Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys

Abstract

This paper analyses the prevalence of 'catastrophic' out-of-pocket health expenditure in Turkey and identifies the factors which are associated with its risk using the Turkish Household Budget Surveys from 2002 to 2008. A sample selection approach based on Sartori (2003) is adopted to allow for the potential selection problem which may arise if poor households choose not to seek health care due to concerns regarding its affordability. The results suggest that poor households are less likely to seek health care as compared to non-poor households and that a negative relationship between poverty and experiencing catastrophic health expenditure remains even after allowing for such selection bias. Our findings, which may assist policy-makers concerned with health care system reforms, also highlight factors such as insurance coverage, which may protect households from the risk of incurring catastrophic health expenditure. JEL Classification: I10, C25

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

“…The results overall are consistent with the study by Brown et al (2014); however, our analysis is expanded examining all the health insurance types, including the accessibility to health centers and transportation, wealth, as well as, the DID approach will be applied in order to see the effectiveness of the health reform of 2008. However, these estimates are not based on propensity score matching; thus it is highly possible that there is selection bias and heterogeneity in the sample.…”

“…Following the previous literature (Van Doorslaer et al, 2007;Mugisha et al, 2007;Barros and Bertoldi, 2008;Erus and Aktakke, 2012;Brown et al, 2014) the regressions control for various individual and household characteristics, including gender, age, education level, household income, marital and job status, occupation industry code, rural versus urban area, years of working, years of leaving in the current residence, difficulties in access to transportation points and health centers and year. These controls are useful, since education, job status, years of work and household income may cause the decision and the type of health insurance.…”

What have health care reforms achieved in Turkey? An appraisal of the “Health Transformation Programme”

“…This is because poor households are less likely to seek health care and hence incur less catastrophic health expenses compared to non-poor households. In addition, OOP made by higher income groups are usually directed towards buying private health insurance to afford extra private hospital costs that are not paid by SSI [84]. Overall, our review suggests that a regressive OOP characteristic persisted even after the reforms.…”

Catastrophic Household Expenditure for Healthcare in Turkey: Clustering Analysis of Categorical Data

“…They interpreted these effects as a positive impact of the Health Transformation Programme. Brown et al [25] examined the presence of catastrophic out-of-pocket health expenditures in Turkey and found the crucial factors which had an impact on it by using the Turkish Household Budget Surveys for the 2003-2008 period. According to the different cut-off point of expenditure, they indicated that between 16% and 18% of households spent more than 2.5% of their income on healthcare, and between 1% and 2% of households spent more than 20% of their total expenditure for the 2003-2008 period.…”