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The Vertical Equity in Healthcare Financing: Concentration and Lorenz Curve Analysis for Out-of- Pocket Health Payment in Turkey (2002-2016)

Year 2019, Volume: 15 Issue: 2, 263 - 280, 30.10.2019

Abstract

In this study, the
situation out-of-pocket expenditures for healthcare financing in terms of
vertical equity have been  analyzed
within implementation of Health Transformation Program (HTP) and the following
periods in Turkey. In this context, Lorenz curves based on the capacity to pay
of households have been created and the relative contributions of households
from different economic status to the total out-of-pocket health expenditures
compared with the Concentration curves.
Household Budget Surveys compiled by TURKSTAT for
2002- 2016 were used in the analysis.
The analysis results show that the financial
burden of out-of-pocket health payments in the pre-SDP period is met by the
relative rich households. The participation in finance progressivity has not
continued and follow by regressive pattern. In other words, the contribution of
the poor to participation in financing has begun to increase and vertical
equity has deteriorated.
In 2014 and 2016, the distribution of total out-of-pocket health
expenditures improved at lower ratio in terms of vertical equity however, there
has been no progressivity significant development in the distribution of equity
towards the poor.

References

  • Andersen, R. (1995). “Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?”, Journal of Health and Social Behavior, 36(1), 1-10.
  • Braveman, P.A. (2003). “Monitoring Equity in Health and Healthcare: A Conceptual Framework”, Journal of Health Population and Nutrition, 21(3), 181-192.
  • Culyer, A.J. & Wagstaff, A. (1993), “Equity and Equality in Health and Health Care”, Journal of Health Economics 12(4): 431-57.
  • Culyer, A.J. & Wagstaff, A. (1993). “Equity and Equality in Health and Health Care”, Journal of Health Economics, 12, 431-457.
  • Kakwani, N., Wagstaff, A. & Van Doorslaeff, E. (1997). “Socioeconomic Inequalities In Health: Measurement, Computation, and Statistical Inference” Journal of Econometrics, 77: 87- 103.
  • Kakwani, N., Wagstaff, A., & van Doorslaer, E. (1997). “Socioeconomic Inequalities in Health: Measurement, Computation, and Statistical Inference” Journal of Econometrics, 77(1), 87–103.
  • Kılıç, D. & Çalışkan, Z. (2013). “Sağlık Hizmetleri Kullanımı ve Davranışsal Model” NEÜ Sosyal Bilimler Enstitüsü Dergisi (2), 192-206.
  • Mossialos, E. & Dixon. A. (2002). “Funding Health Care: An Introduction”, içinde Mossialos, E., A. Dixon, J. Figueras, J Kutzin (eds), Funding Health Care: Options for Europe, (Buckingham: Open University Press): 1-30.
  • O’Donnell, O., van Doorslaer, E., Wagstaff, A. & Lindelow, M. (2008). Analysing Health Equity Using Household Survey Data: A Guide To Techniques and Their Implementation, The International Bank for Reconstruction and Development / The World Bank, Washington, DC, ISBN: 978-0-8213-6933-3.
  • Onoka, A.C., Onwujekwe, O.E,, Hanson, K. & Uzochukwu, B.S, (2011). “Examining Catastrophic Health Expenditures at Variable Thresholds Using Household Consumption Expenditure Diaries”, Tropical Medicine and International Health, 16(10) , 1334–1341.
  • Phelan J.C, Link, B.G & Tehranifar P. (2010). “Social Conditions as Fundamental: Causes Of Health Inequalities: Theory, Evidence, and Policy Implications” Journal of Health Social Behavior, 51, 28-40. doi: 10.1177/0022146510383498.
  • Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social Behavior, 51(1), 28–40.
  • Rad, H., E. & Khodaparast, M. (2016). “Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?” Eurasian J. Med., 48: 112-8
  • Sağlık Bakanlığı (2003). “Sağlıkta Dönüşüm”, Aralık 2003, http://www.saglik.gov.tr/TR,11415/saglikta-donusum-programi.html (24. 04. 2019).
