Does Health Reform Reduce Inequalities? Primary Healthcare of Young Children in Turkey

Health service utilization in early childhood is crucial. It is often observed that children from low-resource households lack sufficient access to health services. We investigate whether the family medicine system introduced as part of the Turkish Health Transformation Program equalized utilization of health services between young children from low- and high-resource households. Using difference-in-differences analysis, we compare the change in service utilization over time between the two groups of children, using official nationally representative microdata from the Health Research Surveys in 2008, 2010, and 2012. We study a set of measures of service utilization and alternative indicators of household resources. Moreover, we test the common trends assumption. Overall, the effect of the reform depends on the measure of utilization. Considering ‘being taken to a health institution’ as the measure, we find no evidence for a positive differential effect on children from low-resource households. On the other hand, considering ‘being taken to a health institution when not sick’, the reform benefited children from lower-resource households more than it benefited better-off children. The evidence for having newborn screening is weak. Regarding the utilization of family health centers, we find no evidence for a positive differential effect for lower-resource households.