The relationship between income, ageing population, and public health expenditures in G-7 countries: A panel ARDL approach
Published 2025-12-25
Keywords
- Ageing Population, Income, Public Health Expenditures, Panel ARDL, G-7
- Yaşlı Nüfus, Gelir, Kamu Sağlık Harcamaları, Panel ARDL, G-7
How to Cite
Copyright (c) 2025 Cuma Çakmak

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
Abstract
Health expenditures show an upward trend with increasing income and an ageing population. Modern economies and health systems are seriously feeling this pressure on public health expenditures and are seeking solutions. This study analyses the short- and long-term relationships among income, an ageing population, and public health expenditures. The G-7 countries, which are developed, were included in this study. The revenue, elderly population, and public health expenditures of the G-7 countries were analysed using the Panel ARDL method. According to the findings, the income variable is negatively related to public health expenditures in the short term. In contrast, the elderly population variable does not affect public health expenditures. In the long term, both income and the elderly population ratio positively impact public health expenditures. The elderly population does not exert significant long-term pressure on health expenditures. Recommendations include redesigning optimal health systems and increasing demand for preventive health services.
References
- Atella, V., Piano Mortari, A., Kopinska, J., Belotti, F., Lapi, F., Cricelli, C., & Fontana, L. (2019). Trends in age‐related disease burden and healthcare utilisation. Aging Cell, 18(1), e12861. https://doi.org/10.1111/acel.12861
- Bai, J., & Ng, S. (2007). Panel unit root tests with cross-section dependence: A further investigation. Working Paper, Department of Economics, New York University.
- Baltagi, B. H., Feng, Q., & Kao, C. (2012). A Lagrange multiplier test for cross-sectional dependence in a fixed effects panel data model. Journal of Econometrics, 170(1), 164–177. https://doi.org/10.1016/j.jeconom.2012.04.004
- Bedir, S. (2016). Healthcare expenditure and economic growth in developing countries. Advances in Economics and Business, 4(2), 76–86. https://doi.org/10.13189/aeb.2016.040203
- Behera, D., & Dash, U. (2016). Nexus between public health expenditure and income: Empirical evidence from Indian states. Nexus, 11(6), 44–52.
- Biçer, İ., Konca, M., & Sarıgül, S. S. (2025). Sağlık harcamalarının belirleyicileri: Bir kantil regresyon uygulaması. Trakya Üniversitesi Sosyal Bilimler Dergisi, 27(Ek), 63-92.
- Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, T., Bloom, L. R., Fathima, S., ... & Sweet, S. (2011). The global economic burden of noncommunicable diseases. World Economic Forum.
- Brucker, D. L., Lauer, E., & Boege, S. (2023). Americans aging with disabilities are more likely to have multiple chronic conditions. Journal of Disability Policy Studies, 34(1), 52–60. https://doi.org/10.1177/10442073221134665
- Cutler, D. M. (2001). The contribution of better health to economic growth. In J. M. Poterba (Ed.), Health and welfare policy in the United States (pp. 91–125). University of Chicago Press.
- De Meijer, C., Wouterse, B., Polder, J., & Koopmanschap, M. (2013). The effect of population aging on health expenditure growth: A critical review. European Journal of Ageing, 10, 353–361. https://doi.org/10.1007/s10433-013-0276-2
- Deaton, A. (2003). Health, income, and inequality. NBER Working Paper Series, No. 9809. National Bureau of Economic Research. https://doi.org/10.3386/w9809
- Economou, C., Kaitelidou, D., Kentikelenis, A., Maresso, A., & Sissouras, A. (2015). The impact of the crisis on the health system and health in Greece. In B. Rechel, E. Jakubowski, M. McKee, & E. Nolte (Eds.), Economic crisis: Health systems and health in Europe (pp. xx–xx). World Health Organization.
- European Commission. (2024). 2024 ageing report: Economic and budgetary projections for the EU Member States (2022–2070). Publications Office of the European Union.
- Farag, M., Nandakumar, A. K., Wallack, S. S., Hodgkin, D., & Gaumer, G. (2013). Health expenditures, income, and health status in a new panel of countries. Review of Economics and Statistics, 95(1), 1-14.
- Getzen, T. E. (2000). Health care is an individual necessity and a national luxury: Applying multilevel decision models to the analysis of health care expenditures. Journal of health economics, 19(2), 259-270.
- Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255. https://doi.org/10.1086/259880
- Hall, R. E., & Jones, C. I. (2007). The value of life and the rise in health spending. The Quarterly Journal of Economics, 122(1), 39–72. https://doi.org/10.1162/qjec.122.1.39
- Han, J. W., Kim, D. J., Min, I. S., & Hahm, M. I. (2019). Association of supplementary private health insurance type with unmet health care needs. Health Policy and Management, 29(2), 184–194. https://doi.org/10.4332/KJHPA.2019.29.2.184
- Kallestrup-Lamb, M., Marin, A. O., Menon, S., & Søgaard, J. (2024). Aging populations and expenditures on health. The Journal of the Economics of Ageing, 29, 100518.
