Examining the Economic Burden of Out-of-Pocket Health Expenditures for Households in Different Socio-Economic Groups in Turkey

Yıl 2020, Cilt: 28 Sayı: 46, 25 - 49, 31.10.2020

Gökçe Manavgat , Fatih Saygılı , Martine Audıbert

https://doi.org/10.17233/sosyoekonomi.2020.04.02

Cited By: 5

Öz

In this study, the varying nature of catastrophic threshold for out-of-pocket health expenditures of Turkish households has been investigated by the help of Household Budget Surveys compiled by TurkStat (2002-2016). Two methods have been used in the calculation of catastrophic health expenditures: (i) The fixed (same) catastrophic thresholds and (ii) variable thresholds based on different socio-economic groups (quintile) have been calculated and compared. Also, catastrophic health expenditures risk factors have been analysed by using binary logistic regression models. Unlike previous studies, poor households have been found more likely to experience catastrophic health expenditure in Turkey. Thus, the result indicates that analyses using the same threshold level for all socio-economic groups of a society might lead policymakers to misleading conclusions.

Anahtar Kelimeler

Catastrophic Health Expenditure, Health Financing, Out-Of-Pocket Health Expenditure, Health Policy, Financial Burden, Turkey

Türkiye’de Farklı Ekonomik Gruptaki Hanehalkları için Cepten Yapılan Sağlık Harcamalarının Ekonomik Yükünün İncelenmesi

Öz

Bu çalışmada, TÜİK tarafından derlenen Hanehalkı Bütçe Anketleri (2002-2016) kullanılarak, Türkiye’de hanehalklarının cepten yapmış oldukları sağlık harcamalarının katastrofik düzeyi araştırılmıştır. Katastrofik sağlık harcamalarının hesaplanmasında iki yöntem kullanılmıştır. Geleneksel sabit katastrofik eşik değerleri ve daha önce Türkiye için uygulanmamış farklı sosyo ekonomik gruplar için değişim gösteren değişken eşik değerleri yaklaşımları kullanılarak analizler yapılmış ve sonuçlar karşılatılırmıştır. Ayrıca, katastrofik sağlık harcamalarında olası risk faktörleri lojistik regresyon modelleri kullanılarak analiz edilmiştir. Türkiye için yapılan önceki araştırmaların aksine, bu çalışmada yoksul hanehalkları arasında katastrofik sağlık harcamalarına maruz kalma olasılığı daha yüksek olduğu belirlenmiştir. Bu sonuç, her bir farklı ekonomik grupta yer alan hanehalkları arasında aynı eşik değeri seçilerek yapılan analizlerin, harcama eşiği sonrası aynı oranda harcama yapma eğilimine sahip olacağı mantığının yanıltıcı olabileceğini dikkate almak gerektiğini ortaya koymaktadır.

Anahtar Kelimeler

Katastrofik Sağlık Harcaması, Sağlık Finansmanı, Cepten Sağlık Harcaması, Sağlık Politikası, Finansal Yük, Türkiye

