SAĞLIK HİZMETLERİNDE CEPTEN ÖDEMELERİN BİR ÇEŞİDİ: KATKI PAYLARI

Year 2018, Issue: 32, 265 - 313, 26.12.2018

Kevser Sezer Korucu , Aygen Oksay

Abstract

Türkiye’de
sağlık hizmetlerinin finansmanın sağlanmasına dair birçok yöntem vardır. Bu
yöntemlerden biri de cepten yapılan ödemeler kapsamındaki kullanıcı
katkılarıdır. Kullanıcı katkıları hastaların sağlık hizmetinden yararlanabilmek
için genel sağlık sigortası veya bakmakla yükümlü olduğu kişiler tarafından
ödenecek tutardır. Bu bağlamda çalışma, literatür taramasına dayalı bir teorik
araştırma niteliğini taşımaktadır. Çalışma kapsamında, literatür çalışması
yapılarak kullanıcı katkılarının kullanılma sebepleri, katkı paylarının
avantajları, dezavantajları ve Türkiye’de uygulanan kullanıcı katkı
miktarlarına yer verilerek GSS’de yer alan kullanıcı katkıları oranları
incelenmiştir.

Keywords

Katkı Payı, Sağlık Ekonomisi

References

• Akdur, R., Çöl M., Işık A., İdil A., Durmuşoğlu M., Tunçbilek A., (1998), Halk Sağlığı, Ankara: Ankara Üniversitesi Tıp Fakültesi Yayınları. Asenso-Okyere, W.K., (1995), “Financing Healthcare in Ghana”, World Health Forum, 14(1): 86-91.Ataay, F., (2008), “Sağlık Reformu ve Yurttaşlık Hakları, Amme İdaresi Dergisi, 41(3): 169-184. Ateş, M., (2011), Sağlık Hizmetleri Yönetimi, 1. Baskı, İstanbul: Beta Yayıncılık. Austvoll-Dahlgren, A., Aaserud, M., Vist, G., Ramsay, C., Oxman, A.D. Sturm, H., et al, (2008), “Pharmaceutical Policies: Effects on Cap and Co-payment on Rational Drug Use”, Cochrone Database Systems Review, 23(1): 4-8. Azores, K. F., (2013), “Catastrophic Drug Coverage in Canada”, Healthy Dialogue, 2(1): 1-9.
• Banarjee, A., Duflo, E., Glennerster, R., and Kothari, D., (2010), “Improving Immunization Covarage in Rural India: A Clustered Randomized Controlled Evaluation of Immunization Campaigns with and Without Incentives”, British Medical Journal, 340(2220): 5-10.
• Barnum, H. and Kutzin L., (1993), Public Hospitals in Developing Countries, Washington: The John University Press.
• Beck, R.G., (1974), “The Effects of Co-Payment on the Poor”, Journal of Human Resources, 9(1): 129-142. Benli, B., (2011), Sağlıkta Geri Ödeme Yöntemleri ve Teknik Verimlilik, Sosyal Güvenlik Uzmanlık Tezi, Ankara.
• Bigdeli, M. and Ir, P., (2010), A Role for User Charges? Thoughts From Health Financing Reforms in Cambodia, Thailand World Health Report Background Paper No:42.
• Birch, S., (1986), “Increasing Patient Charges in the National Health Service, A Method of Privatizing Primary Care”, Journal Soial Policy, 15(2): 163-184.
• Blair T., Adeola F., Amoako K.Y., Boker N.K., Ben H., Brown G., Camdessus M., et al, (2005), Commissions for Africa: Our Common Interest, Executive Summary 14.
• Bloor, K., and Freemantle, N., (1996), “Lessons from International Experience in Controlling Pharmaceutical Expenditure II: Influencing Doctors, British Medical Journal, 312(7045): 1525-1527.