  • Sanwald, A. & Theurl, E. (2015). “Out-of-Pocket Payments in The Austrian Healthcare System – A Distributional Analysis”, International Journal for Equity in Health, 14:94. Schang L. K., Czabanowska K. M. & Lin V. (2012). “Securing Funds for Health Promotion: Lessons from Health Promotion Foundations Based on Experiences From Austria, Australia, Germany, Hungary and Switzerland. Health Promotion International, 27, 295–305. Tatar, M. (2011). “Sağlık Hizmetlerinin Finansman Modelleri: Sosyal Sağlık Sigortasının Türkiye’de Gelişimi” Sosyal Güvenlik Dergisi (1) 103:132.
  • TÜİK (2002). Hanehalkı Bütçe Anketi Klavuzu. Ankara: TÜİK.TÜİK (2004). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2006). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2008). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2010). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2012). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2014). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2016). Hanehalkı Bütçe Anketi Mikro Verileri.
  • TÜİK (2016). Hanehalkı Bütçe Anketinin Kapsamı, Yöntemi, Tanım ve Kavramları Hakkında Genel Açıklamalar Ankara: TÜİK.
  • Uğurluoğlu, E. & Özgen, H. (2008). “Sağlık Hizmetleri Finansmanı ve Hakkaniyet” Hacettepe Sağlık İdaresi Dergisi, 11(2), 133-158.
  • Van Doorslaer, Masseria, C. & Koolman (2006). “The OECD Health Equity Research Group, Inequalities in Access to Medical Care By income in Developed Countries”, Canadian Medical Association Journal, 174 (2), 177-183.
  • Wagstaff, A. &van Doorslaer, E. (2003). “Catastrophe and Impoverishment in Paying for Health Care: with Applications to Vietnam 1993–98”, Health Economics, 12(11), 921–34.
  • Wagstaff, A. and Van Doorslaer, E. (1994), “Measuring Inequalities in Health: In the Presence of Multiple-Category Morbidity Indicators”, Health Economics 3: 281-291.
  • Wagstaff, A. and Van Doorslaer, E. (1997), “Progressivity, Horizontal Equity and Reranking in Health Care Finance: A Decomposition Analysis for The Netherlands”, Journal of Health Economics 16: 499-516.
  • Wagstaff, A., Paci, P. & Van Doorslaer, E. (1991), “On the Measurement of Inequalities in Health”, Social Science Medicine, 33(5): 545-57.
  • Walley J. (2001). Public Health: An Action Guide to Improving Health in Developing Countries. New York: Oxford University Press.
  • Whitehead, M. (2001). “Eşitlik ve Sağlık: Kavram ve İlkeler”, Türk Tabipleri Birliği Yayını, http://www.ttb.org.tr/kutuphane/esiktlik_saglik.pdf (30.04.2019)
  • WHO (2000). “The World Health Report 2000, Health Systems: Improving Performance”, The World Health Organization, Geneva.
  • WHO, (2004). “Reaching Universal Coverage via Social Health Insurance: Key Design Features in the Transition Period, by Guy Carrin and Chris James, Discussion Paper, No.2: Department “Health System Financing, Expenditure and Resource Allocation (FER), Cluster “Evidence and Information for Policy (EIP)”, Geneva.
  • Xu K. (2005). “Distribution of Health Payments and Catastrophic Expenditures: Methodology, Department of ‘‘Health System Financing”, World Health Organization: Geneva.
  • Xu, K., Evans, D.B., Kawabata, K., Zeramdini, R., Klavus, J., Murray, C.J. (2003). “Household Catastrophic Health Expenditure: A Multicountry Analysis”, Lancet 362 (9378), 111–117.
  • Yardım, M.S., Cilingiroglu, N., Yardim, N. (2010). “Catastrophic Health Expenditure and Impoverishment in Turkey, Health Policy 94 (1), 26–33.
  • Yıldırım, H.H., Yıldırım, T. & Erdem, R. (2011). “Sağlık Hizmetleri Finansmanında Kullanıcı Katkıları: Genel Bir Bakış ve Türkiye İçin Bir Durum Değerlendirmesi” Amme İdaresi Dergisi, Cilt 44, Sayı 2, 71-98.

SAĞLIK HİZMETLERİ FİNANSMANINDA DİKEY HAKKANİYET: TÜRKİYE’DE CEPTEN YAPILAN SAĞLIK ÖDEMELERİ İÇİN KONSANTRASYON VE LORENZ EĞRİLERİ ANALİZİ (2002-2016)

