Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees

Eur J Health Econ. 2012 Jun;13(3):337-46. doi: 10.1007/s10198-011-0306-2. Epub 2011 Mar 19.


The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Health Care Reform / economics*
  • Health Care Reform / statistics & numerical data
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data*
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data
  • Health Status Disparities
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Male
  • Multivariate Analysis
  • Residence Characteristics / statistics & numerical data
  • Single-Payer System / economics*
  • Single-Payer System / statistics & numerical data
  • Socioeconomic Factors
  • Turkey