Sağlık Hizmetleri Finansmanında Eşitsizlik ve Hakkaniyet İle Katastrofik Sağlık Harcamaları Arasındaki İlişki

Abstract

The increase in the level of out-of-pocket (OOP) spending on health is creating a serious burden for households in financial difficulties and damages principles of equality and equity. It is necessary to examine health financing system (HFS) reforms in terms of equality and equity from a broader perspective in Turkey which is a country experiencing structural reform applications for more than a decade. For this necassity, in this study it is aimed to investigate households’ contributions to the HFS by OOP health expenditures for the years 2003-2015, in terms of equality and equity and catastrophic and impoverishment effect in a holistic perspective. For this aim households’ financial contributions to the HFS by OOP health expenditures examined by using TUIK Household Budget Survey data for the years 2003-2015. Standart Deviation, FFCI, Entropy, Atkinson, Gini, Concentration, Kakwani and Suits indexes are calculated and departure of Concentration Curve from Lorenz Curve examined. Catastrophic and impoverishment effects of OOP health expenditures determined by using Xu (2005) methodology. Study results revealed that there are strong relationships between inequality and equity (rs=-0.83, p<0.01), catastrophic and impoverishment effect (rs=0.81, p<0.01), inequality and catastrophic effect (rs=0.78, p<0.01), inequality and impoverishment effect (rs=0.69, p<0.01), equity and catastrophic effect (rs=-0.86, p<0.01) and equity and impoverishment effect (rs=-0.81, p<0.01). Study results highlights that inequalities, catastrophic and impoverishment effects are decreasing in terms of households OOP health expenditures in Turkey, OOP health expenditures are a progressive financial source and there is an increasing deterioration in progressive pattern. As a result, it is seen that, despite policies to ensure an inclusive HFS in Turkey make important contributions to the balanced risk sharing of financial burden, new reforms are needed to protect financially disadvantageous populations. It is hoped that study results will be a useful source to improve awareness of decision and policy makers for better design of HFS in Turkey.