Sağlık Hizmetleri Finansmanında Cepten Harcama: Nedir? Neden Önemlidir?

Yıl 2007, Cilt: 10 Sayı: 2, 201 - 228, 01.04.2007

Hacer Özgen

Öz

Cepten harcamalar, birçok ülkede değişen boyutlarda sağlık sistemi finansman aracı olarak kullanılmaktadır. Özellikle düşük gelirli ülkeler açısından önemli bir finansman kaynağı olan cepten harcamalar, olumlu etkilerinin yanı sıra bireyler ve sağlık sistemi açısından birçok önemli sorun yaratma potansiyeline sahiptir. Bu nedenle, cepten harcamalar, ülkelerin temel finansman politikaları ile ilgili sorunlarından biridir. Bu makalede, cepten sağlık harcamasının tanımı, unsurları ve etkileri açıklanmakta ve cepten harcamaların etkileri ile baş edebilme yollarına ilişkin tartışmalar sunulmaktadır

Anahtar Kelimeler

Sağlık Finansmanı, Cepten Sağlık Harcaması

Kaynakça

• Asenso-okyere W. et al. (1998) Cost Recovery in Ghana: Are There Any Changes in Health Care Seeking Behaviour? Health Policy and Planning 13(2): 181–188.
• Austvoll-Dahlgren A. et al. (2008) Pharmaceutical Policies: Effects of Cap and Co-payment on Rational Drug Use. Cochrane Database Systems Review 23(1): CD007017.
• Balabanova D. and McKee M. (2002) Understanding Informal Payments for Health Care: The Example of Bulgaria. Health Policy 62(3): 243- 273.
• Banthin J.S. and Bernard D.M. (2006) Changes in Financial Burdens for Health Care. JAMA 296: 2712-2719.
• Belli P. et al. (2002) Qualitative Study on Informal Payments for Health Services in Georgia. HNP Discussion Paper. Washington DC: World Bank.
• Biritwum R.B. (1994) The Cost of Sustaining the Ghana’s “Cash and Carry” System of Health Care Financing At A Rural Health Center. West African Journal of Medicine 13: 124-127.
• Blas E. and Limbambala M.E. (2001) User-payment, Decentralization and Health Service Utilization in Zambia. Health Policy and Planning 16(2): 19-28.
• Bojalil R. and Calva J. (1994) Antibiotic Misuse in Diarrhea: A Household Survey in A Mexican Community. Journal of Clinical Epidemiology 47(4): 147–156.
• Briggs J. (2000) The Economic Consequences of Inadequate Prescribing on Health Care Users and Providers: A Case Study in San Cristobel, Mexico. Liverpool: Liverpool School of Tropical Medicine.
• Burnham G. et al. (2004) Discontinuation of Cost Sharing in Uganda. Bulletin of the World Health Organization 82(3): 187–195.
• Castrol-Leal F. et al. (2000) Public Spending on Health Care in Africa: Do the Poor Benefit? Bulletin of World Health Organization 78(1):66- 74.
• Chaudhuri A. and Roy K. (2008) Changes in Out of Pocket Payments for Healthcare in Vietnam and Its Impact on Equity in Payments, 1992-2002. Health Policy Elektronik Sürüm (www.sciencedirect.com) (Erişim tarihi 20 Ekim 2007).
• Chiu Y. et al. (2007) Gifts, Bribes and Solicitions: Print Media and the Social Construction of Informal Payments to Doctors in Taiwan. Social Science and Medicine 64(3): 521-530.
• Creese A. and Kutzin J. (1995) Lessons from Cost-recovery in Health. WHO: Geneva.
• Delcheva E. et al. (1997) Under-the-counter Payments for Health Care: Evidence from Bulgaria. Health Policy 42: 89-100.
• Ensor T. (2004) Informal Payments for Health Care in Transition Economies. Social Science and Medicine 58(2): 237-246. 17.
