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Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees

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  • Burcay Erus
  • Nazli Aktakke

Abstract

The Turkish health care system has been subject to major reform during the last five years. During the reform process, access to private and public providers was eased for public insurees. Despite the importance of the reform, there is no rigorous study of the reform’s impact on health expenditures and access. This study analyzes a rich dataset on healthcare expenditures to look into the presence and size of out-of-pocket (OOP) health expenditures. The study uses Household Budget Surveys from 2003 to 2006, which provide a range of individual and household level data, as well as aggregate and detailed health care expenditures. Using econometric methods we analyze the presence of health expenditures, the share of health expenditures in total monthly expenditures and the level of health expenditures. Results show that the ratio of households with non-zero OOP expenditure has increased with the reforms, but the share and level of OOP expenditures have decreased. In addition, the impact is different across income levels. The results of a semi-parametric analysis show that wealthier individuals have benefited more in terms of the decrease in OOP health expenditures.
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  • Burcay Erus & Nazli Aktakke, 2012. "Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(3), pages 337-346, June.
    • Handle: RePEc:spr:eujhec:v:13:y:2012:i:3:p:337-346
    DOI: 10.1007/s10198-011-0306-2
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    1. Brown, Sarah & Hole, Arne Risa & Kilic, Dilek, 2014. "Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys," Economic Modelling, Elsevier, vol. 41(C), pages 211-218.
    2. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    3. Abdullah TİRGİL & Fatih Cemil ÖZBUĞDAY, 2020. "Does Public Health Insurance Provide Financial Protection Against Out-Of-Pocket Health Payments? Evidence from TurkeyAbstract: Turkey hasinitiated comprehensive reformsto increase equity among its cit," Sosyoekonomi Journal, Sosyoekonomi Society, issue 28(45).
    4. Burcay Erus, 2020. "Out of pocket health expenditures in Turkey following introduction of co‐payments along with improved primary care services," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(2), pages 433-440, March.
    5. repec:jet:dpaper:dpaper391 is not listed on IDEAS
    6. Eleftherios Giovanis & Oznur Ozdamar, 2016. "Who Pays More: Public, Private, Both or None? The Effects of Health Insurance Schemes and Health Reforms on Out-of-Pocket and Catastrophic Health Expenditures in Turkey," Working Papers 1058, Economic Research Forum, revised 10 2016.
    7. Emrah Konuralp & Sermin Bicer, 2021. "Putting the Neoliberal Transformation of Turkish Healthcare System and Its Problems into a Historical Perspective," Review of Radical Political Economics, Union for Radical Political Economics, vol. 53(4), pages 654-674, December.
    8. Erus, Burcay & Hatipoglu, Ozan, 2017. "Physician payment schemes and physician productivity: Analysis of Turkish healthcare reforms," Health Policy, Elsevier, vol. 121(5), pages 553-557.
    9. Giovanis, Eleftherios & Ozdamar, Oznur, 2017. "The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey," MPRA Paper 95837, University Library of Munich, Germany.
    10. Songul Cinaroglu, 2017. "A Fresh Look at Out-of-Pocket Health Expenditures after More than a Decade Health Reform Experience in Turkey: A Data Mining Application," International Journal of Economics and Financial Issues, Econjournals, vol. 7(5), pages 33-40.
    11. Esra N. Kilci, 2021. "A study on financial sustainability of healthcare indicators for Turkey under the health transformation program," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(4), pages 1287-1307, July.
    12. Burcay Erus, 2016. "Out of Pocket Health Expenditures in Turkey in the Aftermath of the Reforms: Impact of Co-payments on Expenditures and Use of Health Services," Working Papers 1070, Economic Research Forum, revised 12 Jun 2016.
    13. Ozdamar, Oznur & Giovanis, Eleftherios, 2017. "The causal effects of survivors’ benefits on health status and poverty of widows in Turkey: Evidence from Bayesian Networks," Economic Analysis and Policy, Elsevier, vol. 53(C), pages 46-61.
    14. Reham Rizk & Hala Abou-Ali, 2016. "Out of Pocket Health Expenditure and Household Budget: Evidence from Arab Countries," Working Papers 1065, Economic Research Forum, revised 12 Jan 2016.
    15. Dilek Basar & Sarah Brown & Arne Risa Hole, 2012. "Out-of-Pocket Health Care Expenditure in Turkey: Analysis of the Household Budget Surveys 2002-2008," Working Papers 2012020, The University of Sheffield, Department of Economics.
    16. Hasan Tekguc & Z. Nurdan Atalay-Gunes, 2011. "Health Consequences of an Eclectic Social Security Regime: The Case of Turkey," Working Papers 2011-05, Mardin Artuklu Univeristy, Department of Economics.
    17. Cinaroglu, Songul, 2024. "Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms," World Development Perspectives, Elsevier, vol. 34(C).

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    More about this item

    Keywords

    Out-of-pocket health expenditures; Financial burden; Health insurance; Turkey; Health reform; I18;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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