The Determinants of Turkey Household Catastrophic Health Expenditures: A Different Approach by Data Mining

Year 2021, Volume: 9 Issue: 2, 229 - 246, 31.12.2021

Uğur Ercan

https://doi.org/10.17093/alphanumeric.940744

Cited By: 3

Abstract

This study aims to determine socioeconomic, demographic, and household characteristics that affect Turkish household catastrophic health expenditure (CHE). Data gathered by TurkStat belonging to 40,033 households for the years 2009-2012 were used in the analysis. In the study, CHE was defined as household health expenditures that were 40% (or above) greater than the capacity pay of the household. CHAID analysis was used to determine characteristics affecting Turkish household CHE. According to the CHAID analysis; income, presence of a sick/disabled person, residential area, household size, age, education level and gender of the household head, presence of individuals aged 65+, presence of people between the ages of zero and five, and access to health institutions have been observed to affect CHE, while the marital status, age, and employment status of the head of the household, or the household type do not affect CHE. The proportion of households exposed to CHE was 0.62%, and the proportion of households making out-of-pocket health expenditure (OOPHE) was 62.71%. It was especially observed that households with low income, with sick/disabled individuals, and those with difficult access to healthcare facilities are more likely to be exposed to CHE. None of the households exposed to CHE has supplementary health insurance.

Keywords

Catastrophic Health Expenditure, Out-of-pocket Health Expenditure, Household budget survey, Turkey, Chaid Analysis