- Kao, C. (1999). Spurious regression and residual-based tests for cointegration in panel data. Journal of Econometrics, 90(1), 1–44. https://doi.org/10.1016/S0304-4076(98)00023-2
- Kao, C., & Chiang, M. H. (2000). On the estimation and inference of a cointegrated regression in panel data. Advances in Econometrics, 15, 179–222. https://doi.org/10.1016/S0731-9053(00)15007-8
- Kar, M., Nazlıoğlu, Ş., & Ağır, H. (2011). Financial development and economic growth nexus in the MENA countries: Bootstrap panel Granger causality analysis. Economic Modelling, 28(1–2), 685–693. https://doi.org/10.1016/j.econmod.2010.05.015
- Lama, P. (2023). The Economic Impact of Ageing on Healthcare. In The Ageing Population: Impact Analysis on'Societal and Healthcare Cost' (pp. 69-81). Singapore: Springer Nature Singapore.
- Lau, M. K., & Pung, H. K. (2016). Aging population and public health expenditure in the G7 countries: A dynamic panel analysis. Journal of Public Economics, 138, 26-38.
- Navarro, F. H. (2014). Patterns of health-related behavior as predictors of medical expenditures (Doctoral dissertation, Walden University).
- Noy, S., & Sprague-Jones, J. (2016). Comparative dynamics of public health spending: Re-conceptualising delta-convergence to examine OECD and Latin America. International Journal of Comparative Sociology, 57(6), 425–448. https://doi.org/10.1177/0020715216674262
- OECD. (2005). Long-term care for older people (The OECD Health Project). OECD Publishing. https://doi.org/10.1787/9789264015852-en
- Özyilmaz, A., Bayraktar, Y., Işık, E., Toprak, M., Er, M. B., Besel, F., ... & Collins, S. (2022). The relationship between health expenditures and economic growth in EU countries: empirical evidence using panel fourier toda–yamamoto causality test and regression models. International journal of environmental research and public health, 19(22), 15091.
- Pedroni, P. (1999). Critical values for cointegration tests in heterogeneous panels with multiple regressors. Oxford Bulletin of Economics and Statistics, 61(S1), 653–670. https://doi.org/10.1111/1468-0084.0610s1653
- Pedroni, P. (2000). Fully modified OLS for heterogeneous cointegrated panels. Advances in Econometrics, 15, 93–130. https://doi.org/10.1016/S0731-9053(00)15004-2
- Pedroni, P. (2004). Panel cointegration: Asymptotic and finite sample properties of pooled time series tests with an application to the PPP hypothesis. Econometric Theory, 20(3), 597–625. https://doi.org/10.1017/S0266466604203073
- Pesaran, M. H. (2004). General diagnostic tests for cross section dependence in panels. Cambridge Working Papers in Economics, No. 0435.
- Pesaran, M. H. (2006). Estimation and inference in large heterogeneous panels with a multifactor error structure. Econometrica, 74(4), 967–1012. https://doi.org/10.1111/j.1468-0262.2006.00692.x
- Pesaran, M. H., Shin, Y., & Smith, R. J. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16(3), 289–326. https://doi.org/10.1002/jae.616
- Pesaran, M. H., Shin, Y., & Smith, R. P. (1999). Pooled mean group estimation of dynamic heterogeneous panels. Journal of the American Statistical Association, 94(446), 621–634. https://doi.org/10.1080/01621459.1999.10474156
- Pesaran, M., & Yamagata, T. (2008). Testing slope homogeneity in large panels. Journal of Econometrics, 142(1), 50–93. https://doi.org/10.1016/j.jeconom.2007.05.010
- Pesaran, M., Ullah, A., & Yamagata, T. (2008). A bias-adjusted LM test of error cross-section independence. Journal of Econometrics, 11(1), 105–127. https://doi.org/10.1016/j.jeconom.2007.05.001
- Phillips, P. C. B., & Hansen, B. E. (1990). Statistical inference in instrumental variables regression with I(1) processes. Review of Economic Studies, 57(1), 99–125. https://doi.org/10.2307/2297545
- Rechel, B., Jakubowski, E., McKee, M., & Nolte, E. (Eds.). (2018). Organisation and financing of public health services in Europe (No. 50). World Health Organization.
- Ryan, C., Feldman, R., & Parente, S. (2022). The demand for individual insurance: Evidence from a private online marketplace. American Journal of Health Economics, 8(2), 275–299. https://doi.org/10.1086/718324
- Sarıgül, S. S., Konca, M., & Biçer, İ. (2024). Yatak kapasitesinin ve kamu sağlık harcamalarının hasta memnuniyet düzeyi üzerindeki etkisi: Gelişmiş ve gelişmekte olan ülkeler örneği. Pamukkale Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, (2024), 269-284.
- Varabyova, Y., & Schreyögg, J. (2013). International comparisons of the technical efficiency of the hospital sector: panel data analysis of OECD countries using parametric and non-parametric approaches. Health Policy, 112(1-2), 70-79.
- Wang, L., & He, J. (2019). The relationship between health expenditure and economic growth in G7 countries: A panel causality analysis. Sustainability, 11(18), 5006.
- World Health Organization. (2010). The world health report 2010: Health systems financing: The path to universal coverage. World Health Organization.
- Yıldırım, Z., & Cebeci, A. (2021). Gelişmiş ülkelerde kamusal sağlık harcamaları ve sermaye birikimi İlişkisi: Panel eşbütünleşme analizi. Yaşar Üniversitesi E-Dergisi, 16(62), 982-1004.


