Interrelationships between sociodemographic characteristics, poverty and out of pocket health expenditures in Turkey

Health expenditures have had a rapidly increasing trend around the world due to technological advancements in the health sector, population growth, changes in sociodemographic characteristics, higher quality and more accessible health care service expectations etc. Managing the increasing health expenditures by means of health financing methods has been an essential part of health policies in the last two centuries. Out-of-pocket (OOP) health expenditure has been among one of the most common health financing methods across the world. Even though, its scope within the health financing systems varies according to economic, social and developmental outlook of countries, OOP health expenditures have a wide variety of social and economic consequences. Catastrophic health expenditures and impoverishment are the most important ones. This study is looking for answers for the research questions stated as i) "How sociodemographic characteristics of individuals and households affect OOP health expenditures and catastrophic health expenditures in Turkey?" and ii) "Do OOP health expenditures cause impoverishment of individuals and households in Turkey?" Within the context of statistical analyses and calculations, Household Budget Surveys data is used conducted by Turkish Statistical Institute between 2004 and 2017 to observe a long period including the health transformation process of Turkey. The method of World Health Organization is applied for determining households that experienced catastrophic health expenditures for predetermined four thresholds and impoverishment. According to the results of the logistic regression analysis of OOP health expenditures, almost all independent variables included in the model have a statistically significant effect on households' OOP health expenditures. Although from 2004 to 2012 a notable decline trend was observed in catastrophic health expenditures, as of 2012, the rate has ever-growing trend in every threshold. When impoverished households due to OOP health expenditures are examined, it is seen that health insurance status, education, household type, having pre-school age or elderly or disabled member are prominent features. In conclusion, households with low social and economic opportunities cannot benefit from health care services adequately or become poor when they access to them. Key words: OOP health expenditure, catastrophic health expenditure, impoverishment, health insurance, health care service