Research Article
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Year 2021, Volume: 3 Issue: 3, 137 - 169, 15.12.2021
https://doi.org/10.52675/jhesp.1004601

Abstract

References

  • Arsenault, C., English, M., Gathara, D., Malata, A., Mandala, W., & Kruk, M. E. (2019). Variation in competent and respectful delivery care in Kenya and Malawi: A retrospective analysis of national facility surveys. Tropical Medicine and International Health, 25,442-453. Atun, R. (2015). Transforming Turkey's health system-lessons for universal coverage. New England Journal of Medicine, 373,1285-1289.
  • Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I., Nazlıoğlu, S., Özgülcü, Ş., Aydoğan, Ü., Ayar, B., Dilmen, U., Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382,65-99.
  • Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., Schneider, M.D., Wright, B.J., Zaslavsky, A.M., Finkelstein, A. N. (2013). The Oregon experiment-effects of medicaid on clinical outcomes. New England Journal of Medicine, 368,1713-1722.
  • Banerjee, A., Duflo, E. (2011). Poor economics: A radical rethinking of the way to fight global poverty. New York: Public Affairs.
  • Chaudhury, N., Hammer, J., Kremer, M., Muralidharan, K., Rogers, F. H. (2006). Missing in action: Teacher and health worker absence in developing countries. Journal of Economic Perspectives, 20,91-116.
  • Das, J., Hammer, J. (2005). Which doctor? Combining vignettes and item response to measure clinical competence. Journal of Development Economics, 78,348-383.
  • Dupas, P. (2009). What matters (and what does not) in households' decision to invest in malaria prevention? American Economic Review, 99,224-230.
  • Engström, S., Foldevi, M., Borgquist, L. (2001). Is general practice effective? A systematic literature review. Scandinavian Journal of Primary Health Care, 19,131-144.
  • Grogger, J., Arnold, T., León, A. S., Ome, A. (2014). Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: The case of Mexico. Health Policy and Planning, 30,593-599.
  • Gruber, J., Hendren, N., Townsend, R. M. (2014). The great equalizer: Health care access and infant mortality in Thailand. American Economic Journal: Applied Economics, 6,91-107.
  • Hacettepe University Institute of Population Studies. (1994). Demographic Health Survey 1993, Ankara.
  • Hacettepe University Institute of Population Studies. (2004). Demographic Health Survey 2003, Ankara.
  • Karra, M., Fink, G., Canning, D. (2016). Facility distance and child mortality: A multi-country study of health facility access, service utilization, and child health outcomes. International Journal of Epidemiology, 46,817-826.
  • King, G., Gakidou, E., Imai, K., Lakin, J., Moore, R. T., Nall, C., Ravishankar, N., Vargas, M., Rojo, M.M.T., Ávila, J.E.H., Ávila, M.H., Llamas, H.H. (2009). Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme. The Lancet, 373,1447-1454.
  • Knaul, F.M., Arreola-Ornelas, H., Wong, R., Lugo-Palacios, D. G., Méndez-Carniado, O. (2018). The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012. Salud Pública de México, 60,130-140.
  • Knaul, F.M., González-Pier, E., Gómez-Dantés, O., García-Junco, D., Arreola-Ornelas, H., Barraza-Lloréns, M., Sandoval, R., Caballero, F., Avila, M.H., Juan, M., Kershenobich, D., Nigenda, G., Ruelas, E., Sepulveda, J., Tapia, R., Soberon, G., Chertorivski, S., Frenk, J. (2012). The quest for universal health coverage: Achieving social protection for all in Mexico. The Lancet, 380, 1259-1279.
  • Knaul, F.M., Wong, R., Arreola-Ornelas, H., Méndez, O., Bitran, R., Campino, A. C., Rathe, M. (2013). Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Mexican Health Foundation, International Development Center. Boston: Harvard University Press.
  • Kutzin, J. (2013). Health financing for universal coverage and health system performance: Concepts and implications for policy. Bulletin of the World Health Organization, 91,602-611.
  • Leonard, K.L., Masatu, M.C. (2007). Variations in the quality of care accessible to rural communities in Tanzania: Some quality disparities might be amenable to policies that do not necessarily relate to funding levels. Health Affairs, 26,380-392.
  • Masters, S.H., Burstein, R., Amofah, G., Abaogye, P., Kumar, S., Hanlon, M. (2013). Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis. Social Science and Medicine, 93,147-154.
  • Ministry of Health. (2010). Health Statistics Yearbook 2008, Ankara.
  • Ministry of Health. (2014). Health Statistics Yearbook 2013, Ankara.
  • Sahin, I., Ozcan, Y.A., Ozgen, H. (2011). Assessment of hospital efficiency under health transformation program in Turkey. Central European Journal of Operations Research, 19,19-37.
  • Stokes, J., Gurol Urganci, I., Hone, T., Atun, R. (2015). Effect of health system reforms in Turkey on user satisfaction. Journal of Global Health, 5,020403.
  • Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., Mills, A. (2011). Health-financing reforms in southeast Asia: challenges in achieving universal coverage. The Lancet, 377,863-873.
  • Thiede, M., Akweongo, P., McIntyre, D. (2007). Exploring the dimensions of access. D. McIntyre, G. Mooney (Ed.), The economics of health equity içinde (103-124. ss.). Cambridge: Cambridge University Press.
  • Tirgil, A., Dickens, W. T., Atun, R. (2019). Effects of expanding a non-contributory health insurance scheme on out-of-pocket healthcare spending by the poor in Turkey. BMJ Global Health, 4,e001540.
  • Tirgil, A., Gurol Urganci, I., Atun, R. (2018). Early experience of universal health coverage in Turkey on access to health services for the poor: Regression kink design analysis. Journal of gGobal Health, 8,020412.
  • TurkStat. (2013, October 10). Life Satisfaction Survey. http://tuik.gov.tr/MicroVeri/YMA_2013/index.html
  • TurkStat. (2013, October 10). Province indicators and health. https://biruni.tuik.gov.tr/ilgosterge/?locale=en
  • Ugur, Z., Tirgil, A. (2018). Sağlıkta dönüşüm programi ve kamunun sağlık hizmetlerinden memnuniyeti. Ombudsman Akademik, 1,295-327.
  • Wagstaff, A., Lindelow, M., Jun, G., Ling, X., Juncheng, Q. (2007). Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme. Journal of Health Economics, 28,1-19.
  • Waters, H.R. (2000). Measuring equity in access to health care. Social Science and Medicine, 51,599-612.
  • World Health Organization. (2010). World Health Report, 2010: Health systems financing the path to universal coverage.
  • Yardim, M.S., Cilingiroglu, N., Yardim, N. (2013). Financial protection in health in Turkey: The effects of the health transformation programme. Health Policy and Planning, 29,177-192.