Year 2019, Volume: 15 Issue: 2, 263 - 280, 30.10.2019

Abstract

Bu
çalışmada, Türkiye’de uygulamaya konulan Sağlıkta Dönüşüm Programı (SDP) ve
sonrasındaki süreçte, sağlık finansmanına yönelik doğrudan cepten yapılan
harcamalarının dikey hakkaniyet açısından durumu  analiz edilmiştir. Bu kapsamda,
hanehalklarının ödeme gücüne dayalı Lorenz eğrileri oluşturulmuş ve toplam cepten
yapılan sağlık harcamalarına farklı ekonomik kesimlerden hanehalklarının  göreli katkıları Konsantrasyon eğrileriyle
karşılaştırılmıştır.  Analizlerde 2002-2016
dönemi için iki yıl aralıklı olarak TÜİK tarafından derlenen Hanehalkı Bütçe
Anketleri kullanılmıştır.
Analiz sonuçları, SDP öncesi dönemde cepten
yapılan sağlık ödemelerinin mali yükünün göreli zengin hanehalkları tarafından
karşılandığını ortaya koymaktadır.  Ancak
sonrasında özellikle 2006, 2010 ve 2012 yıllarında finansmana katılımda
progresif (
progressive) -artan oranlı durum devam etmemiş ve regresif (regressive)- azalan
oranlı bir desen (pattern) izlemiştir. Başka bir ifadeyle, finansmana katılımda
yoksul kesimlerin katkısı artmaya başlamış ve dikey hakkaniyet bozulmuştur. 2014
ve 2016 yıllarında ise genel olarak, çok az oranda da olsa, toplam cepten
yapılan sağlık harcamalarının dağılımında dikey hakkaniyet açsından bir iyileşme
kaydedilmiş, ancak yoksul kesimlere doğru hakkaniyetin dağılımında progresif
olarak önemli bir gelişme yaşanmamıştır. 

