The Impact of Financial Inclusion on Borrowing, Concerns and Perceived Hardship for Health Expenditures in Türkiye

Abstract

Aim: The adverse effects of financial barriers to accessing healthcare on individual well-being underscore the importance of analyzing the role of financial instruments in covering health expenditures, particularly in societies with high economic vulnerability. The aim of this study is to examine the role of financial inclusion in addressing financial hardships related to health expenditures in Turkey and to determine the correlation of financial inclusion with sociodemographic variables. Method: Data from a 2021 nationally representative survey of 1000 adults in Turkey, conducted by the World Bank, in the World Bank Global Findeks database were used. Probit Regression analysis was applied to examine the impact of respondents' financial inclusion and demographic characteristics on various indicators of financial hardship related to health expenditures. Results: The financial inclusion rate was 84% and was found to vary by demographic characteristics such as gender, education level and age groups. Concerns about not having money for emergency expenses within 7 and 30 days and not being able to cover medical expenses in an emergency are higher among men compared to women. The rate of borrowing for health reasons was highest among those aged 25-34 years and lowest among those aged 55 years and older. Conclusion: Financial inclusion has an important impact on reducing the difficulties associated with obtaining money for emergency expenses. Therefore, it is important for policymakers and health service providers to prioritize financial inclusion and support programs for low-income individuals to increase access to health services.

Keywords

• Financial inclusion
• financial hardship
• health services
• health expenditures
• Türkiye

Türkiye’de Finansal Katılımın Sağlık Harcamaları İçin Borçlanma, Endişeler ve Zorluk Algısına Etkisi

Abstract

Amaç: Sağlık hizmetlerine erişimde finansal engellerin bireylerin refahı üzerindeki olumsuz etkileri, özellikle ekonomik kırılganlığın yüksek olduğu toplumlarda, finansal araçların sağlık harcamalarını karşılamadaki işlevini analiz etmeyi önemli kılmaktadır. Çalışmanın amacı, Türkiye’de sağlık harcamalarıyla ilgili finansal zorlukların giderilmesinde finansal katılımın rolünü incelemek ve sosyodemografik değişkenlerle olan korelasyonunu belirlemektir. Yöntem: 2021 Global Findeks veri tabanında Dünya Bankası tarafından oluşturulan, Türkiye’deki 1000 yetişkin ile gerçekleştirilen ulusal temsili anket verileri kullanılmıştır. Katılımcıların finansal katılımı ve demografik özelliklerinin sağlık harcamalarıyla ilgili çeşitli finansal zorluk göstergelerindeki etkisini incelemek için Probit Regresyon analizi uygulanmıştır. Bulgular: Finansal katılım oranının toplamda %84 olduğu, bunun cinsiyet, yaş grubu, eğitim düzeyi gibi demografik özelliklere göre değiştiği tespit edilmiştir. Acil harcamalar için 7 ve 30 gün içinde para bulamama ve acil bir durumda tıbbi masrafları karşılayamama endişesi kadınlara kıyasla erkeklerde daha fazladır. Sağlık nedeniyle borçlanma oranı 25-34 yaş arasında en yüksek iken, en düşük 55 yaş ve üstünde görülmüştür. Sonuç: Finansal katılımın acil harcamalarda para elde etme ile ilgili zorlukları azaltmada önemli bir etkisi bulunmaktadır. Bu nedenle, yöneticilerin sağlık hizmetlerine erişimde finansal katılıma öncelik vermesi ve düşük gelirli bireylere yönelik programları desteklemesi önemlidir.

Keywords

• Finansal katılım
• finansal zorluk
• sağlık hizmetleri
• sağlık harcamaları
• Türkiye

Ethical Statement

Bu çalışmada kullanılan veri seti herkes tarafından erişilebilir kamuya açık verilerin kullanılması ve verilerin tamamen anonim olması nedeniyle Helsinki Tıbbi Araştırmalar İçin Etik İlkeler Deklarasyonu kapsamında herhangi bir etik kurul onayına ihtiyaç duyulmamıştır.