• Carrin, G., (2011), Health Financing in Developing World: Supporting Countries Search for Viable Systems, Antwerp, Belgium: University Press.
• Chalkley, M., and Robinson, R., (1997), Theory and Evidence on Cost Sharing in Healthcare: An Economic Perspective, London: BSC Print.
• Chuma, J., Musimbi, J., Okungu, U., Goodman C., and Malyneux, C., (2009), “Reducing User Fees for Primacy Healthcare in Kenya: Policy on Paper or Policy in Practice?”, International Journal for Equity in Health, 8(15): 1-10.
• Cichon, M., and Normand, C., (1994), “Between Beverigde and Bismarck Options for Healthcare Financing in Central and Eastern Europe”, World Health Forum, 15(4): 323-328.
• Çelik, Y., (2011), Sağlık Ekonomisi, 1. Baskı, Ankara: Siyasal Kitabevi.
• Docteur, E. and Oxley H., (2003), Healthcare Systems: Lessons From the Reform Experience, Paris: OECD Health Working Papers.
• Donabedian, A., (1971), “Social Responsibility for Personel Health Services: An Examination of Basic Values” Inquiry Review, 8(2): 3-19.DPT, (Devlet Planlama Teşkilatı), (2001), Sekizinci Beş Yıllık Kalkınma Planı Sağlık Hizmetlerinde Etkinlik Özel İhtisas Komisyonu Raporu, Ankara.
• DPT, (Devlet Planlama Teşkilatı), (2006), Dokuzuncu Beş Yıllık Kalkınma Planı, (2007- 2013), DPT, Ankara. DPT, (Devlet Planlama Teşkilatı), (2010), Dokuzuncu Beş Yıllık Kalkınma Planı, (2007- 2013), 2010 yılı Programı, DPT, Ankara.
• Duff, D.G., (2004), “Benefit Taxes and User Fees in Theory and Practice”, University of Toronto Law Journal, 54(4): 391-447. Dupas, P. And Nber S., (2012), Global Health System: Pricing and User Fees, Elsevier Encylopedia of the Health Economics.
• Ersöz, F., (2008), “Türkiye ile OECD Ülkelerinin Sağlık Düzeyleri ve Sağlık Harcamaları Analizi”, İstatistik Dergisi, 2(98): 95-104.
• Gilson, L., (1996), Sustainable Healthcare Financing in Southern Africa: The Lessons of User Fee Experience in Africa, Johannesburg: World Bank Publications.
• Gilson, L., and McLntyne D., (2005), “Removing User Fees for Primary Carein Africa: The Need for Careful Action”, British Medical Journal, 331(7519): 762-765.
• Gilson, L., Russel, S., and Buse, K., (1995), “The Political Economiy of User Fees with Targeting: Developing Equitable Health Financing Policy?”, Journal International Development, 7(3): 369-401.
• Gümüş, F., Çelikay, F., ve Glewwe, P. and Gaag, J., (1988), Confronting Poverty in Developing Countries: Living Standards Measurement Study, Washington: Working Paper, The World Bank.
• Gottret P., and Schieber G., (2006), Health Financing Revisited: A Practitioner’s Guide, Washington: The World Bank.
• Gottret, P., G. Schieber and Waters, H., (2008), Good Practices in Health Financing: Lessons from Reforms in Low and Middle-Income Countries, Washington: World Bank.
• Gulliford, M. and Morgan, M., (2003), Access to Healthcare, London: New Fetter Line. Gümüş, E., (2014), “Türkiye’de Sağlık Hizmetleri ve Finansmanı”, Eskişehir Osmangazi Üniversitesi Sosyal Bilimler Dergisi, 11(1): 177-216
• Hamzaoğlu, O., (2011), Türkiye’de Sağlık Reformları: Kapitalizm Krizi ve Sağlık, Uluslararası Sağlık Politikaları Birliği XVI Konferansı, Ankara.