Kaynakça

• Adisa, O. (2015), “Investigating Determinants of Catastrophic Health Spending Among Poorly Insured Elderly Households in Urban Nigeria”, International Journal for Equity in Health, 14(1), 79.
• Aran, M.A. & J.S. Hentschel (2012), “Protection in Good and Bad Times? The Turkish Green Card Health Program”, Policy Research Working Paper 6178, The World Bank, <http://documents.worldbank.org/curated/en/258701468172771874/pdf/wps6178.pdf>, 25.09.2017.
• Arsenijevic, J. & M. Pavlova & M. Groot (2013), “Measuring the catastrophic and impoverishing effect of household health care spending in Serbia”, Social Science and Medicine, (78), 17-25.
• Atun, R. & S. Aydın & S. Chakraborty & S. Sumer & M. Aran & I. Gurol & S. Nazlıoğlu & S. Ozgulcu & U. Aydoğan & B. Ayar & U. Dilmen & R. Akdağ (2013), “Universal Health Coverage in Turkey: Enhancement of Equity”, The Lancet, <https://doi.org/10.1016/S0140-6736(13)61051-X>, 25.09.2017.
• Aykaç, G. (2018), “Engel Yasası’nın Türkiye Sınaması ve Gıda Talebinin Gelir Esnekliği: Gıda Harcamalarının Bütçe Payının Hane Profili ve Toplam Harcama ile İlişkisi (2003-2013)”, Sosyoekonomi, 26(38), 105-133.
• Berki, S.E. (1986), “A Look at Catastrophic Medical Expenses and The Poor”, Health Affairs, 5(4), 139-145.
• 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.
• Ekman, B. (2004), “Community-Based Health Insurance in Low-Income Countries: A Systematic Review of The Evidence”, Health Policy Plan, 19(5), 249-70.
• Erus, B. & N. Aktakke (2012), “The Impact of Healthcare Reforms on Out-Of-Pocket Health Expenditures in Turkey For Public Insurance”, European Journal of Health Economics, 13(3), 337-346.
• Gotsadze, G. & A. Zoidze & N. Rukhadze (2009), “Household Catastrophic Health Expenditure: Evidence from Georgia And Its Policy Implications”, BMC Health Services Research, 9(69), 1-9.
• Goudge, J. & S. Russell & L. Gilson & C. Molyneux & K. Hanson (2009), “Household Experiences of Ill-Health and Risk Protection Mechanisms”, Journal of International Development, 21, 159-168.
• Kim, Y. & B. Yang (2011), “Relationship between Catastrophic Health Expenditures and Household Incomes and Expenditure Patterns in South Korea”, Health Policy, (100), 239-246.
• Lee, J.E. & H.I. Shin & Y.K. Do & E.J. Yang (2016), “Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel”, Journal of Korean Medical Science, 31(3), 336-344.
• Minh, H.V. & N.T.K. Phuong & P. Saksena & D.C. James & K. Xu (2013), “Financial Burden of Household Out-Of Pocket Health Expenditure in Vietnam: Findings from the National Living Standard Survey 2002-2010”, Social Science and Medicine, (96), 258-263.
• Ministry of Health (2015), Annual Health Statistics, <http://www.saglikistatistikleri.gov.tr/dosyalar/SIY_2015.pdf>, 27.09.2018.
• Onoka, A.C. & O.E. Onwujekwe & K. Hanson & B.S. Uzochukwu (2011), “Examining Catastrophic Health Expenditures at Variable Thresholds Using Household Consumption Expenditure Diaries”, Tropical Medicine and International Health, 16(10), 1334-1341.
• Ozgen, N.H. & İ. Sahin & H.H. Yıldırım (2015), “Financial Catastrophe and Poverty Impacts of Out-of-Pocket Health Payments in Turkey”, European Journal of Health Economics, 16(3), 255-270.
• Ruger, R. & 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.
• Somkotra, T. & L.P. Lagrada (2009), “Which Households Are at Risk of Catastrophic Health Spending: Experience in Thailand After Universal Coverage?”, Health Affairs, 28(3), 467-478.
• Su, T. & B. Kouyaté & S. Flessa (2006), “Catastrophic Household Expenditure for Health Care in A Low -Income Society: A Study from Nouna District Burkina Faso”, Bulletin of the World Health Organization, 84(1), 21-27.