References

1. ABEL, S., MUTANDWA, L., & ROUX, P. LE. (2018). A Review of Determinants of Financial Inclusion. International Journal of Economics and Financial Issues, 8(3), 1–8.
2. ACERENZA, S., BARTALOTTİ, O., & KÉDAGNİ, D. (2023). Testing identifying assumptions in bivariate probit models. Journal of Applied Econometrics, 38(3), 407–422. https://doi.org/10.1002/jae.2956
3. AGUİLA, E., ANGRİSANİ, M., & BLANCO, L. R. (2016). Ownership of a bank account and health of older Hispanics. Economics Letters, 144, 41–44. https://doi.org/10.1016/j.econlet.2016.04.013
4. AJEFU, J. B., DEMİR, A., & HAGHPANAHAN, H. (2020). THE İMPACT OF FİNANCİAL İNCLUSİON ON MENTAL HEALTH. SSM - Population Health, 11, 100630. https://doi.org/10.1016/j.ssmph.2020.100630
5. AJEFU, J., DEMİR, A., & HAGHPANAHAN, H. (2020). The impact of financial inclusion on mental health. SSM - Population Health, 11, 1–10. https://doi.org/10.1016/j.ssmph.2020.100630
6. AL-HANAWİ, M. K., CHİRWA, G. C., KAMNİNGA, T. M., & MANJA, L. P. (2020). Effects of Financial Inclusion on Access to Emergency Funds for Healthcare in the Kingdom of Saudi Arabia. Journal of Multidisciplinary Healthcare, Volume 13, 1157–1167. https://doi.org/10.2147/JMDH.S277357
7. ALKİRE, S., & DENEULİN, S. (2009). The Human Development and Capability Approach. In S. Deneulin (Ed.), An Introduction to the Human Development and Capability Approach: Freedom and Agency (First edit, pp. 22–49). Routledge. https://doi.org/10.4324/9781849770026
8. ALLEN, F., DEMİRGUC-KUNT, A., KLAPPER, L., & MARTİNEZ PERİA, M. S. (2016). The foundations of financial inclusion: Understanding ownership and use of formal accounts. Journal of Financial Intermediation, 27, 1–30. https://doi.org/10.1016/j.jfi.2015.12.003