• Ensor T. and Savelyeva L. (1998) Informal Payments for Health Care in the Former Soviet Union: Some Evidence from Kazakstan. Health Policy and Planning 13(1): 41-49.
• Ensor T. and San P.B. (1996) Access and Payment for Health Care. The Poor of Northern Vietnam. International Journal of Health Planning and Management 11(1): 69-83.
• Falkingham J. (2004) Poverty, Out-of-pocket Payments and Access to Health Care: Evidence from Tajikistan. Social Science & Medicine 58(2): 247-258.
• Foster A. (1994) Poverty and Illness in Low-Income Rural Areas. American Economic Review 84(2): 216–220.
• Fu W. (1999) Health Care for China’s Rural Poor. International Policy Programme. Washington: World Bank.
• Gaal P., Belli P., McKee M. and Szocska M. (2006) Informal Payments for Health Care: Definitions, Distinctions, and Dilemmas. Journal of Health Politics Policy and Law 31(2): 251-293.
• Gaal P., Evetovits T. and McKee M. (2006) Informal Payment for Health Care: Evidence from Hungary. Health Policy 77(1): 86-102.
• Gaal P. and McKee M. (2005) Fee-for-service or Donation? Hungarian Perspectives on Informal Payment for Health Care. Social Science and Medicine 60(7): 1445-1457.
• Garg C.C. and Karan A.K. (2005) Health and Millennium Development Goal 1: Reducing out-of-pocket expenditures to reduce income poverty -Evidence from India. EQUITAP Project: Working Paper #15.
• Gemmill M.C. et al. (2008) What Impact Do Prescription Drug Charges Have on Efficiency and Equity? Evidence from High-income Countries. International Journal for Equity in Health 7: 12-122.
• Gilson L. and McIntyre D. (2005) Removing User Fees for Primary Care in Africa: The Need for Careful Action. BMJ 331: 762-765.
• Gottlieb S. (2000) Medical Bills Account for 40% of Bankruptcies. BMJ 320(7245): 1295.
• Gotsadze G. et al. (2005) Health Care-Seeking Behaviour and Out-of- pocket Payments in Tbilisi, Georgia. Health Policy and Planning 20(4): Gottret P. and Schieber G. (2006) Health Financing Revisited: A Practitioner’s Guide. The World Bank, Washington D.C.
• Gross D.J. et al. (1999) Out-of-pocket Health Spending by Poor and Near-Poor Elderly Medicare Beneficiaries. Health Services Research 34(1 Pt 2): 241-254.
• Himmelstein D.U. et al. (2005) Illness and Injury As Contributors to Bankruptcy. Health Affairs Suppl Web Exclusives: W5-63-W5-73.
• Hopkins S. and Cumming J. (2001) The Impact of Changes in Private Health Expenditure on New Zealand Households. Health Policy 58(3): 215–229.
• Hotchkiss D.R. et al. (2005) Out-of-pocket Payments and Utilization of Health Care Services in Albania: Evidence from Three Districts. Health Policy 75(1): 18–39. 35.
• Iyer A. and Sen G. (2000) Health Sector Changes and Health Equity in the 1990s in India. In: Roghuram S. (ed.) Health and Equity: Technical Report Series 1.8. Bangalore: HIVOS.
• Jacobs B. and Price N. (2004) The Impact of the Introduction of User Fees At A District Hospital in Cambodia. Health Policy and Planning 19(5): 310–321.
• James C.D. et al. (2006) To Retain or Remove User Fees?: Reflections on the Current Debate in Low- and Middle-income Countries. Applied Health Economics and Health Policy 5(3): 137-153.
• Kabir M.A. et al. (2000) Sickness Among the Urban Poor: A Barrier to Livelihood Security. Journal of International Development 12: 707– 722.
• Kawabata K. et al. (2002) Preventing Impoverishment Through Protection Against Catastrophic Health Expenditure. Bulletin of World Health Organization 80(8): 612.