• Sulku, S.N. & D. Bernard (2012), “Financial Burden of Health Care Expenditures: Turkey”, Iranian Journal of Public Health, 41(3), 48-64.
• Tokatlıoğlı, İ. & Y. Tokatlıoğlu (2014), “Türkiye’de 2002-2011 Yılları Arasında Katastrofik Sağlık Harcamalarının Yoksulluk Yaratma Kapasitesi”, Ekonomik Yaklaşım, 24(87), 1-36.
• Tokatlıoğlı, Y. & İ. Tokatlıoğlu (2018), “Türkiye’de Katastrofik Sağlık Harcamaları ve Bu Harcamaları Belirleyen Faktörler: 2002-2014 Dönemi”, Sosyoekonomi, 26(35), 59-78.
• TurkStat Turkish Statistical Institute (2002-2014), Household Budget Survey Micro Data Set, <http://www.tuik.gov.tr/Kitap.do?metod=KitapDetay&KT_ID=7&KITAP_ID=312>, 23.09.2018.
• TurkStat Turkish Statistical Institute (2003), Based Consumer Price Index Numbers, <http://www.turkstat.gov.tr/UstMenu.do?metod=temelist>, 22.08.2018.
• TurkStat Turkish Statistical Institute (2013), Population Projections 2013-2075, <http://www.turkstat.gov.tr/PreHaberBultenleri.do?id=15844>, 23.09.2018.
• TurkStat Turkish Statistical Institute (2016), Health Expenditure Statistics, <http://www.tuik.gov.tr/PreTablo.do?alt_id=1084>, 23.09.2018.
• van Doorslaer, E. & O. O’Donnell & R.P. Rannan-Eliya & P. Somanathan & S.H. Adhikari & B. Akkazieva & D. Harbianto & C.G. Garg & P. Hanvoravongchai & A.N. Herrin & M.N. Huq & S. Ibragimova & A. Karan & T.J. Lee & G.M. Leung & J.R. Lu & C.W. Ng & B.R. Pande & R. Racelis & S. Tao & K. Tin & L. Trisnantoro & C. Vasavid & B.M. Yang & Y. Zhao (2007), “Catastrophic Payments For Health Care in Asia”, Health Economics, 16(11), 1159-84.
• Wagstaff, A. & E. van Doorslaer, (2003), “Catastrophe and Impoverishment in Paying for Health Care: With Applications to Vietnam 1993-98”, Health Economics, 12(11), 921-34.
• Wagstaff, A. & M. Lindelow (2008), “Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China”, Journal of Health Economics, 27, 990-1005.
• WHO World Health Organization (2000), World Health Report 2000, Health Systems: Improving Performance?, Geneva, <http://www.who.int/whr/2000/en/whr00_en.pdf?ua=1>, 15.09.2017.
• WHO World Health Organization (2005), “Social Health Insurance: Sustainable Health Financing, Universal Coverage and Social Health Insurance”, Report by the Secretariat, A58/20, Provisional agenda item 13-16, <http://apps.who.int/iris/bitstream/10665/20302/1/A58_20-en.pdf?ua=1>, 27.09.2017.
• World Bank (2016), Out-of-Pocket Expenditure (% of current health expenditure) Statistics, <https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS>, 27.01.2020.
• WVS World Values Survey Wave- 6 (2010-2014), State of health Stat., <http://www.worldvaluessurvey.org/WVSOnline.jsp>, 27.09.2018.
• Xu, K. & D.B. Evans & K. Kawabata & R. Zeramdini & J. Klavus & C.J. Murray (2003), “Catastrophic Health Expenditure: A Multicounty Analysis”, The Lancet, 362(9378), 111-117.
• Xu, K. & D.B. Evans & P. Kadama (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. (2005), “Distribution of Health Payments and Catastrophic Expenditures Methodology”, World Health Organization, Department of Health System Financing, Discussion Paper: Number 2, Geneva, <http://www.who.int/health_financing/documents/dp_e_05_2distribution_of_health_payments.pdf>, 27.09.2018.
• Yardım, M.S. & N. Cilingiroglu & N. Yardim (2010), “Catastrophic Health Expenditure and Impoverishment in Turkey”, Health Policy, 94(1), 26-33.
• Yardım, M.S. & N. Cilingiroglu & N. Yardim (2014), “Financial protection in health in Turkey: the effects of the Health Transformation Programme”, Health Policy and Planning, 29(2), 177-192.
• Yereli, A.B. & A.M. Köktaş & I.S. Selçuk, (2014), “Türkiye’de Katastrofik Sağlık Harcamalarını Etkileyen Faktörler”, Sosyoekonomi, 22(22), 274-296.