The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey

Yıl 2017, Cilt: 17 Sayı: 36, 71 - 102, 20.11.2017

Eleftherios Gıovanıs , Öznur Özdamar

https://doi.org/10.25294/auiibfd.357616

Cited By: 2

Öz

The Turkish health care system has been subject to significant and
critical changes and reforms since 2003. One of the most important reforms
has been implemented in 2008 where the Green Card holders are entitled to the same
services, without any fee, as those with public health insurance, such as
the Emekli Sandığı, BAĞKUR, SSK. This study initially examines
the characteristics of health insurance schemes, determinants of holding one of
the health insurance schemes (public, private, green card, no-insurance) in
Turkey. It further analyses the effect of 2008 reform on out of pocket
expenditures (OOPEs). The study will be the first in the related literature
analysing the effect of this reform especially on the OOPEs of green card
holders. The analysis relies on a detailed micro-data level survey, TUİK
Household Budget Survey, over the period 2002-2011 and employs a
difference-in-difference approach using a pseudo-panel based on propensity
score matching. Initial results show that individuals who have public insurance
are less inclined to face out-of-pocket health expenditures compared to those
without health insurance and the Green Card holders. However, the difference of the OOPEs
between the public health insurees and green card holders is reduced after the
implementation of the 2008 reform.

Anahtar Kelimeler

Difference-in-Difference Approach, Health Insurance Schemes, Health Reforms, Out-of-Pocket Expenditures, Propensity Score Matching Method, Pseudo-Panel Data, Turkey

Türkiye’de 2008 Yılı Sağlık Reformunun Cepten Yapılan Sağlık Harcamaları Üzerindeki Etkisi

Öz

Türkiye
sağlık sisteminde 2003 yılından bu yana önemli değişiklikler yaşanmış ve
anlamlı reformlar yapılmıştır. Bunların en önemlilerinden biri hiçbir ek ödeme
talep edilmeksizin yeşil kartlıların Emekli Sandığı, BAĞ-KUR, SSK gibi diğer
kamusal sağlık sigortası yararlanıcıları ile aynı hizmetlerden yararlanmaya
başladığı 2008 reformudur. Bu çalışma öncelikle Türkiye’deki sağlık sigortası
planlarının özelliklerini, kamusal sigorta, özel sigorta ve yeşil kart
sahipliği ile sigortasız olmanın bireyler açısından belirleyicilerini
incelemektedir. Bunların yanı sıra 2008 reformunun cepten sağlık harcamaları
üzerindeki etkisi analiz edilmiştir. Reformun özellikle yeşil kartlıların
cepten sağlık harcamaları üzerindeki etkisinin analizi ilgili literatürde ilk
defa bu çalışma ile yer bulacaktır. İlgili analizlerde 2002-2011 dönemini
kapsayan TÜİK Hanehalkı Bütçe Anketi Mikro Veri Seti kullanılmış ve eğilim
skoru eşleştirme yöntemiyle oluşturulan sözde panel verilere farkın farkı
yöntemi uygulanmıştır. İlk bulgular, kamusal sağlık sigortası sahiplerinin
yeşli kart sahipleri yada sigortasızlara oranla cepten daha az sağlık harcaması
yaptıklarını göstermiştir. Bunun yanısıra 2008 reformu ile birlikte kamusal
sigorta sahipleri ile yeşil kartlılar arasında cepten harcama farkının azaldığı
tespit edilmiştir.

Anahtar Kelimeler

Farkın Farkı Yaklaşımı, Sağlık Sigortası Planları, Sağlık Reformları, Cepten Sağlık Harcamaları, Eğilim Skoru Eşleştirme Yöntemi, Sözde Panel Veri, Türkiye

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