9. AMBROSİUS, C., & CUECUECHA, A. (2013). Are Remittances a Substitute for Credit? Carrying the Financial Burden of Health Shocks in National and Transnational Households. World Development, 46, 143–152. https://doi.org/10.1016/j.worlddev.2013.01.032
10. BAKHSHİ, P., & AGARWAL, T. (2020). Impact of Education on Financial Inclusion: Study for India. Journal Of Xi An University of Architecture & Technology, 12(7), 1179–1194. https://doi.org/10.37896/JXAT12.07/2429
11. BAZA, A. U., & RAO, K. S. (2017). Financial Inclusion in Ethiopia. International Journal of Economics and Finance, 9(4), 191–201. https://doi.org/10.5539/ijef.v9n4p191
12. BEİN, M., & COKER-FARRELL, E. Y. (2020). The association between medical spending and health status: A study of selected African countries. Malawi Medical Journal, 32(1), 37–44. https://doi.org/10.4314/mmj.v32i1.8
13. ÇALIŞ, N., & GÖKÇELİ, E. (2022). THE RELATIONSHIP BETWEEN FINANCIAL INCLUSION AND INCOME INEQUALITY; EVIDENCE FROM TURKEY. Yönetim ve Ekonomi Araştırmaları Dergisi, 20(4), 401–414. https://doi.org/10.11611/yead.1177426
14. CAPPELLARİ, L., & JENKİNS, S. P. (2003). Multivariate Probit Regression using Simulated Maximum Likelihood. The Stata Journal: Promoting Communications on Statistics and Stata, 3(3), 278–294. https://doi.org/10.1177/1536867X0300300305
15. ÇİÇEK, B., & ÇOPUR, Z. (2018). Bireylerin Kadınların Çalışmasına ve Toplumsal Cinsiyet Rollerine İlişkin Tutumları. International Journal Of Eurasian Education And Culture, 3(4), 1–21.
16. CİSLAGHİ, B., & HEİSE, L. (2020). Gender norms and social norms: differences, similarities and why they matter in prevention science. Sociology of Health & Illness, 42(2), 407–422. https://doi.org/10.1111/1467-9566.13008
17. DEMİRGUC-KUNT, A., KLAPPER, L., SİNGER, D., ANSAR, S., & HESS, J. (2018). The Global Findex Database 2017: Measuring Financial Inclusion and the Fintech Revolution. Washington, DC: World Bank. https://doi.org/10.1596/978-1-4648-1259-0
18. EDOH, O. M., NCHOFOUNG, T. N., ANCHİ, O. E., & MUNNA, A. S. (2021). The impact of financial inclusion on household health expenditures in Africa (AGDI Working Paper, No. WP/21/080). http://hdl.handle.net/10419/250104
19. GAO, Q., LİU, Y., AYUB, B., & HUSSAİN, M. (2022). Does Health Crises Effect Tourism: Role of Financial Inclusion for Green Financial Development. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.896894
20. GİMENEZ-NADAL, J. I., & MOLİNA, J. A. (2016). Commuting Time and Household Responsibilities: Evidence Using Propensity Score Matching. Journal of Regional Science, 56(2), 332–359. https://doi.org/10.1111/jors.12243
21. GİULİANO, P. (2020). Gender and culture. Oxford Review of Economic Policy, 36(4), 944–961. https://doi.org/10.1093/oxrep/graa044
22. GYASİ, R. M., ADAM, A. M., & PHİLLİPS, D. R. (2019). Financial Inclusion, Health-Seeking Behavior, and Health Outcomes Among Older Adults in Ghana. Research on Aging, 41(8), 794–820. https://doi.org/10.1177/0164027519846604
23. HUCK, W. (2023). Transforming our world: the 2030 Agenda for Sustainable Development. Sustainable Development Goals. https://doi.org/10.5040/9781509934058.0025
24. KAZEMİKHASRAGH, A., & BUONİ PİNEDA, M. V. (2022). Financial inclusion and education: An empirical study of financial inclusion in the face of the pandemic emergency due to Covid‐19 in Latin America and the Caribbean. Review of Development Economics, 26(3), 1785–1797. https://doi.org/10.1111/rode.12884
25. KİRWAN, S. (2021). The economy key ideas: Financial inclusion. Agenda Publishing.
26. KOOMSON, I., ABDUL-MUMUNİ, A., & ABBAM, A. (2021). Effect of financial inclusion on out-of-pocket health expenditure: empirics from Ghana. The European Journal of Health Economics, 22(9), 1411–1425. https://doi.org/10.1007/s10198-021-01320-1
27. LASHİTEW, A. A., VAN TULDER, R., & LİASSE, Y. (2019). Mobile phones for financial inclusion: What explains the diffusion of mobile money innovations? Research Policy, 48(5), 1201–1215. https://doi.org/10.1016/j.respol.2018.12.010