Regional Health Disparities in the Aftermath of Health System Reforms in Turkey

Year 2021, Volume: 3 Issue: 3, 137 - 169, 15.12.2021
https://doi.org/10.52675/jhesp.1004601

Abstract

          Starting in 2003, Turkey introduced major health system reforms through the Health Transformation Program (HTP). The HTP aimed to address inequities in health care services across Turkey. This study explores whether regional disparities in several health care indicators persist ten years after the HTP. For this purpose, we use administrative records and individual-level data from the only regionally representative survey, Life Satisfaction Survey, undertaken by the Turkish Statistical Institute in 2013. First, the disadvantaged North-East, Middle-East, and South-East Anatolia regions experienced the most substantial increases in all health inputs and the odds of receiving the non-contributory Green Card insurance was also higher in these regions. Yet, there is still substantial disparity across regions in many health care access and satisfaction indicators. Especially, the disadvantaged regions still have lower utilization, lower satisfaction with healthcare, and lower subjective health scores in 2013 even after accounting for a wide range of control variables. While the HTP enabled the provision of a generous insurance benefits package, there is still room for progress in regional distribution of other major indicators such as subjective assessment of health, healthcare utilization, and satisfaction with health services. To further reduce health inequities across regions, the quality aspect of healthcare provision needs to be prioritized.