• Hamzaoğlu, O., ve Yavuz, C., (2006), “Sağlıkta AKP’li Dönemin Bilançosu Üzerine”, Mülkiye, 30(252): 275-297.
• Hollander, M.J., Liu, G., Chappel, N.L., (2009), “Who Cares and How Much? The Imputed Economic Contribition to the Canadian Healthcare System of Middle Aged and Older Unpaid Caregivers Providing Care to the Elderly”, Law and Governance, 12(2): 42-49.
• Hurley, J. ve Johnson, N.A., (2011), “The Effects of Co-payments Within Drug Reimbursement Programs”, Canadian Public Policy, 17(2), 473-489.İstanbulluoğlu, H., Güleç, M., Oğur, R., (2010), “Sağlık Hizmetlerinde Finansman Yöntemleri”, Dirim Tıp Dergisi, 85(2): 86-89.
• Jarret, S., and Ofosu-Amaah, S., (1992), “Stregthening Health Services for MCH in Africa: The First Four Years of the Bamoka Initiative”, Health Policy and Planning, 7(2): 164-176.
• John, E.U., (2013), “The Impacts of User Fees on Health Services in Sub-Saharan African Countries: A Critical Analysis of the Evidence”, American Journal of Public Health Research, 1(18): 196-202.
• Johson, A., and Goss, A., Beckerman, J., Castro, A., (2012), “Hidden Costs: The Direct and İndirect İmpact of User Fees on Access to Malaria Tratment and Primary care in Mali”, Social Science and Medicine, 30: 1786-1792.
• Keshavjee, S., (2004), The Contradicts of Revolving Drug Find in Past-Soviet Tajikistan Selling Medicines to Storving Patients, Walnut Greek: Alto Mira Press.
• Kiliingworth, J.R., Hossain, N., Hedrick, Van Y., Thomas, S.D., Rahman A., and Begun T., (1999), “Unofficial Fees in Bangladesh: Price, Equity and Instutional Issues”, Health Policy Plan, 14(2): 152-163.Kurt, Ö. A., ve Şaşmaz, T., (2012), “Türkiye’de Sağlık Hizmetlerinin Sosyalleştirilmesi: 1961-2003”, Lokman Hekim Dergisi, 2(11): 21-30.
• Kutzin J., (2000), Towards Universal Healthcare Coverage, A Goal-Oriented Framework for Policy Analysis, Washington: HNP The World Bank.
• Kutzin, J., Cashin C. and Jakab M., (2010), Implementing Health Financing Reform (Lessons from Countries in Transition), Unıted Kingdom:European Observatory on Health Systems and Policies.
• Lagarde M., and Palmer, N., (2008), “The Impact of User Fees on Health Service Utilization in Low and Middle Income Countries: How Strong is the Evidence?”, Bulletin of World Health Organization, 86(11): 839-848.
• Lesen, E., Sundell, K.A., Carlston, A., Mardby, A.C., and Jonsson A.K., (2014), “Is the Level of Patient Co-payment for Medicines Associated with Refill Adherence in Sweden?”, European Journal of Public Health, 24(1), 85-90
• .Lohr K.N., Brook R.H., Komberg C.J., Goldberg A.G., Leibowitz A., Keesey J., et al, (1986), Use of Medical care in the RAND Health Insurance Experiment:Diagnosis and Service Specific Analysis in Randomized Controlled Trial, Philedelphia: JB Lippincott Co.
• Maynard, A. and Dixon A., (2002), Private Health Insurance and Medical Savings Accounts Theory and Experience, Buckingham: Open University Press, 109- 127.
• Mossialos, E. and Dixon, A., (2002), Funding Healthcare: An Introduction, Buckingham Philadelphia: Open University Press.
• Mossialos, E., Dixon, A., Figueras, J. and Kutzin, J., (2002), Funding Healthcare: Options For Europe, Buckingham: Open University Press.