28. MORSY, H. (2020). Access to finance – Mind the gender gap. The Quarterly Review of Economics and Finance, 78, 12–21. https://doi.org/10.1016/j.qref.2020.02.005
29. MURPHY, A., MCGOWAN, C., MCKEE, M., SUHRCKE, M., & HANSON, K. (2019). Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Global Health, 4(4), e001475. https://doi.org/10.1136/bmjgh-2019-001475
30. MWALE, M. L., MCHENGA, M., & CHİRWA, G. C. (2022). A spatial analysis of out-of-pocket payments for healthcare in Malawi. Health Policy and Planning, 37(1), 65–72. https://doi.org/10.1093/heapol/czab090
31. NEAİME, S., & GAYSSET, I. (2018). Financial inclusion and stability in MENA: Evidence from poverty and inequality. Finance Research Letters, 24, 230–237. https://doi.org/10.1016/j.frl.2017.09.007
32. NGUYEN, T. A. N. (2023). The power of financial behavior in emergency funds: Empirical evidence from a developing country. Journal of Eastern European and Central Asian Research (JEECAR), 10(3), 455–467. https://doi.org/10.15549/jeecar.v10i3.1223
33. NİAZ, M. U. (2022). Socio-Economic development and sustainable development goals: a roadmap from vulnerability to sustainability through financial inclusion. Economic Research-Ekonomska Istraživanja, 35(1), 3243–3275. https://doi.org/10.1080/1331677X.2021.1989319
34. NUSSBAUM, M. C. (2009). Creating Capabilities: The Human Development Approach and Its Implementation. Hypatia, 24(3), 211–215.
35. ÖKSÜZ NARİNÇ, N., & AKTAN, M. N. (2022). Comparison of Financial Inclusion and Income Between Countries with Multiple Correspondence Analysis. Ankara Hacı Bayram Veli Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 24(1), 230–259.
36. OLSON, K. E., O’BRİEN, M. A., ROGERS, W. A., & CHARNESS, N. (2011). Diffusion of Technology: Frequency of use for Younger and Older Adults. Ageing International, 36(1), 123–145. https://doi.org/10.1007/s12126-010-9077-9
37. OMAR, M. A., & INABA, K. (2020a). Does financial inclusion reduce poverty and income inequality in developing countries? A panel data analysis. Journal of Economic Structures, 9(1), 37. https://doi.org/10.1186/s40008-020-00214-4
38. OMAR, M. A., & INABA, K. (2020b). Does financial inclusion reduce poverty and income inequality in developing countries? A panel data analysis. Journal of Economic Structures, 9(1), 1–25. https://doi.org/10.1186/s40008-020-00214-4
39. PALLANT, J. (2020). SPSS Survival Manual: A step by step guide to data analysis using IBM SPSS (7th Edition (ed.)). Routledge. https://doi.org/10.4324/9781003117452
40. PARK, C.-Y., & MERCADO, R. V. (2016). Does Financial Inclusion Reduce Poverty and Income Inequality in Developing Asia? In S. Gopalan & T. Kikuchi (Eds.), Financial Inclusion in Asia: Issues and Policy Concerns (pp. 61–92). Palgrave Macmillan UK.
41. POLLONİ-SİLVA, E., DA COSTA, N., MORALLES, H. F., & SACOMANO NETO, M. (2021). Does Financial Inclusion Diminish Poverty and Inequality? A Panel Data Analysis for Latin American Countries. Social Indicators Research, 158(3), 889–925. https://doi.org/10.1007/s11205-021-02730-7
42. RAHMAN, T., GASBARRO, D., & ALAM, K. (2022). Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Research Policy and Systems, 20(1), 1–23. https://doi.org/10.1186/s12961-022-00886-3
43. SAHA, S. K., & QİN, J. (2023). Financial inclusion and poverty alleviation: an empirical examination. Economic Change and Restructuring, 56(1), 409–440. https://doi.org/10.1007/s10644-022-09428-x
44. SAHAY, R., CİHAK, M., N’DİAYE, P., BARAJAS, A., MİTRA, S., KYOBE, A., MOOİ, Y., & YOUSEFİ, R. (2015). Financial Inclusion: Can it Meet Multiple Macroeconomic Goals? Staff Discussion Notes, 15(17), 1–34. https://doi.org/10.5089/9781513585154.006
45. SAKANKO, M. A., DAVİD, J., & ONİMİSİ, A. M. (2020). Advancing inclusive growth in Nigeria: The role of financial inclusion in poverty, inequality, household expenditure, and unemployment. Indonesian Journal of Islamic Economics Research, 2(2), 70–84.
