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

Year 2017, Volume: 17 Issue: 36, 71 - 102, 20.11.2017

Eleftherios Gıovanıs , Öznur Özdamar

https://doi.org/10.25294/auiibfd.357616

Cited By: 2

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

References

• Akinci, F., Hamidi, S., Suvankulov, F. and Akhmedjonov, A. (2014) Examining the Impact of Health Care Expenditures on Health Outcomes in the Middle East and North Africa (MENA) Region, Journal of Health Care Finance, 41(1), 1-23.
• Anyanwu, J.C. and Erhijakpor, A.E.O. (2007) Health Expenditures and Health Outcomes in Africa. Economic Research Working Paper. No. 91, African Development Bank.
• Aran, M.A. and Hentschel, J.S. (2012) Protection in Good and Bad Times? The Turkish Green Card Health Program. Policy Research Working Paper 6178, The World Bank Europe and Central Asia Region Human Development Department.
• Brown, S., Risa A. and Kilic D., (2014) Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys. Economic Modelling, 41, 211-218.
• Barros, A.J.D. and Bertoldi, A.D. (2008) Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil, International Journal of Epidemiology, 37, 758–765.
• Chakraborty, S. (2009. Europe & Central Asia: Knowledge Brief. Volume 12, December 2009. The World Bank.
• Chuma, J. and Maina, T. (2012). Catastrophic Health Care Spending and Impoverishment in Kenya, BMC Health Services Research, 12(3), 413.
• Da Silva, M.T., Barros, A. J. D. , Bertoldi, A. D., De Andrade Jacinto, P., Matijasevich, A., Santos, I.S. and Tejada, C.A.O. (2015) Determinants of Out-of-Pocket Health Expenditure on Children: An Analysis of the 2004 Pelotas Birth Cohort, International Journal for Equity in Health, 14, 53.
• Dehijia, R.. and Wahba, S. (1999) Causal Effects in Nonexperimental Studies: Reevaluating the Evaluation of Training Programs, Journal of American Statistical Association, 94(448), 1053-1062
• Elwert, F. and Winship, C. (2014) Endogenous Selection Bias: The Problem of Conditioning on a Collider Variable, Annual Review of Sociology, 40, 31-53.
• Erus, B. and Aktakke N. (2012) Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insures, The European Journal of Health Economics, 13(3), 337-346.
• Garg, C.C. and Karan, A.K. (2009) Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India, Health Policy and Planning, 24,116–128.
• Gottret, P. and Schieber, G. (2006) Health Financing Revisited: A Practioner’s Guide, The World Bank, Washington, D.C
• Goudge, J., Gilson, L., Russell, S., Gumede, T. and Mills, A. (2009) The Household Costs of Health Care in Rural South Africa with Free Public Primary Care and Hospital Exemptions for the Poor, Tropical Medicine and International Health, 14(4), 458-467.
• Greene, W. (2011) Econometric Analysis. Seventh Edition. Upper Saddle River, New Jersey: Prentice Hall.
• Heckman, J., Ichimura, H. and Todd, P. (1997) Matching as an Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme, Review of Economic Studies, 64, 605–654.
• Knaul, F.M., Arreola-Ornelas, H., Méndez-Carniado, O., Bryson-Cahn, C., Barofsky, J., Maguire, R., Miranda, M. and Sesma, S. (2006) Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico, Lance, 368, 1828–1841.
• Mugisha, F., Kouyate, B., Gbangou, A. and Sauerborn, R.. (2007) Examining out-of pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy, Tropical Medicine and International Health, 7, 187–96.
• OECD. (2010) OECD Health Data 2010, Selected Data.
• OECD (2008) OECD Reviews of Health Systems Turkey, OECD and IBRD/THE WORLD BANK.
• OECD. (2014) OECD Reviews of Health Care Quality: Turkey 2014. Raising Standards. http://www.oecd-ilibrary.org/social-issues-migration-health/oecd-reviews-of-health-care-quality-turkey-2013_9789264202054-en
• Rahman, M. M., Gilmour, S., Saito, E., Sultana, P. and Shibuya, K. (2013). Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh, PloS One, 8(2), e56873.
• Rosenbaum, P. R. And Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects, Biometrika, 70(1), 41–55.
• Sartori, A.E. (2003) An Estimator for Some Binary-Outcome Selection Models without Exclusion Restrictions, Political Analysis, 11(2), 111-138.
• Smith, J. and Todd, P. (2005). Does matching overcome LaLonde’s critique of nonexperimental estimators?, Journal of Econometrics, 125(1-2), 305-353.
• Turkish Statistical Institute (TurkStat) (2011) 2008 Health Expenditure Statistics.
• Xu, K. (2005). Distribution of health payments and catastrophic payments methodology. Discussion Paper 2 November-2005, Department "Health System Financing" (HSF) Cluster "Evidence and Information for Policy" (EIP). Geneva: World Health Organization.
• Van Doorslaer, E., O’donnell, O., Rannan-Eliya, R.P., et al. (2007) Catastrophic expenditures on health care in Asia, Health Economics, 16(11), 1159-1184.
• Wagstaff, A. (2007) Health Insurance for the Poor: Initial Impacts of Vietnam’s Health Care Fund for the Poor. Impact Evaluation Series No. 11, Policy Research Working Paper No. WPS4134. Washington, DC: World Bank.
• Wagner, A., Reiss, S., Johnson, A., and Ross-Degnan, D. (2007) Results of Feasibility Study Using World Health Survey Data to Measure Medicines Need, Use and Out-of-Pocket Expenditures in Eight Low and Lower-Middle Income Countries. Boston: World Health Organization, Harvard Medical School and Harvard Pilgrim Health Care.