Sulku S Nur, Bernard D Minbay
Dept. of Econometrics, Economics and Management Sciences Faculty, Gazi University, Ankara, Turkey.
Iran J Public Health. 2012;41(3):48-64. Epub 2012 Mar 31.
In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to "The Health Transformation Programme". Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection.
在本研究中，我们考察了土耳其的医疗保险体系在《健康转型计划》实施之前的时期，是否以及在何种程度上为抵御高额自付费用提供了充分保障。此外，我们还考察了自付费用按人口特征、贫困状况、医疗服务类型、医疗保健可及性和自我报告的健康状况的分布情况。我们利用2002/03年全国家庭医疗支出调查数据来分析医疗保健支出的经济负担。按照文献，我们将高负担定义为超过收入10%和20%的费用。我们发现，19%的非老年人口生活在家庭医疗支出超过家庭收入10%的家庭中，14%的非老年人口生活在家庭医疗支出超过家庭收入20%的家庭中。此外，贫困人口和生活在经济欠发达地区的人口面临高额自付负担的风险最大。由于改革前提供医疗保险的五个不同公共计划的福利存在差异，参保人群中高经济负担的风险因保险类型而异。我们的结果对于负担衡量的三种替代设定以及将老年人纳入样本总体都是稳健的。我们发现，在改革之前，对于高额医疗支出没有充分的保障。我们的研究提供了一个基线，政策制定者可以据此衡量医疗改革在提供经济保障方面的成效。
