Out of Pocket Payments for Healthcare in Turkey and Equity in Financing, 2003-2006

Background: The Turkish health care system, like other countries, has been subject to efficient and equity oriented reforms during the last six years, which in turn is expected to change the composition of financing, as one of the objectives is to ensure financial protection. Objective: This study’s aim is to examine the equity in health care financing before and after the HTP and the financial consequences of the health care reform on the welfare of the households. Methods: To assess the impact of the reforms on health care finance, cross sectional analyses are performed on the Household Budget Survey 2003/2006, using Stata statistical software package. In order to assess the equity in health care financing, progressivity of the OOP payments is measured by Kakwani Index. In addition, catastrophic and impoverishing impacts of the OOP payments are measured as well. Results: Results show that the out-of-pocket payments are regressive in both periods. On the other hand, the incidence of catastrophic payments is low with approximately 5 percent of households spending more than 10 percent of total expenditure on health. As for the impoverishing effect, the results suggest that the OOP payments had a relatively stronger effect in 2003 on the impoverishment of households, compared to 2006. Conclusion: The results are not sufficient to criticize the policies and the results of the reform. Especially in order to analyze the impact of the reform on the financial protection of the poor, the results of the universal health insurance system that is introduced and initiated in 2008 should be evaluated.