# Investigating the determinants of under-five child mortality in Türkiye: the role of inequality in access to healthcare

## TL;DR

This study explores how unequal access to healthcare in Türkiye affects child mortality, finding that fair distribution of health resources is crucial for reducing deaths among children under five.

## Contribution

The study introduces a novel econometric framework to quantify how health equality modulates the impact of health expenditures on child mortality.

## Key findings

- Health expenditures and human capital consistently reduce under-five mortality.
- Health equality is the strongest factor in lowering child mortality.
- Inequitable distribution weakens the mortality-reducing effects of health expenditures.

## Abstract

Under-five mortality remains a key indicator of healthcare effectiveness, yet disparities persist due to inequitable health investments, and human capital development.

This study investigates the long-run determinants of under-five mortality in Türkiye by incorporating health expenditures, human capital, and health equality into a robust econometric framework. A key focus is to examine the extent to which health equality modulates the impact of health expenditures on child mortality and whether an inequitable distribution of healthcare services undermines the mortality-reducing effects of financial investments.

This study employs time-series econometric techniques to analyze secondary data from 1975 to 2022. Stationarity is tested using the ADF and KPSS tests, while the Bayer-Hanck cointegration test assesses long-run equilibrium. The FMOLS method estimates the long-term impact of key variables on under-five mortality, addressing autocorrelation and heteroscedasticity concerns.

The results indicate that increased health expenditures and greater human capital reduce under-five mortality, and this pattern remains consistent across both model specifications. When health equality is included in the analysis, its influence emerges as the strongest factor in lowering mortality. However, the interaction between health expenditures and health equality shows that the mortality-reducing effect of health expenditures weakens when resources are distributed unfairly. These findings highlight that the effectiveness of financial investments depends heavily on the degree of equity within the health system.

This study confirms that health expenditure, human capital development, and equitable resource distribution are key to reducing under-five mortality. However, the results also show that when health expenditures are allocated inequitably, their impact becomes weaker, underscoring the critical role of equality. Policies must therefore prioritize fairness in the distribution of health resources, while future research should continue to examine how health expenditures and human capital can be optimized to improve accessibility and efficiency.