• Kipp W. et al. ( 2001) User Fees, Health Staff Incentives, and Service Utilization in Kabarole District, Uganda. Bulletin of the World Health Organization 79(11): 1032–1037.
• Le Grand A. et al. (1999) Intervention Research in Rational Use of Drugs: A Review. Health Policy and Planning 14: 89–102. 42.
• Lewis M. (2000) Who is Paying for Health Care in Eastern Europe and Central Asia? Human Development Sector Unit, Europe and Central Asia, Region, Washington, DC, The World Bank.
• Liaropoulos L. and Tragakes E. (1998) Public/Private Financing in the Greek Health Care System: Implications for Equity. Health Policy 43: 153-169.
• Liaropoulos L. et al. (2008) Informal Payments in Public Hospitals in Greece. Health Policy 87: 72–81.
• Liu Y. ve diğerleri (2005) Türkiye’de Sağlık ve İlaç Harcamaları. Sağlıkta Umut Vakfı.
• Liu G.G. and Zhao Z. (2006) Urban Employee Health Insurance Reform and the Impact on Out-of-pocket Payment in China. International Journal of Health Planning and Management 21(3): 211-228.
• Mastilica M. and Bozikov J. (1999) Out-of-pocket Payments for Health Care in Croatia: Implications for Equity. Croatian Medical Journal 40(2): 152-159.
• Maynard A. and Dixon A. (2002) Private Health Insurance and Medical Savings Accounts: Theory and Experience. Mossialos, E. et al. (eds.). Funding Health Care: Options for Europe, pp:80-109. Buckingham & Philadelphia: Open University Press. 49.
• McIntyre D. et al. (2006) What are the Economic Consequences for Households of Illness and of Paying for Health Care in Low- and Middle-Income Country Contexts? Social Science and Medicine 62(4): McPake B. et al. (1999) Informal Economic Activities of Public Health Workers in Uganda: Implications for Quality and Accessibility of Care. Social Science and Medicine 49(7): 849–865.
• Meuwissen L.E. (2002) Problems of Cost Recovery Implementation in District Health Care: A Case Study from Niger. Health Policy and Planning 17(3): 304–313. 52.
• Mossialos E. and Dixon A. (2002) Funding Health Care: An Introduction. Mossialos, E. et al. (eds.). Funding Health Care: Options for Europe, pp:1-30. Buckingham & Philadelphia: Open University Press.
• Mwabu G. et al. (1995) User Charges in Government Health Facilities in Kenya—Effect on Attendance and Revenue. Health Policy and Planning 10(2): 164–170.
• Nahar S ve Costello AM (1998). The hidden cost of ‘free’ maternity care in Dhaka, Bangladesh. Health Policy and Planning, 13(4): 417–422.
• Nolan B. and Turbat V. (1995) Cost Recovery in Public Health Services in Sub-Saharan Africa. Washington, DC, Economic Development Institute of The World Bank.
• O’Donnell O et al. (2008) Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington, DC, USA: World Bank.
• Öz E (2008) Ulusal Hanehalkı Cepten Sağlık Harcamalarının Finansmanda Dikey Hakkaniyet Açısından Değerlendirilmesi. Yayınlanmamış Doktora Tezi, Hacettepe Üniversitesi.
• Özgen H. et al. Predictors of Informal Health Payments: The Example from Turkey. Journal of Medical Systems (Baskıda).
• Özgür S. ve diğerleri (2008) GAP Bölgesinde Halkın Sağlık Kuruluşlarından Yararlanımı. Elektronik Sürüm.
• (www.dicle.edu.tr/~halks/m10.9.htm) (Erişim Tarihi, 20 Temmuz 2008). Palmer D. et al. (1991) Striving for Quality in Health Care: An Inquiry into Policy and Practice. Washington, DC: Health Administration Press.
• Pannarunothai S. and Mills A. (1997) The Poor Pay More: Health- Related Inequality in Thailand. Social Science and Medicine 44(12): 1781–1790.