References

  • Arsenault, C., English, M., Gathara, D., Malata, A., Mandala, W., & Kruk, M. E. (2019). Variation in competent and respectful delivery care in Kenya and Malawi: A retrospective analysis of national facility surveys. Tropical Medicine and International Health, 25,442-453. Atun, R. (2015). Transforming Turkey's health system-lessons for universal coverage. New England Journal of Medicine, 373,1285-1289.
  • Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I., Nazlıoğlu, S., Özgülcü, Ş., Aydoğan, Ü., Ayar, B., Dilmen, U., Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382,65-99.
  • Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., Schneider, M.D., Wright, B.J., Zaslavsky, A.M., Finkelstein, A. N. (2013). The Oregon experiment-effects of medicaid on clinical outcomes. New England Journal of Medicine, 368,1713-1722.
  • Banerjee, A., Duflo, E. (2011). Poor economics: A radical rethinking of the way to fight global poverty. New York: Public Affairs.
  • Chaudhury, N., Hammer, J., Kremer, M., Muralidharan, K., Rogers, F. H. (2006). Missing in action: Teacher and health worker absence in developing countries. Journal of Economic Perspectives, 20,91-116.
  • Das, J., Hammer, J. (2005). Which doctor? Combining vignettes and item response to measure clinical competence. Journal of Development Economics, 78,348-383.
  • Dupas, P. (2009). What matters (and what does not) in households' decision to invest in malaria prevention? American Economic Review, 99,224-230.
  • Engström, S., Foldevi, M., Borgquist, L. (2001). Is general practice effective? A systematic literature review. Scandinavian Journal of Primary Health Care, 19,131-144.
  • Grogger, J., Arnold, T., León, A. S., Ome, A. (2014). Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: The case of Mexico. Health Policy and Planning, 30,593-599.
  • Gruber, J., Hendren, N., Townsend, R. M. (2014). The great equalizer: Health care access and infant mortality in Thailand. American Economic Journal: Applied Economics, 6,91-107.
  • Hacettepe University Institute of Population Studies. (1994). Demographic Health Survey 1993, Ankara.
  • Hacettepe University Institute of Population Studies. (2004). Demographic Health Survey 2003, Ankara.
  • Karra, M., Fink, G., Canning, D. (2016). Facility distance and child mortality: A multi-country study of health facility access, service utilization, and child health outcomes. International Journal of Epidemiology, 46,817-826.
  • King, G., Gakidou, E., Imai, K., Lakin, J., Moore, R. T., Nall, C., Ravishankar, N., Vargas, M., Rojo, M.M.T., Ávila, J.E.H., Ávila, M.H., Llamas, H.H. (2009). Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme. The Lancet, 373,1447-1454.
  • Knaul, F.M., Arreola-Ornelas, H., Wong, R., Lugo-Palacios, D. G., Méndez-Carniado, O. (2018). The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012. Salud Pública de México, 60,130-140.
  • Knaul, F.M., González-Pier, E., Gómez-Dantés, O., García-Junco, D., Arreola-Ornelas, H., Barraza-Lloréns, M., Sandoval, R., Caballero, F., Avila, M.H., Juan, M., Kershenobich, D., Nigenda, G., Ruelas, E., Sepulveda, J., Tapia, R., Soberon, G., Chertorivski, S., Frenk, J. (2012). The quest for universal health coverage: Achieving social protection for all in Mexico. The Lancet, 380, 1259-1279.
  • Knaul, F.M., Wong, R., Arreola-Ornelas, H., Méndez, O., Bitran, R., Campino, A. C., Rathe, M. (2013). Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Mexican Health Foundation, International Development Center. Boston: Harvard University Press.
