Kamu Sağlık Sigortası Cepten Yapılan Sağlık Harcamalarına Karşı Finansal Koruma Sağlar Mı? Türkiye Örneği

Yıl 2020, , 11 - 24, 30.07.2020

Abdullah Tirgil , Fatih Cemil Özbuğday

https://doi.org/10.17233/sosyoekonomi.2020.03.01

Cited By: 3

Öz

Türkiye, vatandaşları arasında sağlık hizmetlerinin finansmanı, sağlık hizmetlerine erişim ve sağlık çıktıları açısından hakkaniyeti artırmak için kapsamlı reformlar başlatmıştır. Bu süreç içerisinde uygulanan önemli bir reform, düşük gelirli hanehalkları için yürürlükte olan prim ödemesi olmayan kamu sağlık sigortasının kapsamının genişletilmesidir. Bu çalışma kamu sigortasının kapsamının artırılmasının yoksulların cepten yapacakları sağlık harcamalarına olan etkisini incelemektedir. Bulgularımız, kamu sigortasından faydalanan bireylerin tıbbi tedavi görebilmek için gelirlerinin önemli bir kısmını harcamadıklarını ifade etmektedir. Genelde kamu sigortası, yoksul hanehalklarının cepten yaptıkları sağlık harcamalarını düşürerek finansal koruma sağlamıştır.

Anahtar Kelimeler

Prim Ödenmeyen Sağlık Sigortası, Cepten Yapılan Sağlık Harcamaları, Dikey Hakkaniyet, Orta-Gelirli Ülkeler, Türkiye

Does Public Health Insurance Provide Financial Protection Against Out-Of-Pocket Health Payments? Evidence from Turkey

Öz

Turkey has initiated comprehensive reforms to increase equity among its citizens for healthcare financing, access to health services, and health outcomes. A significant change in this process was expanding the benefits package for the non-contributory public health insurance for low-income households. This study examines the impact of the public insurance expansion on out-of-pocket healthcare expenditures for the poor. We find that public insurance helped the beneficiaries not spend a sizeable portion of their income to get medical treatment. Overall, the public insurance program provided financial protection for the poor households by decreasing out-of-pocket health expenditures.

Anahtar Kelimeler

Non-Contributory Health Insurance, Out-Of-Pocket Health Expenditures, Vertical Equity, Middle-Income Countries, Turkey

Kaynakça

• Sepehri, A. & S. Sarma & W. Simpson (2006), “Does non‐profit health insurance reduce financial burden? Evidence from the Vietnam living standards survey panel”, Health economics, 15(6), 603-616.
• World Health Organization (2010). The World Health Report: Health Systems Financing: the path to universal Coverage. Geneva. World Health Organization.
• Atun, R. & S. Aydın & S. Chakraborty & S. Sümer & M. Aran & I. Gürol & ... & U. Dilmen (2013), “Universal health coverage in Turkey: enhancement of equity”, The Lancet, 382(9886), 65-99.
• Ruger, J. P. & H. J. Kim (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.
• Whitehead, M. & G. Dahlgren & T. Evans (2001), “Equity and health sector reforms: can low-income countries escape the medical poverty trap?”, The Lancet, 358(9284), 833-836.
• Malik, A. M. & S. I. A. Syed (2012), “Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan”, International journal for equity in health, 11(1), 51.
• Aran, M. A. & J. S. Hentschel (2012), “Protection in good and bad times? the Turkish green card health program”, The World Bank.
• Bump, J. & S. Sparkes & M. Tatar & Y. Celik (2014), “Turkey on the way of universal health coverage through the health transformation program”, (2003-13).
• Tatar, M. & H. Ozgen & B. Sahin & P. Belli & P. Berman (2007), “Informal payments in the health sector: a case study from Turkey”, Health Affairs, 26(4), 1029-1039.
• Menon, R. & S. Mollahaliloglu & I. Postolovska (2013), “Toward universal coverage: Turkey’s green card program for the poor”.
• Yardim, M. S. & N. Cilingiroglu & N. Yardim (2010), “Catastrophic health expenditure and impoverishment in Turkey”, Health policy, 94(1), 26-33.
• Sulku, S. N. & D. M. Bernard (2012), “Financial burden of health care expenditures: Turkey”, Iranian journal of public health, 41(3), 48.
• Yilmaz, F. & A. Kisa & M. Younis (2009), “Overwhelming health expenditures among the poor in a transition economy: A case study from Turkey”, International journal of health promotion and education, 47(3), 72-78.
• Brown, S. & A. R. Hole & D. Kilic (2014), “Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys”, Economic Modelling, 41, 211-218.
• Erus, B. & B. Yakut-Çakar & S. Cali & F. Adaman (2015), “Health policy for the poor: an exploration on the take-up of means-tested health benefits in Turkey”, Social Science & Medicine, 130, 99-106.
• Greene, W. H. (2003). Econometric analysis. Pearson Education India.
• Finkelstein, A. & S. Taubman & B. Wright & M. Bernstein & J. Gruber & J. P. Newhouse & ... & Oregon Health Study Group (2012), “The Oregon health insurance experiment: evidence from the first year”, The Quarterly journal of economics, 127(3), 1057-1106.
• Wagstaff, A. & M. Lindelow (2008), “Can insurance increase financial risk?: The curious case of health insurance in China”, Journal of health economics, 27(4), 990-1005.
• Ettner, S. L. (1997), “Adverse selection and the purchase of Medigap insurance by the elderly”, Journal of health economics, 16(5), 543-562.
• Angrist, J. D. & J. S. Pischke (2008), Mostly harmless econometrics: An empiricist's companion. Princeton university press.
• Baicker, K. & A. Finkelstein & J. Song & S. Taubman (2014), “The impact of Medicaid on labor market activity and program participation: evidence from the Oregon Health Insurance Experiment”, American Economic Review, 104(5), 322-28.
• Galárraga, O. & S. G. Sosa-Rubí & A. Salinas-Rodríguez & S. Sesma-Vázquez (2010), “Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico”, The European Journal of Health Economics, 11(5), 437-447.
• Angrist, J. D. & W. N. Evans (1996), “Children and their parents' labor supply: Evidence from exogenous variation in family size”, 5778, National Bureau of Economic Research, Cambridge, Mass.
• Terza, J. V. & A. Basu & P. J. Rathouz (2008), “Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling”, Journal of health economics, 27(3), 531-543.
• Erten, M. Z. & A. J. Davidoff & I. H. Zuckerman & T. Shaffer & J. S. Dougherty & X. Ke, & B. Stuart (2014), “The effect of supplemental medical and prescription drug coverage on health care spending for Medicare beneficiaries with cancer”, Value in Health, 17(1), 15-21.
• Rasu, R. S. & W. A. Bawa & & R. Suminski & K. Snella & B. Warady (2015), “Health literacy impact on national healthcare utilization and expenditure”, International journal of health policy and management, 4(11), 747.
• Erus, B., & N. Aktakke (2012), “Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees”, The European Journal of Health Economics, 13(3), 337-346.
• Bound, J. & A. B. Krueger (1991), “The extent of measurement error in longitudinal earnings data: Do two wrongs make a right?”, Journal of Labor Economics, 9(1), 1-24.
• Damme, W. V. & L. V. Leemput & I. Por & W. Hardeman & B. Meessen (2004), “Out‐of‐pocket health expenditure and debt in poor households: evidence from Cambodia”, Tropical Medicine & International Health, 9(2), 273-280.
• World Health Organization. (2000), The world health report 2000: health systems: improving performance. World Health Organization.