Financial Burden of Health Care Expenses among the Nonelderly Population in Turkey: 2002-2003

Presenter: Seher Nur Sulku, Turkish Ministry of Health

Abstract

Background and objective: In 2001, Turkey has set out a plan to allign its health care system with the health regulations of the European Union and OECD countries. The “Health Transformation Programme” (HTP) was launched in 2003. Between 2003 and 2008 a series of reforms have taken place. Most importantly the Universal Health Insurance (UHI) system was implemented in October, 2008. Prior to the UHI, health insurance was provided by five separate public schemes each with its own provider network. UHI covers the whole the population and provides health services under one scheme. Providing financial protection is one of the main goals of the Turkish health care reform. However, there are no nationally representative studies of the distribution of health care expenditure burdens under the different insurance schemes for the period prior to the health care reform implemented in 2008. Our goal is to fill this gap.

In this study, we examine the risk of high financial burden due to out of pocket health spending for the non elderly population. We also estimate high burdens by insurance status, income, and other socioeconomic characteristics.

Our study provides a benchmark so that policymakers can evaluate the performance of the new system in terms of providing adequate protection against high out of pocket expenditures.

Data: We use the National Household Health and Expenditure Survey which was conducted in 2002-2003.

Methodology: Health care burdens are defined as the share of out of pocket health care expenditures within family income. Following previous literature, we define high burdens as expenses above 10 and 20 percent of family income.

Main Findings: We find that 19 percent of the nonelderly population (12.6 million individuals) were living in families spending more than 10 percent of family income on health care and that 14 percent of the nonelderly population were living in families spending more than 20 percent of family income on health care. We find that the poor and people located in economically less developed regions have the greatest risk of having high out of pocket burdens. More significantly, we find that the risk of high financial burden varied by the type of insurance among the insured due to differences in provider networks, benefit packages and differences in financing and regulations among the five separate public schemes that provided health insurance in the pre-reform period.

Conclusions: Our results indicate that prior to the HTP reforms, there was wide variation in the level of health related financial burdens among those covered by the five separate public insurance schemes. The next ‘National Household Health and Expenditure Survey’ will be conducted in 2010 by the Turkish Statisical Institute. Our study will provide the benchmark against which policymakers can measure the success of the health care reform in terms of providing financial protection.