References

• Ahmed, Sayem, Sylvia Szabo, and Kristine Nilsen. 2018. “Catastrophic Healthcare Expenditure and Impoverishment in Tropical Deltas: Evidence from the Mekong Delta Region.” International Journal for Equity in Health 17(1):1–13. doi: 10.1186/s12939-018-0757-5.
• Akhtar, A., Nadeem Ahmad, and Indrani Roy Chowdhury. 2020. Socio-Economic Inequality in Catastrophic Health Expenditure among Households in India: A Decomposition Analysis. Vol. 55. Springer India.
• Aregbeshola, Bolaji Samson, and Samina Mohsin Khan. 2018. “Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty among Households in Nigeria 2010.” International Journal of Health Policy and Management 7(9):798–806. doi: 10.15171/ijhpm.2018.19.
• Arsenijevic, Jelena, Milena Pavlova, and Wim Groot. 2013. “Measuring the Catastrophic and Impoverishing Effect of Household Health Care Spending in Serbia.” Social Science and Medicine 78(1):17–25. doi: 10.1016/j.socscimed.2012.11.014.
• Bank, The World. n.d. “Current Health Expenditure per Capita (Current US$) | Data.” Retrieved January 8, 2021a (https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD).
• Bank, The World. n.d. “Out-of-Pocket Expenditure per Capita (Current US$) | Data.” Retrieved January 8, 2021b (https://data.worldbank.org/indicator/SH.XPD.OOPC.PC.CD).
• Barros, Aluísio J. D., João Luiz Bastos, and Andréa H. Dâmaso. 2011. “Catastrophic Spending on Health Care in Brazil: Private Health Insurance Does Not Seem to Be the Solution.” Cadernos de Saude Publica 27(SUPPL.2):254–62. doi: 10.1590/s0102-311x2011001400012.
• Berry, M. J. A., Linoff, G. S. 2004. Data Mining Techniques For Marketing, Sales, and Customer Relationship Management. Second Edi. John Wiley & Sons, Inc.
• Choi, Jae Woo, Jong Won Choi, Jae Hyun Kim, Ki Bong Yoo, and Eun Cheol Park. 2015. “Association between Chronic Disease and Catastrophic Health Expenditure in Korea.” BMC Health Services Research 15(1):1–8. doi: 10.1186/s12913-014-0675-1.
• Cleopatra, Ibukun, and Komolafe Eunice. 2018. “Household Catastrophic Health Expenditure : Evidence from Nigeria.” Scientific & Academic Publishing 6(1):1–8. doi: 10.5923/j.m2economics.20180601.01.
• Cylus, Jonathan, Sarah Thomson, and Tamás Evetovits. 2018. “Catastrophic Health Spending in Europe: Equity and Policy Implications of Different Calculation Methods.” Bulletin of the World Health Organization 96(9):599–609. doi: 10.2471/BLT.18.209031.
• Dalui, Anirban, Sitikantha Banerjee, and Ramaprasad Roy. 2020. “Determinants of Out-of-Pocket and Catastrophic Health Expenditure in Rural Population: A Community-Based Study in a Block of Purba Barddhaman, West Bengal.” Indian Journal of Public Health 64(3):223–28. doi: 10.4103/ijph.IJPH_848_20.
• Goryakin, Yevgeniy, and Marc Suhrcke. 2014. “The Prevalence and Determinants of Catastrophic Health Expenditures Attributable to Non-Communicable Diseases in Low- and Middle-Income Countries : A Methodological Commentary.” 1–5.
• Han, J., Kamber, M., & Pei, J. 2011. Data Mining Concepts and Techniques. Third Edit. the United States ofAmerica.
• Ilesanmi, Olayinka Stephen, Akindele Olupelumi Adebiyi, and Akinola Ayoola Fatiregun. 2014. “National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?” International Journal of Health Policy and Management 2(4):175–80. doi: 10.15171/ijhpm.2014.39.
• Kantardzic, Mehmed. 2020. Data Mining: Concepts, Models, Methods, and Algorithms. Vol. 36. Third Edit. New Jersey: John Wiley & Sons, Inc.
• Kavosi, Zahra, Ali Keshtkaran, Ramin Hayati, Ramin Ravangard, and Mohammad Khammarnia. 2014. “Household Financial Contribution to the Health System in Shiraz, Iran in 2012.” International Journal of Health Policy and Management 3(5):243–49. doi: 10.15171/ijhpm.2014.87.