• Phadke A. (1996) The Quality of Prescribing in An Indian District. National Medical Journal of India 9(2): 60–65.
• Prescott N. (1997) Poverty, Social Services and Safety Nets in Vietnam. World Bank discussion paper no 376. Washington: World Bank.
• Rasell E. (1999) An Equitable Way to Pay for Universal Coverage. International Journal of Health Services 29(1): 179-188.
• Rice T. (1997) Can Markets Give Us the Health System We Want? Journal of Health Politics, Policy and Law 22(2): 383–426.
• Ruger J.P. and Kim H. (2007) Out-of-Pocket Healthcare Spending by the Poor and Chronically Ill in the Republic of Korea. American Journal of Public Health 97(5): 804-811.
• Russell S. and Gilson L. (1997) User Fee Policies to Promote Health Service Access for Poor: A Wolf in Sheep’s Clothing? International Journal of Health Services 27(2): 359–379.
• Sağlık Bakanlığı, RSHMB, Hıfzıssıhha Mektebi Müdürlüğü (2006) Türkiye Ulusal Hanehalkı Sağlık Harcamaları Araştırması 2002- 2003. Yayın No: SB-HM-2005/09, Ankara.
• Sağlık Bakanlığı (2007) Türkiye’de Sağlığa Bakış. Refik Saydam Hıfzıssıhha Merkezi Başkanlığı, Hıfzıssıhha Mektebi Müdürlüğü, Ankara.
• Scitovsky A.A. and McCall N. (1977) Coinsurance and the Demand for Physician Services: Four Years Later. Social Security Bulletin 40(5): 19-27.
• Segall M. et al. (2000) Health Care Seeking by the Poor in Transitional Economies; The Case of Vietnam. Research report no 43. Sussex: Institute of Development Studies.
• Shahriari H. et al. (2001) Institutional Issues in Informal Health Payments in Poland: Report on the Qualitative Part of the Study. HNP Discussion Paper. Washington DC: World Bank.
• Shen Y. and McFeeters J. (2006) Out-of-Pocket Health Spending Between Low- and Higher-Income Populations: Who is at Risk of Having High Expenses and High Burdens? Medical Care 44(3): 200- 209.
• Shmueli A. et al. (2008) Financing the Package of Services During the First Decade of the National Health Insurance Law in Israel: Trends and Issues. Health Policy Elektronik Sürüm (www.sciencedirect.com) (Erişim Tarihi 20 Haziran 2008).
• Skarbinski J. et al. (2002) The Burden of Out-of-pocket Payments for Health Care in Tbilisi, Republic of Georgia. JAMA 287(8): 1043-1049.
• Smith P.C. (2005) User Charges and Priority Setting in Health Care: Balancing Equity and Efficiency. Journal of Health Economics 24(5): 1018-1029.
• Szende A. and Culyer A.J. (2006) The Inequity of Informal Payments for Health Care: The Case of Hungary. Health Policy 75(3): 262-271.
• Tatar M. et al. (2007) Formal and Informal Household Spending on Health: A Case Study from Turkey. Health Affairs 26(4): 1029-1039. 79.
• Tediosi F. et al. (2008). Access to Medicines and Out-of-pocket Payments for Primary Care: Evidence from Family Medicine Users İn Rural Tajikistan. BMC Health Services Research 8: 109-118.
• Thomason J. et al. (1994) User Charges for Rural Health Services in Papua-New-Guinea. Social Science and Medicine 39(8): 1105–1115.
• Thompson R. and Xavier A. (2002) Unofficial Payments for Acute State Hospital Care in Kazakhstan. A model of Physician Behaviour With Price Discrimination and Vertical Service Differentiation. LICOS Working Paper 124.
• Tibaijuka A.K. (1997) AIDS and Economic Welfare in Peasant Agriculture: Case Studies from Kagabiro Village, Kagera Region, Tanzania. World Development 25(6): 963–975. 83.
