İlknur ARSLAN ARAS
Journal of International Health Sciences and Management - 2026;12(2):1-10
Public health administrations are exposed to simultaneous uncertainty in revenue, labour expenditure and supply prices, but consolidated financial statements are usually interpreted through retrospective point estimates. This study develops a probabilistic fiscal-monitoring framework for Türkiye's Ministry of Health without treating accounting outcomes as measures of managerial performance. Comparable consolidated accrual statements for 2024 and 2025 were reconciled into reported, operating and researcher-defined core views. Revenue and expenditure concentration, liquidity, rigidity and the change in core coverage were examined; the latter was decomposed through a two-factor Shapley procedure. Three conditional 2026 scenarios were then evaluated using 100,000 correlated beta-PERT draws per scenario with Latin hypercube sampling. Core coverage increased from 47.75% to 49.49%, although the core financing gap widened from TRY 635.7 billion to TRY 867.0 billion. Revenue growth contributed 18.86 percentage points to coverage, while expenditure growth offset 17.12 points. Labour-related costs represented 67.28% of 2025 core expenditure, and one revenue category generated 83.68% of gross revenue. In the baseline scenario, the median financing gap was TRY 1,205.6 billion and the 95% Fiscal-at-Risk was TRY 1,324.5 billion. Under managed disinflation, coverage improved in most simulations while the nominal gap widened. The framework demonstrates that proportional coverage and absolute financing need can move in opposite directions and converts static accounts into transparent, scenario-conditioned risk measures. For policymakers, the results support combining conventional fiscal indicators with probabilistic early-warning thresholds and closer monitoring of labour, procurement and short-term financing pressures; future research should extend the framework using longer time series and integrate service volume, procurement, supplier-payment and health-service performance indicators. The outputs are not official forecasts, causal estimates, audit findings or performance evaluations.
