The financial burden of out-of-pocket healthcare expenditures and their impacts on different expenditure groups in Turkey

In Turkey, regulations about the improvement and the dissemination of health services have begun to constitute a major debate issue in the area of social and economic policy in recent years. In this context, the most comprehensive reform process for health has come to the fore with the "Health Transformation Program" (HTP) which put into practice in 2003 and health policies have entered a dynamic process. With HTP, it is aimed to expand the general health insurance coverage and to protect poor from the financial burden by including them in the insurance system. However, it has become widespread to encourage the purchase of services from private health institutions through contracts, so called passive privatization. Furthermore, in recent years as in other countries payments or contributions in Turkey began to be used in the provision of health services in order to obtain additional income for health services, to prevent unnecessary demand and thus to limit public health expenditures. While improvements in health care provisions are targeted, the question of how prosperity is distributed among different economic groups that benefit from these improvements has become an important issue in terms of health financing and equality. The purpose of this study with this respect is to investigate the financial effect of out- of -pocket health expenditures by households within SDP term by using TURKSTAT Household Budget Survey (HBS) 2002-2016 micro data. When analyzing the financial effect of out-of-pocket expenditures the study focused on the level of "catastrophic expenditure" that used in the health economics literature and catastrophic threshold values have been determined for different socioeconomic groups in addition to capacity to pay approach. Thus, unlike previous studies; more detailed analyses were done for different socioeconomic groups (between poor and rich). In this study, possible risk factors for the financial burden of out-of-pocket health expenditures examined by using Heckman selection model, which also takes into consideration the selection bias. In general, according to the results of the analysis, the catastrophic burden of out-of-pocket health expenditures decreased moderately, but the risks of the poor groups are still high and financial burden of expenditures is increasing among hospitals services utilizer.