Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees
The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expendit...
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| Published in | The European journal of health economics Vol. 13; no. 3; pp. 337 - 346 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer
01.06.2012
Springer-Verlag Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1618-7598 1618-7601 1618-7601 |
| DOI | 10.1007/s10198-011-0306-2 |
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| Abstract | The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual-and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures. |
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| AbstractList | The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual-and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures. The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures. The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures. [PUBLICATION ABSTRACT] |
| Author | Aktakke, Nazli Erus, Burcay |
| Author_xml | – sequence: 1 givenname: Burcay surname: Erus fullname: Erus, Burcay – sequence: 2 givenname: Nazli surname: Aktakke fullname: Aktakke, Nazli |
| BackLink | http://www.econis.eu/PPNSET?PPN=718956680$$DView this record in ZBW - Deutsche Zentralbibliothek für Wirtschaftswissenschaften https://www.ncbi.nlm.nih.gov/pubmed/21424211$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1163/187633710X500739 10.1016/S0167-6296(02)00012-7 10.1377/hlthaff.26.4.1029 10.1002/hec.1080 10.1016/0277-9536(95)00267-7 10.1093/heapol/czn009 10.1016/j.jhealeco.2008.02.002 10.1377/hlthaff.24.6.1467 |
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| Keywords | Health insurance I18 Out-of-pocket health expenditures Turkey Financial burden Health reform |
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| References_xml | – reference: KnaulF.FrenkJ.Health insurance in Mexico: achieving universal coverage through structural reformHealth Affairs200524614671476 – reference: OECD and World Bank. Reviews of Health Systems: Turkey. OECD and IBRD/The World Bank (2008) – reference: TatarM.OzgenH.SahinB.BelliP.BermanP.Informal payments in the health sector: a case study from TurkeyHealth Aff.200726410291039 – reference: Earl-SlaterA.Health-care reforms in the Czech RepublicJ. Manag. Med.19961021322 – reference: Altınok, M., Üçer, A.: Sağlıkta Dönüşüm Sürecinde Sağlık Harcamaları (Health Expenditures in Tarnsformation in Health Process). http://www.tipkurumu.org/files/SagliktaDonusumSurecindeSaglikHarcamalari-son.doc. Accessed on January 21, 2011 – reference: Sulku, S., Bernard, D.: Financial burden of health care expenditures in Turkey: 2002–2003. Agency for Healthcare Research and Quality Working Paper No. 09004 (2009) – reference: WagstaffALindelowMCan Insurance Increase Financial Risk? The Curious Case of Health Insurance in ChinaJ. Health Econ.20082799010051834296310.1016/j.jhealeco.2008.02.002 – reference: SepehriA.SarmaS.SimpsonW.Does non-profit Health Insurance Reduce Financial Burden? Evidence from the Vietnam living standards survey panelHealth Econ.2006156603616 – reference: Hanehalkı Bütçe Anketi, 2003–2006.: TÜİK (Turkish Statistics Institution) – reference: Agartan, T.: Health Sector Reform in Turkey: Old Policies New Politics. Paper presented at the 2005 ESPANET Young Researchers Workshop, 2005 – reference: EkmanB.LiemT.DucA.AxelsonH.Health insurance reform in Vietnam: a review of recent developments and future challengesHealth Policy Plan.2008234252263 – reference: World Bank: Turkey: Country Economic Memorandum-Structural Reforms for Sustainable Growth. World Bank Report No. 20029-TU, (2001) – reference: Aran, M., Hentschel, J.: Household Level Health Expenditures and Health Insurance Coverage of the Poor in Turkey. World Bank (forthcoming) – reference: Adaman, F.: Study on the Social Protection Systems in Turkey. Entry for the report Study on the Social Protection Systems in the 13 Applicant Countries, prepared for European Commission (2003) – reference: BorissovV.RathwellT.Health care reforms in Bulgaria: an initial appraisalSoc. Sci. Med.1996421115011510 – reference: AlanSCrossleyTGrootendorstPMichaelVThe effects of drug subsidies on out-of-pocket prescription drug expenditures by seniors: regional evidence from Canada. JHealth Econ.20022180582610.1016/S0167-6296(02)00012-7 – reference: Akbulut, Y., Sarp, N., Ugurluoglu, E.: Reform of the health care system in Turkey: a review of universal health insurance. World Hosp. Health Serv. 43(1), 13–16 (2007) – reference: BugraA.KeyderC.The Turkish welfare regime in transformationJ. Eur. Soc. Policy2006163211228 – reference: EderMRetreating state? Political economy of welfare regime change in TurkeyMiddle East Law and Governance20102215218410.1163/187633710X500739 – volume: 2 start-page: 152 issue: 2 year: 2010 ident: 306_CR3 publication-title: Middle East Law and Governance doi: 10.1163/187633710X500739 – volume: 21 start-page: 805 year: 2002 ident: 306_CR12 publication-title: Health Econ. doi: 10.1016/S0167-6296(02)00012-7 – ident: 306_CR13 – ident: 306_CR2 – ident: 306_CR14 – ident: 306_CR1 – ident: 306_CR18 – ident: 306_CR19 doi: 10.1377/hlthaff.26.4.1029 – ident: 306_CR5 – ident: 306_CR8 doi: 10.1002/hec.1080 – ident: 306_CR10 doi: 10.1016/0277-9536(95)00267-7 – ident: 306_CR16 – ident: 306_CR17 – ident: 306_CR15 – ident: 306_CR4 – ident: 306_CR11 – ident: 306_CR9 doi: 10.1093/heapol/czn009 – volume: 27 start-page: 990 year: 2008 ident: 306_CR6 publication-title: J. Health Econ. doi: 10.1016/j.jhealeco.2008.02.002 – ident: 306_CR7 doi: 10.1377/hlthaff.24.6.1467 – reference: 10162753 - J Manag Med. 1996;10(2):13-22 – reference: 16284018 - Health Aff (Millwood). 2005 Nov-Dec;24(6):1467-76 – reference: 12349883 - J Health Econ. 2002 Sep;21(5):805-26 – reference: 16389632 - Health Econ. 2006 Jun;15(6):603-16 – reference: 18424793 - Health Policy Plan. 2008 Jul;23(4):252-63 – reference: 18342963 - J Health Econ. 2008 Jul;27(4):990-1005 – reference: 17630446 - Health Aff (Millwood). 2007 Jul-Aug;26(4):1029-39 – reference: 8771633 - Soc Sci Med. 1996 Jun;42(11):1501-10 – reference: 17621768 - World Hosp Health Serv. 2007;43(1):13-6 |
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