• Murray, C., and Frank, J., (2001), “World Health Report 2000: A Step Towards Evidence-Based Healthy Policy”, Lancet, 357(9269): 1698-1700.Mutlu, A., ve Işık, A. K. (2012), Sağlık Ekonomisine Giriş, 3.Baskı, Bursa: Ekin KitabeviNolan, B. and Turbat V., (1995), Cost Recovery in Public Health Services in SubSaharan Africa, Washington: The World Bank.
• Normand C. and Busse R., (2002), Social Health Insurance Financing, içinde E. Mossialos, A. Dixon, J. Figuereras, J. Kutzin, Funding Healthcare: Options for Europe, Buckingham: Open University Press.OECD, http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT, (Erişim Tarihi: 25.03.2017).
• Or, Z., Cases, C., Lisac, M., Vrangbaek, K., Winblad, V. and Bevan, G., (2009), Are Health Problems Systemic? Politics of Access and Choice Under Beveridge and Bismarck Systems, Paris: Irdes Publishers. Orhaner, E., (2014), Türkiye’de Sağlık Sigortası, Ankara: Siyasal Kitapevi.
• Orton, S.N., Menkens A.J. and Sontos P., (2009), Public Health Bussiness Planning, A Practical Guide, Sudbury Mass: Jones and Bortlett Publishers.
• Özdemir, O., Ocaktan, E. ve Akdur, R., (2003), “Sağlık Reformu Sürecinde Türkiye ve Avrupa’da Birinci Basamak Sağlık Hizmetlerinin Değerlendirilmesi”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, 56(4): 207-216.
• RAND, (2006), “The Health Insurance Experiment. A Classic RAND Study Speaks to the Current Health Care Refrom Debate”, http://www.rand.org, (Erişim Tarihi: 12.03.2017).
• Resmi Gazete, (1961), “Sağlık Hizmetlerinin Sosyalleştirilmesi Hakkında Kanun”, Kanun No: 224, 12.01.1961, Sayı: 10705, Ankara.
• Resmi Gazete, (1992), “Ödeme Gücü Olmayan Vatandaşlara Tedavi Giderlerinin Yeşil Kart Verilerek Devlet Tarafından Karşılanması Hakkında Kanun”, Kanun No: 3816, 3.07.1992, Sayı: 21273, Ankara.
• Resmi Gazete, (2006), “Sosyal Sigortalar ve Genel Sağlık Sigortası Kanunu”, Kanun No: 5560, 16.06.2016, Sayı: 26200, Ankara.
• Resmi Gazete, (2008), “Sosyal Sigortalar ve Genel Sağlık Sigortası Kanunu ile Bazı Kanun Hükmünde Kararname Yapılmasına Dair Kanun”, Kanun No: 5474, 08.05.2008, Sayı: 26870, Ankara.
• Ros, C.C., Groenewegen, P.P.,and Delnoij, D.M.J. (2000), “All Rights Reserved or Can We Just Copy? Cost Sharing Arrngements and Characteristics of Health Care Systems”, Health Policy, 52(1): 1-13.
• Russel, S., and Gilson L., (1997), “User Fee Policies to Promote Health Service Access for the Poor: An Wolf in Sheep’s Clothing?”, International Journal Health Services, 27(2): 359-379.
• Saltman, R. B. and Figueras, J., (1997), European Health Care Reform: Analysis of Current Strategies, Copenhagen: World Health Organization, Regional Office for Europe.Sepehri A., and Chernomas R., (2001), “Are User Charges Efficiency and Equity Enhancing?”, Journal of International Development, 13(2):183-209.
