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

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