46. SHABİR, S., & ALİ, J. (2022). Determinants of financial inclusion across gender in Saudi Arabia: evidence from the World Bank’s Global Financial Inclusion survey. International Journal of Social Economics, 49(5), 780–800. https://doi.org/10.1108/IJSE-07-2021-0384
47. SİMATUPANG, M., & SİNAGA, B. M. (2020). Impact of Financial Inclusion, Government Expenditures In Education And Health Sectors On Human Development In Indonesia. Journal of Economic Development, Environment and People, 9(2), 5–17. https://doi.org/10.26458/jedep.v9i2.643
48. SU, C.-W., Lİ, W., UMAR, M., & LOBONŢ, O.-R. (2022). Can green credit reduce the emissions of pollutants? Econ Anal Policy, 74, 205–219. https://doi.org/10.1016/j.eap.2022.01.016
49. SU, C.-W., YUAN, X., UMAR, M., & LOBONŢ, O.-R. (2022). Does technological innovation bring destruction or creation to the labor market? Technology in Society, 68, 101905. https://doi.org/10.1016/j.techsoc.2022.101905
50. SU, T. T., POKHREL, S., GBANGOU, A., & FLESSA, S. (2006). Determinants of household health expenditure on western institutional health care. The European Journal of Health Economics, 7(3), 195–203. https://doi.org/10.1007/s10198-006-0354-1
51. SWAMY, V. (2014). Financial Inclusion, Gender Dimension, and Economic Impact on Poor Households. World Development, 56, 1–15. https://doi.org/10.1016/j.worlddev.2013.10.019
52. TEKER, S., TEKER, D., & GUZELSOY, H. (2023). FINANCIAL INCLUSION FOR SELECTED OECD COUNTRIES. Pressacademia. https://doi.org/10.17261/Pressacademia.2023.1758
53. THANH, P. T., & DUONG, P. B. (2017). Health shocks and the mitigating role of microcredit—The case of rural households in Vietnam. Economic Analysis and Policy, 56, 135–147. https://doi.org/10.1016/j.eap.2017.08.006
54. VENKATESWARAN, S., & SİNGH, A. K. (2022). Health System in Turkey: Reforms, Transformations, and Challenges (CSEP Working Paper 36).
55. WAGSTAFF, A., FLORES, G., SMİTZ, M.-F., HSU, J., CHEPYNOGA, K., & EOZENOU, P. (2018). Progress on impoverishing health spending in 122 countries: a retrospective observational study. The Lancet Global Health, 6(2), e180–e192. https://doi.org/10.1016/S2214-109X(17)30486-2
56. WALE, L. E., & MAKİNA, D. (2017). Account ownership and use of financial services among individuals. African Journal of Economic and Management Studies, 8(1), 19–35. https://doi.org/10.1108/AJEMS-03-2017-146
57. WANG, Q.-S., SU, C.-W., HUA, Y.-F., & UMAR, M. (2022). How can new energy vehicles affect air quality in China?— From the perspective of crude oil price. Energy & Environment, 33(8), 1524–1544. https://doi.org/10.1177/0958305X211044388
58. WİRAJİNG, M. A. K., HARUNA, A., & NCHOFOUNG, T. N. (2023). Financial inclusion and healthcare in Africa: Examining the moderating role of education. Review of Development Economics. https://doi.org/10.1111/rode.13043
59. World Bank. (2016). Poverty in rising Africa: African poverty report. https://www.worldbank.org/en/region/afr/publication/poverty-rising-africa-poverty-report
60. World Bank. (2021). Global Financial Inclusion (Global Findex) Database 2021. https://doi.org/10.48529/fact-m635
61. World Bank. (2022). Financial Inclusion. www.worldbank.org/en/topic/financialinclusion
62. World Bank. (2024). Poverty, Prosperity, and Planet Report. https://www.worldbank.org/en/publication/poverty-prosperity-and-planet
63. XİAO, W., & TAO, R. (2022). Financial Inclusion and Its Impact on Health: Empirical Evidence From Asia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.948964
64. YAN, Y., & Qİ, S. (2021). Childhood matters: Family education and financial inclusion. Pacific-Basin Finance Journal, 65, 1–17. https://doi.org/10.1016/j.pacfin.2020.101489
65. ZHANG, Q., & POSSO, A. (2019). Thinking Inside the Box: A Closer Look at Financial Inclusion and Household Income. The Journal of Development Studies, 55(7), 1616–1631. https://doi.org/10.1080/00220388.2017.1380798