The Effects of Policy Reforms on Out-of-Pocket Health Expenditures: Evidence from Turkey - Economic Research Forum (ERF)

• Out-of-pocket payments on health care constitute a substantial portion of the household expenditure in many developing countries. These payments become catastrophic when a household is not able to pay and has to reduce other spending, including food, clothing and education, to compensate for the health expenditures.
• The principal objective of any health system should be the financial protection of the population. Commonly used indicators for financial protection are the out-of-pocket expenses as a share of total health expenditure and the amount of households driven into poverty by catastrophic health expenditures.
• In 2001 Turkey was facing large challenges in the health sector, where the infant and maternal rates were significantly higher than the average Organisation for Economic Co-operation and Development (OECD) countries’ rates.
• There were large differences in the rural and urban areas and large disparities between the poorest and richest groups in terms of health care services and out-of-pocket expenditures. The resources of health care were not efficiently managed and the distribution and access was not equal everywhere, resulting to increases of out-of-pocket expenditures.
• In 2003 the Health Transformation Program has been launched with commitment to health reform targeting a people centered vision. The main objective of this program was the efficient and productive organisation of the resources in the health care system.
• In 2008 the Universal Health Insurance has been established aiming at the reduction of out-of-pocket payments. Within the same system, the Green Card Holders enjoy the same benefits with the enrolees in the other health insurance schemes. The Green Card, program is a non-contributory health insurance scheme for the poor.
• Under the Universal Health Insurance the out-of-pocket and catastrophic health expenditures for the poor who are enrolled in the Green Card program have been significantly reduced.
• The improvements that gradually took place in the health care service delivery within a comprehensive reform of the health sector and the health care coverage of the poor through the Green Card program makes Turkey a unique example of universal coverage for quality health services.

Eleftherios Giovanis

Oznur Ozdamar



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