• Tipping G. (2000) The Social Impact of User Fees for Health Care on Poor Households: Commissioned Report to the Ministry of Health, Hanoi, Vietnam.
• Tokat M. (1998) Türkiye Sağlık Harcamaları ve Finansmanı 1992- 1996. Sağlık Bakanlığı, Sağlık Projesi Genel Koordinatörlüğü, Ankara.
• Van de Ven WPMM (1983) Effects of Cost-sharing in Health Care. Effective Health Care 1: 47–58.
• Van Doorslaer E. et al. (2007). Catastrophic Payments for Health Care in Asia. Health Economics 16(11): 1159–1184.
• Van Doorslaer E. et al. (2006) Effect of Health Payments on Poverty Estimates in 11 Countries in Asia: An Analysis of Household Survey Data. Lancet 368(14): 1357–64.
• Van Doorslaer E. et al. (1999) The Redistributive Effect of Health Care Finance in Twelve OECD Countries. Journal of Health Economics 18(3): 291-313.
• Xu K. et al. (2007) Protecting Households From Catastrophic Health Spending. Health Affairs Jul/Aug 26(4): 972-983.
• Xu K. et al. (2006) Understanding the Impact of Eliminating User Fees: Utilization and Catastrophic Health Expenditures in Uganda. Social Science and Medicine 62(4): 866–876.
• Xu K. et al. (2003) Household Catastrophic Health Expenditure: A Multicountry Analysis. Lancet 362(9378): 111–117.
• Wagstaff A. and Van Doorslaer E. (2003) Catastrophe and Impoverishment in Paying for Health Care: with Applications to Vietnam 1993–98. Health Economics 12(11): 921–933.
• Wagstaff A. and Van Doorslaer E. (2001) Paying for Health Care: Quantifying Fairness, Catastrophe and Impoverishment, with Applications to Vietnam, 1993-98. (Policy Research Working Paper: 2715), The World Bank.
• Wagstaff A. (2002) Reflections on and Alternatives to WHO's Fairness of Financial Contribution Index. Health Economics 11(2): 103-15.
• Wagstaff A. (2001) Poverty and Health.
• Macroeconomics and Health (CMH) Working Paper Series, (Paper No. WG1: 5).
• Commission on Walley J. et al. (2001) Public Health: An Action Guide to Improving Health in Developing Countries. New York: Oxford University Press.
• Whitehead M. et al. (2001) Equity and Health Sector Reforms: Can Low- income Countries Escape the Medical Poverty Trap? The Lancet 358(9284): 833–836.
• WHO (2000). The World Health Report 2000, Health Systems: Improving Performance. Geneva.
• WHO (2004) What are The Equity, Efficiency, Cost Containment and Choice Implications of Private Health-Care Funding in Western Europe? WHO Regional Office for Europe’s Health Evidence Network (HEN) Report.
• WHO (2007). World Health Statistics.
• Wilkes A. et al. (1997) Coping with the Costs of Severe Illness in Rural China. IDS Working Paper 58.
• Willis C.Y. and Leighton C. (1995) Protecting the Poor Under Cost Recovery: the Role of Means Testing. Health Policy and Planning 10(3): 241-256.
• Witter S. (2005) An Unnecessary Evil? User Fees for Health Care in Low-income Countries.
• (www.savethechildren.org.uk/scuk_cache/scuk/cache/cmsattach) (Erişim tarihi 22 Temmuz 2008).
• World Bank (2004) Republic of Tajikistan Health Sector Note. Main Report. Human Development Unit, Europe and Central Asia Region, Washington.
• World Bank (1999) The Kyrgyz Republic: Participatory Poverty Assessment, Prepared for the Global Synthesis Workshop Poverty Programme. Washington: World Bank.
• Wouters A. (1995) Improving Quality Through Cost Recovery in Niger. Health Policy and Planning 10(3): 257-270.