Who Pays More: Public, Private, Both or None? The Effects of Health Insurance Schemes and Health Reforms on Out-of-Pocket and Catastrophic Health Expenditures in Turkey

29 Pages Posted: 28 May 2016 Last revised: 4 Nov 2016

See all articles by Eleftherios Giovanis

Eleftherios Giovanis

Manchester Metropolitan University-Business School, Department of Economics, Policy and International Business; Aydin Adnan Menderes University, Nazilli Faculty of Economics and Administrative Sciences

Oznur Ozdamar

Aydın Adnan Menderes University

Date Written: February 1, 2016

Abstract

This study explores the determinants and characteristics of the out-of-pocket to capacity to pay and catastrophic health expenditures in Turkey using a detailed micro-level survey, the Household Budget Survey during the period 2002-2011. The results show that those who have public health insurance are less likely to face out-of-pocket to capacity to pay and catastrophic health expenditures, than those with private or without health insurance. In addition, the study explores the expansion of the health reform of 2003, where in 2008 the Green Card (Yeşil Kart) holders are entitled, without fee, to the same services as those with public health insurance such as Emekli Sandığı, BAĞ-KUR, SSK. The analysis employs a differences-in-differences approach using a pseudo-panel based on propensity score matching. The results support that the difference of pocket health expenditures between the public health insurers and green card holders has been reduced. Furthermore, those who are located in rural areas are compared with those residing in urban areas, as the health reform in 2008 included expansion and improvement on the emergency services and infrastructure in rural areas.

Keywords: Catastrophic Health Expenditures, Differences-in-Differences, Health Insurance Schemes, Health Reforms, Out-of-Pocket Expenditures, Propensity Score Matching, Pseudo-Panel, Turkey

JEL Classification: I13, I14

Suggested Citation

Giovanis, Eleftherios and Ozdamar, Oznur, Who Pays More: Public, Private, Both or None? The Effects of Health Insurance Schemes and Health Reforms on Out-of-Pocket and Catastrophic Health Expenditures in Turkey (February 1, 2016). Available at SSRN: https://ssrn.com/abstract=2784936 or http://dx.doi.org/10.2139/ssrn.2784936

Eleftherios Giovanis (Contact Author)

Manchester Metropolitan University-Business School, Department of Economics, Policy and International Business ( email )

Business School
All Saints Campus
Manchester, M15 6BH
United Kingdom

Aydin Adnan Menderes University, Nazilli Faculty of Economics and Administrative Sciences ( email )

Nazilli IIBF
Sumer Kampusu
Aydin, Nazilli 09800
Turkey

Oznur Ozdamar

Aydın Adnan Menderes University ( email )

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