  • Kutzin, J. (2013). Health financing for universal coverage and health system performance: Concepts and implications for policy. Bulletin of the World Health Organization, 91,602-611.
  • Leonard, K.L., Masatu, M.C. (2007). Variations in the quality of care accessible to rural communities in Tanzania: Some quality disparities might be amenable to policies that do not necessarily relate to funding levels. Health Affairs, 26,380-392.
  • Masters, S.H., Burstein, R., Amofah, G., Abaogye, P., Kumar, S., Hanlon, M. (2013). Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis. Social Science and Medicine, 93,147-154.
  • Ministry of Health. (2010). Health Statistics Yearbook 2008, Ankara.
  • Ministry of Health. (2014). Health Statistics Yearbook 2013, Ankara.
  • Sahin, I., Ozcan, Y.A., Ozgen, H. (2011). Assessment of hospital efficiency under health transformation program in Turkey. Central European Journal of Operations Research, 19,19-37.
  • Stokes, J., Gurol Urganci, I., Hone, T., Atun, R. (2015). Effect of health system reforms in Turkey on user satisfaction. Journal of Global Health, 5,020403.
  • Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., Mills, A. (2011). Health-financing reforms in southeast Asia: challenges in achieving universal coverage. The Lancet, 377,863-873.
  • Thiede, M., Akweongo, P., McIntyre, D. (2007). Exploring the dimensions of access. D. McIntyre, G. Mooney (Ed.), The economics of health equity içinde (103-124. ss.). Cambridge: Cambridge University Press.
  • Tirgil, A., Dickens, W. T., Atun, R. (2019). Effects of expanding a non-contributory health insurance scheme on out-of-pocket healthcare spending by the poor in Turkey. BMJ Global Health, 4,e001540.
  • Tirgil, A., Gurol Urganci, I., Atun, R. (2018). Early experience of universal health coverage in Turkey on access to health services for the poor: Regression kink design analysis. Journal of gGobal Health, 8,020412.
  • TurkStat. (2013, October 10). Life Satisfaction Survey. http://tuik.gov.tr/MicroVeri/YMA_2013/index.html
  • TurkStat. (2013, October 10). Province indicators and health. https://biruni.tuik.gov.tr/ilgosterge/?locale=en
  • Ugur, Z., Tirgil, A. (2018). Sağlıkta dönüşüm programi ve kamunun sağlık hizmetlerinden memnuniyeti. Ombudsman Akademik, 1,295-327.
  • Wagstaff, A., Lindelow, M., Jun, G., Ling, X., Juncheng, Q. (2007). Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme. Journal of Health Economics, 28,1-19.
  • Waters, H.R. (2000). Measuring equity in access to health care. Social Science and Medicine, 51,599-612.
  • World Health Organization. (2010). World Health Report, 2010: Health systems financing the path to universal coverage.
  • Yardim, M.S., Cilingiroglu, N., Yardim, N. (2013). Financial protection in health in Turkey: The effects of the health transformation programme. Health Policy and Planning, 29,177-192.
There are 35 citations in total.

Details

Primary Language English
Subjects Health Policy
Journal Section Research Articles
Authors

Zeynep Ugur 0000-0002-5141-2529

Abdullah Tirgil 0000-0002-4491-4459

Publication Date December 15, 2021
Published in Issue Year 2021 Volume: 3 Issue: 3

Cite

APA Ugur, Z., & Tirgil, A. (2021). Regional Health Disparities in the Aftermath of Health System Reforms in Turkey. Journal of Health Systems and Policies, 3(3), 137-169. https://doi.org/10.52675/jhesp.1004601

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Contents of the Journal of Health Systems and Policies (JHESP) is licensed under a Creative Commons Attribution 4.0 International License.