References

  • Andersen, R. (1995). “Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?”, Journal of Health and Social Behavior, 36(1), 1-10.
  • Braveman, P.A. (2003). “Monitoring Equity in Health and Healthcare: A Conceptual Framework”, Journal of Health Population and Nutrition, 21(3), 181-192.
  • Culyer, A.J. & Wagstaff, A. (1993), “Equity and Equality in Health and Health Care”, Journal of Health Economics 12(4): 431-57.
  • Culyer, A.J. & Wagstaff, A. (1993). “Equity and Equality in Health and Health Care”, Journal of Health Economics, 12, 431-457.
  • Kakwani, N., Wagstaff, A. & Van Doorslaeff, E. (1997). “Socioeconomic Inequalities In Health: Measurement, Computation, and Statistical Inference” Journal of Econometrics, 77: 87- 103.
  • Kakwani, N., Wagstaff, A., & van Doorslaer, E. (1997). “Socioeconomic Inequalities in Health: Measurement, Computation, and Statistical Inference” Journal of Econometrics, 77(1), 87–103.
  • Kılıç, D. & Çalışkan, Z. (2013). “Sağlık Hizmetleri Kullanımı ve Davranışsal Model” NEÜ Sosyal Bilimler Enstitüsü Dergisi (2), 192-206.
  • Mossialos, E. & Dixon. A. (2002). “Funding Health Care: An Introduction”, içinde Mossialos, E., A. Dixon, J. Figueras, J Kutzin (eds), Funding Health Care: Options for Europe, (Buckingham: Open University Press): 1-30.
  • O’Donnell, O., van Doorslaer, E., Wagstaff, A. & Lindelow, M. (2008). Analysing Health Equity Using Household Survey Data: A Guide To Techniques and Their Implementation, The International Bank for Reconstruction and Development / The World Bank, Washington, DC, ISBN: 978-0-8213-6933-3.
  • Onoka, A.C., Onwujekwe, O.E,, Hanson, K. & Uzochukwu, B.S, (2011). “Examining Catastrophic Health Expenditures at Variable Thresholds Using Household Consumption Expenditure Diaries”, Tropical Medicine and International Health, 16(10) , 1334–1341.
  • Phelan J.C, Link, B.G & Tehranifar P. (2010). “Social Conditions as Fundamental: Causes Of Health Inequalities: Theory, Evidence, and Policy Implications” Journal of Health Social Behavior, 51, 28-40. doi: 10.1177/0022146510383498.
  • Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social Behavior, 51(1), 28–40.
  • Rad, H., E. & Khodaparast, M. (2016). “Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?” Eurasian J. Med., 48: 112-8
  • Sağlık Bakanlığı (2003). “Sağlıkta Dönüşüm”, Aralık 2003, http://www.saglik.gov.tr/TR,11415/saglikta-donusum-programi.html (24. 04. 2019).
  • Sanwald, A. & Theurl, E. (2015). “Out-of-Pocket Payments in The Austrian Healthcare System – A Distributional Analysis”, International Journal for Equity in Health, 14:94. Schang L. K., Czabanowska K. M. & Lin V. (2012). “Securing Funds for Health Promotion: Lessons from Health Promotion Foundations Based on Experiences From Austria, Australia, Germany, Hungary and Switzerland. Health Promotion International, 27, 295–305. Tatar, M. (2011). “Sağlık Hizmetlerinin Finansman Modelleri: Sosyal Sağlık Sigortasının Türkiye’de Gelişimi” Sosyal Güvenlik Dergisi (1) 103:132.
  • TÜİK (2002). Hanehalkı Bütçe Anketi Klavuzu. Ankara: TÜİK.TÜİK (2004). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2006). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2008). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2010). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2012). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2014). Hanehalkı Bütçe Anketi Mikro Verileri.TÜİK (2016). Hanehalkı Bütçe Anketi Mikro Verileri.
  • TÜİK (2016). Hanehalkı Bütçe Anketinin Kapsamı, Yöntemi, Tanım ve Kavramları Hakkında Genel Açıklamalar Ankara: TÜİK.
  • Uğurluoğlu, E. & Özgen, H. (2008). “Sağlık Hizmetleri Finansmanı ve Hakkaniyet” Hacettepe Sağlık İdaresi Dergisi, 11(2), 133-158.
  • Van Doorslaer, Masseria, C. & Koolman (2006). “The OECD Health Equity Research Group, Inequalities in Access to Medical Care By income in Developed Countries”, Canadian Medical Association Journal, 174 (2), 177-183.
  • Wagstaff, A. &van Doorslaer, E. (2003). “Catastrophe and Impoverishment in Paying for Health Care: with Applications to Vietnam 1993–98”, Health Economics, 12(11), 921–34.
  • Wagstaff, A. and Van Doorslaer, E. (1994), “Measuring Inequalities in Health: In the Presence of Multiple-Category Morbidity Indicators”, Health Economics 3: 281-291.
  • Wagstaff, A. and Van Doorslaer, E. (1997), “Progressivity, Horizontal Equity and Reranking in Health Care Finance: A Decomposition Analysis for The Netherlands”, Journal of Health Economics 16: 499-516.
  • Wagstaff, A., Paci, P. & Van Doorslaer, E. (1991), “On the Measurement of Inequalities in Health”, Social Science Medicine, 33(5): 545-57.
  • Walley J. (2001). Public Health: An Action Guide to Improving Health in Developing Countries. New York: Oxford University Press.
  • Whitehead, M. (2001). “Eşitlik ve Sağlık: Kavram ve İlkeler”, Türk Tabipleri Birliği Yayını, http://www.ttb.org.tr/kutuphane/esiktlik_saglik.pdf (30.04.2019)
  • WHO (2000). “The World Health Report 2000, Health Systems: Improving Performance”, The World Health Organization, Geneva.
  • WHO, (2004). “Reaching Universal Coverage via Social Health Insurance: Key Design Features in the Transition Period, by Guy Carrin and Chris James, Discussion Paper, No.2: Department “Health System Financing, Expenditure and Resource Allocation (FER), Cluster “Evidence and Information for Policy (EIP)”, Geneva.
  • Xu K. (2005). “Distribution of Health Payments and Catastrophic Expenditures: Methodology, Department of ‘‘Health System Financing”, World Health Organization: Geneva.
  • Xu, K., Evans, D.B., Kawabata, K., Zeramdini, R., Klavus, J., Murray, C.J. (2003). “Household Catastrophic Health Expenditure: A Multicountry Analysis”, Lancet 362 (9378), 111–117.
  • Yardım, M.S., Cilingiroglu, N., Yardim, N. (2010). “Catastrophic Health Expenditure and Impoverishment in Turkey, Health Policy 94 (1), 26–33.
  • Yıldırım, H.H., Yıldırım, T. & Erdem, R. (2011). “Sağlık Hizmetleri Finansmanında Kullanıcı Katkıları: Genel Bir Bakış ve Türkiye İçin Bir Durum Değerlendirmesi” Amme İdaresi Dergisi, Cilt 44, Sayı 2, 71-98.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Economics
Journal Section Articles
Authors

Gökçe Manavgat

Publication Date October 30, 2019
Acceptance Date November 8, 2019
Published in Issue Year 2019 Volume: 15 Issue: 2

Cite

APA Manavgat, G. (2019). SAĞLIK HİZMETLERİ FİNANSMANINDA DİKEY HAKKANİYET: TÜRKİYE’DE CEPTEN YAPILAN SAĞLIK ÖDEMELERİ İÇİN KONSANTRASYON VE LORENZ EĞRİLERİ ANALİZİ (2002-2016). Ekonomik Ve Sosyal Araştırmalar Dergisi, 15(2), 263-280.

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