• Knaul, Felicia Marie, Rebeca Wong, Héctor Arreola-Ornelas, M. Health Econ, Oscar Méndez, Ricardo Bitran, ..., Rosa Vidarte. 2011. “Household Catastrophic Health Expenditures: A Comparative Analysis of Twelve Latin American and Caribbean Countries.” Salud Publica de Mexico 53(SUPPL. 2):85–95. doi: 10.1590/S0036-36342011000800005.
• Li, Xiaohong, Jay J. Shen, Jun Lu, Ying Wang, Mei Sun, Chengyue Li, Fengshui Chang, and Mo Hao. 2013. “Household Catastrophic Medical Expenses in Eastern China: Determinants and Policy Implications.” BMC Health Services Research 13(1). doi: 10.1186/1472-6963-13-506.
• Maimon, O., Rokach, L. 2005. Data Mining and Knowledge Discovery Handbook Second Edition.
• Memişoğlu, Dilek, and Ayşe Durgun. 2011. “2008 Ekonomi̇k Kri̇zi̇ ve Türki̇ye’de Sağlık Sektörü Üzeri̇ne Etki̇leri̇.” Süleyman Demirel Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 1(13):81–100.
• Nisbet, R., Miner, G., Yale, K. 2017. Handbook of Statistical Analysis and Data Mining Applications. Second Edi. Academic Press.
• Njagi, Purity, Jelena Arsenijevic, and Wim Groot. 2018. “Understanding Variations in Catastrophic Health Expenditure, Its Underlying Determinants and Impoverishment in Sub-Saharan African Countries: A Scoping Review.” Systematic Reviews 7(1). doi: 10.1186/s13643-018-0799-1.
• O’Donnell, O., van Doorslaer, E., Wagstaff, A., and Lindelow, M. 2008. Health Equity Using Household Survey Data A Guide to Techniques and Their Implementation. Vol. 72. Washington.
• OECD. 2019. Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing.
• Özgen Narcı, Hacer, İsmet Şahin, and Hasan Hüseyin Yıldırım. 2015. “Financial Catastrophe and Poverty Impacts of Out-of-Pocket Health Payments in Turkey.” European Journal of Health Economics 16(3):255–70. doi: 10.1007/s10198-014-0570-z.
• Piroozi, Bakhtiar, Ghobad Moradi, Bijan Nouri, Amjad Mohamadi Bolbanabad, and Hossein Safari. 2016. “Catastrophic Health Expenditure after the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran.” International Journal of Health Policy and Management 5(7):417–23. doi: 10.15171/ijhpm.2016.31.
• Proaño Falconi, Diego, and Eduardo Bernabé. 2018. “Determinants of Catastrophic Healthcare Expenditure in Peru.” International Journal of Health Economics and Management 18(4):425–36. doi: 10.1007/s10754-018-9245-0.
• Rao, C. R., Wegman, E. J., Solka, J. L. 2005. Data Mining and Data Visualization. edited by C. R. Rao. Elsevier B.V.
• Rashad, A. S., and M. F. Sharaf. 2015. “Catastrophic and Impoverishing Effects of Out-of-Pocket Health Expenditure: New Evidence from Egypt.” American Journal of Economics 5(5):526–33. doi: 10.5923/j.economics.20150505.13.
• Rokach, L., Maimon, O. 2008. DATA MINING WITH DECISION TREES Theory and Applications. Singapore.
• Rokach, L., Maimon, O. 2015. Data Mining With Decision Trees Theory and Applications 2nd Edition. Singapore.
• Si, Yafei, Zhongliang Zhou, Min Su, Xiao Wang, Xin Lan, Dan Wang, Shaoqing Gong, Xiao Xiao, Chi Shen, Yangling Ren, Dantong Zhao, Zihan Hong, Ying Bian, and Xi Chen. 2019. “Decomposing Inequality in Catastrophic Health Expenditure for Self-Reported Hypertension Household in Urban Shaanxi, China from 2008 to 2013: Two Waves’ Cross-Sectional Study.” BMJ Open 9(5):1–9. doi: 10.1136/bmjopen-2018-023033.
• T.C. Maliye Bakanlığı. 2010. 2009 Yılı Genel Faaliyet Raporu. Ankara.
• Tapkan, P., Özbakır, L., Baykasoğlu, A. 2011. “Weka İle Veri Madenciliği Süreci ve Örnek Uygulama.” Pp. 247–62 in. Endüstri Mühendisliği Yazılımları ve Uygulamaları Kongresi.
• Thu Thuong, Nguyen Thi, Yme Van Den Berg, Tran Quang Huy, Do Anh Tai, and Bui Nu Hoang Anh. 2020. “Determinants of Catastrophic Health Expenditure in Vietnam.” International Journal of Health Planning and Management (January). doi: 10.1002/hpm.3076.
