The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey

Abstract

The Turkish health care system has been subject to significant and critical changes and reforms since 2003. One of the most important reforms has been implemented in 2008 where the Green Card holders are entitled to the same services, without any fee, as those with public health insurance, such as the Emekli Sandığı, BAĞKUR, SSK. This study initially examines the characteristics of health insurance schemes, determinants of holding one of the health insurance schemes (public, private, green card, no-insurance) in Turkey. It further analyses the effect of 2008 reform on out of pocket expenditures (OOPEs). The study will be the first in the related literature analysing the effect of this reform especially on the OOPEs of green card holders. The analysis relies on a detailed micro-data level survey, TUİK Household Budget Survey, over the period 2002-2011 and employs a difference-in-difference approach using a pseudo-panel based on propensity score matching. Initial results show that individuals who have public insurance are less inclined to face out-of-pocket health expenditures compared to those without health insurance and the Green Card holders. However, the difference of the OOPEs between the public health insurees and green card holders is reduced after the implementation of the 2008 reform.

Keywords

• Difference-in-Difference Approach,Health Insurance Schemes,Health Reforms,Out-of-Pocket Expenditures,Propensity Score Matching Method,Pseudo-Panel Data,Turkey

Türkiye’de 2008 Yılı Sağlık Reformunun Cepten Yapılan Sağlık Harcamaları Üzerindeki Etkisi

Abstract

Türkiye sağlık sisteminde 2003 yılından bu yana önemli değişiklikler yaşanmış ve anlamlı reformlar yapılmıştır. Bunların en önemlilerinden biri hiçbir ek ödeme talep edilmeksizin yeşil kartlıların Emekli Sandığı, BAĞ-KUR, SSK gibi diğer kamusal sağlık sigortası yararlanıcıları ile aynı hizmetlerden yararlanmaya başladığı 2008 reformudur. Bu çalışma öncelikle Türkiye’deki sağlık sigortası planlarının özelliklerini, kamusal sigorta, özel sigorta ve yeşil kart sahipliği ile sigortasız olmanın bireyler açısından belirleyicilerini incelemektedir. Bunların yanı sıra 2008 reformunun cepten sağlık harcamaları üzerindeki etkisi analiz edilmiştir. Reformun özellikle yeşil kartlıların cepten sağlık harcamaları üzerindeki etkisinin analizi ilgili literatürde ilk defa bu çalışma ile yer bulacaktır. İlgili analizlerde 2002-2011 dönemini kapsayan TÜİK Hanehalkı Bütçe Anketi Mikro Veri Seti kullanılmış ve eğilim skoru eşleştirme yöntemiyle oluşturulan sözde panel verilere farkın farkı yöntemi uygulanmıştır. İlk bulgular, kamusal sağlık sigortası sahiplerinin yeşli kart sahipleri yada sigortasızlara oranla cepten daha az sağlık harcaması yaptıklarını göstermiştir. Bunun yanısıra 2008 reformu ile birlikte kamusal sigorta sahipleri ile yeşil kartlılar arasında cepten harcama farkının azaldığı tespit edilmiştir.

Keywords

• Farkın Farkı Yaklaşımı,Sağlık Sigortası Planları,Sağlık Reformları,Cepten Sağlık Harcamaları,Eğilim Skoru Eşleştirme Yöntemi,Sözde Panel Veri,Türkiye

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