• SGK (Sosyal Güvenlik Kurumu), http://www.sgk.gov.tr/wps/portal/sgk/tr /kurumsal/kurumumuz/tarihce, (Erişim Tarihi: 25.03.2017). SGK (Sosyal Güvenlik Kurumu), http://www.sgk.gov.tr/wps/portal/sgk/tr/saglik /saglik_hizmetleri/muayene_katilim_payi, (Erişim Tarihi:25.03.2017). SGK (Sosyal Güvenlik Kurumu), http://www.sgk.gov.tr/wps/portal/sgk/ tr/saglik/saglik_hizmetleri/katilim_payi_alinmayacak_haller_saglik_hizmetleri _ve_kisiler, (Erişim Tarihi: 24.03.2017). Shapıro, M.F., Ware, J.E., Sherbourne, C.D., (1986), “Effects of Cost Sharing on Seeking Care for Serious and Minor Symptoms: Results of a Randomized Controlled Trial”, Ann Intern medical, 104: 246-251.
• Sierra Leone, G., (2009), Free Healthcare Services: For Pregnant and Lactating Women and Young Children in Sierra Leone, Freetown: Goverment of Sierra Leone. SUT (Sağlık Uygulama Tebliği), http://www.saglikaktuel.com/haberler/tebligler-sutdegisiklikleri-ve-duyurulari-253-p1.htm, (Erişim Tarihi:24.03.2017).
• Tengilimoğlu D., ve Güzel A., (2011), “Sağlık Sistemleri ve Ülke Örnekleri” Sosyal Güvenlik Dünyası, 14(73): 13-26.
• Waddington, C.J., and Enyiimayev, K.A., (1989), “A Price to Pay: The Impact of User Charges in Ashanti-Akim District of Ghana”, International Journal of Health Planning and Management, 4(1): 17-47.
• Thomson S., FoubisterT., Figueras J., Kutzin J., Permanand G., Bryndova L., (2009), Adressing Financial Sustainability in Health Systems, European Observatory on Health Systems and Policies, Geneva, WHO Regional Office for Europe.
• Thomson, S., Foubister, T. and Mossialos, E., (2008), Health Care Financing in the Context of Social Security, Policy Department Economic and Scientific Policy, European Parliament, Strazburg.Uz, H. M., (2003), Hastane Yöneticiliği, İstanbul: Nobel Tıp Kitapevleri Yayını.
• Ünal, E. (2013), Sağlık Ekonomisi ve Yönetimi, Bursa: Ekin Kitabevi.Weaver, M., (1995), “User Fees and Political Behaviour: Evidence From Niamey National Hospital”, Health Policy and Planning, 10(4): 350-361.
• Wedig, G. J., (1988), “Health Status and the Demand for Health: Results on Price Elasticities”, Journal of Health Economics, 7(2): 151-163., WHO (World Health Organization), (2000), “The World Health Report, Health Systems: Improving Performance, France, 92-98, http://www.who.int/whr/2000/en/ (Erişim Tarihi: 09.02.2017)Wild, C., ve Gibis, I., (2003), “Evaulations of Health Interventions in Social Insurance Based Countries: Germany, The Netherlands and Austria”, Health Policy, 63: 187-196.
• Yenimahalleli Yaşar, G., (2007), Sağlığın Finansmanı ve Türkiye İçin Sağlık Finansmanı Modeli Önerisi, Yayımlanmış Doktora Tezi, Ankara Üniversitesi Sosyal Bilimler Enstitüsü Çalışma Ekonomisi ve Endüstri İlişkileri Anabilim Dalı, Ankara.
• Yıldırım, H. H., Yıldırım, T., ve Erdem R., (2011), “Sağlık Hizmetleri Finansmanında Kullanıcı Katkıları: Genel Bir Bakış ve Türkiye İçin Durum Değerlendirmesi”, Amme İdaresi Dergisi, 44(2): 71-98.
• Yıldırım, H.H., (2016), Sağlık ve Siyaset Yazıları, Birinci Baskı, Ankara: ABSAM.224 Sayılı Sağlık Hizmetlerinin Sosyalleştirilmesi Kanunu, http://www.ttb.org.tr/index.php/TTB/224-sayili-kanun-54.html,