimum, doubling from USD 813 to ~1900 per capita) alongside targeted neonatal care expansion to address extreme efficiency deficits and gender disparities in infant mortality. Background/Objectives: The structure and adequacy of health financing critically shape population health outcomes. This study examines financing typologies in relation to healthy life expectancy (HALE) and infant mortality across 38 OECD countries and Türkiye (2000–2021), quantifying financing model effectiveness and sex-disaggregated disparities. Methods: Time-weighted averages (exponential weighting, λ = 1.5) emphasized recent policy environments while preserving historical context. Principal component analysis addressed multicollinearity among six financial indicators. Multidimensional scaling (stress = 1.16 × 10−12) and K-means clustering identified four financing typologies. TOPSIS composite scores measured proximity to ideal outcomes (maximum HALE, minimum infant mortality), with success rates calculated as the percentage achieving top-quartile performance (TOPSIS ≥ 70). Sex-disaggregated analysis examined gender gaps across clusters. Results: High-Public-Spending systems achieved an 81.2% success rate (mean TOPSIS = 76.0), those with Balanced High-Expenditure achieved 77.8%, whereas Moderate/Emerging systems exhibited only 8.3% success. Türkiye ranked 36th of the 38 (TOPSIS = 24.8), 45% below cluster average, with extreme deficits in HALE (percentile = 15.8%) and infant mortality (7.9%). Low-resource systems showed significantly wider gender gaps (HALE: 3.43 vs. 1.66 years; infant mortality male excess: 1.04 vs. 0.53 per 1000; p < 0.01), with Türkiye demonstrating the third-highest male excess mortality globally (1.69 per 1000), indicating critical neonatal care deficiencies. Conclusions: Robust public financing (>USD 3500 per capita, >7% GDP) is necessary and nearly sufficient for superior outcomes, with success rates differing 10-fold between high- and low-resource systems (81% vs. 8%). Türkiye’s extreme underperformance reflects both inadequate public investment (USD 813 per capita, 22% of high-performing averages) and efficiency deficits requiring doubled expenditure alongside targeted maternal–child health interventions.