• Tokatlıoğlu, Yağmur, and İbrahim Tokatlıoğlu. 2018. “Catastrophic Health Expenditures In Turkey And The Determinants Of These Expenditures: 2002-2014 Period.” Sosyoekonomi 26(35):59–78. doi: 10.17233/sosyoekonomi.302930.
• TÜİK. 2009. Hanehalkı Bütçe Anketi-2009. Ankara.
• TÜİK. 2010. Hanehalkı Bütçe Anketi-2010. Ankara.
• TÜİK. 2011. Hanehalkı Bütçe Anketi- 2011. Ankara.
• TÜİK. 2012. Hanehalkı Bütçe Anketi-2012. Ankara.
• UN, (United Nations). 2015. Resolution Adopted by the General Assembly on 25 September 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. New York.
• Vahedi, Sajad, Aziz Rezapour, Farzad Faraji Khiavi, Firooz Esmaeilzadeh, Javad Javan-Noughabi, Abdollah Almasiankia, and Abbas Ghanbari. 2020. “Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran.” Clinical Epidemiology and Global Health 8(2):437–41. doi: 10.1016/j.cegh.2019.10.004.
• Wagstaff, Adam, and Eddy van Doorslaer. 2003. “Catastrophe and Impoverishment in Paying for Health Care: With Applications to Vietnam 1993-1998.” Health Economics 12(11):921–33. doi: 10.1002/hec.776.
• Wagstaff, Adam, Gabriela Flores, Justine Hsu, Marc François Smitz, Kateryna Chepynoga, Leander R. Buisman, Kim van Wilgenburg, and Patrick Eozenou. 2018. “Progress on Catastrophic Health Spending in 133 Countries: A Retrospective Observational Study.” The Lancet Global Health 6(2):e169–79. doi: 10.1016/S2214-109X(17)30429-1.
• WHO. 2005. “Distribution of Health Payments and Catastrophic Expenditures Methodology.” FER/EIP Discussion Paper ; 1–6.
• WHO. 2019. “Global Spending on Health: A World in Transition 2019.” Global Report 49.
• WHO, and UNICEF. 2018. “A Vision for Primary Health Care in the 21st Century.” World Health Organizarion 1–64.
• Xu, K., Evans, D. B., Carrin, G., and Aguilar-Rivera, A. M. 2005. “Designing Health Financing Systems to Reduce Catastrophic Health Expenditure.”
• Xu, K., Klavus, J. Kawabata, K., Evans, D. B., Hanvoravongchai, P., Ortiz, J. P., Zeramdini, R., Murray, C. J. L. 2003. “Understanding Household Catastrophic Health Expenditures: A Multi-Country Analysis.” Pp. 565–72 in Health Systems Performance Assessment Debates, Methods and Empiricism, edited by D. B. Murray, C J. L., Evans. Geneva.
• Xu, Ke. 2005. “Distribution of Health Payments and Catastrophic Expenditures Methodology.” FER/EIP Discussion Paper ; (no.2.):11 p.
• Xu, Ke, David B. Evans, Guido Carrin, Ana Mylena Aguilar-Rivera, Philip Musgrove, and Timothy Evans. 2007. “Protecting Households from Catastrophic Health Spending.” Health Affairs 26(4):972–83. doi: 10.1377/hlthaff.26.4.972.
• Xu, Ke, David B. Evans, Kei Kawabata, Riadh Zeramdini, Jan Klavus, and Christopher J. L. Murray. 2003. “Household Catastrophic Health Expenditure: A Multicountry Analysis.” Lancet 362(9378):111–17. doi: 10.1016/S0140-6736(03)13861-5.
• Yang, Ting, Minglun Ren, and Kaile Zhou. 2018. “Identifying Household Electricity Consumption Patterns: A Case Study of Kunshan, China.” Renewable and Sustainable Energy Reviews 91(April):861–68. doi: 10.1016/j.rser.2018.04.037.
• Yardim, M. S., Cilingiroglu, N., Yardim, N. 2010. “Catastrophic Health Expenditure and Impoverishment in Turkey.” 94:26–33. doi: 10.1016/j.healthpol.2009.08.006.
• Ye, Nong. 2003. The Handbook of Data Mining.
• Yereli, Ahmet Burcin, Altuğ Murat Köktaş, and Işıl Şirin Selçuk. 2014. “Türkiye’de Katastrofik Sağlık Harcamalarını Etkileyen Faktörler.” Sosyoekonomi 22(22). doi: 10.17233/se.04288.
• Zhao, Yang, Brian Oldenburg, Ajay Mahal, Yaqi Lin, Shenglan Tang, and Xiaoyun Liu. 2020. “Trends and Socio-Economic Disparities in Catastrophic Health Expenditure and Health Impoverishment in China: 2010 to 2016.” Tropical Medicine and International Health 25(2):236–47. doi: 10.1111/tmi.13344.