Journal of Medical Systems

, Volume 34, Issue 3, pp 387–396 | Cite as

Predictors of Informal Health Payments: The Example from Turkey

  • Hacer ÖzgenEmail author
  • Bayram Şahin
  • Paolo Belli
  • Mehtap Tatar
  • Peter Berman
Original Paper


Little is known about the factors that can affect informal health payments in Turkey, which is pertinent given that Turkey has been undergoing and considering a series of reforms in the health sector. This paper aims to examine the predictors of informal payments in Turkey. The study surveyed a random sample of 3,727 people in a medium-sized city, of whom 706 received medical care for illness and/or non-illness related reasons, using a Turkey-specific version of a model questionnaire focused exclusively on informal out-of-pocket payments. Using multivariable logistic model, household health expenditure, health insurance, service type and provider ownership were found to be statistically significant predictors of informal payment. The findings suggest the supply side factors as the main drivers of informal payments and thus a need for radical changes in the supply side as well as actions to rebuild lost confidence in the health care system of Turkey.


Informal payment Turkey Out-of-pocket payment Health policy 



This study was supported by Merck, Sharp and Dohme Turkey and Merck Foundation, through grants to Harvard School of Public Health and Hacettepe University School of Health Administration.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Hacer Özgen
    • 1
    Email author
  • Bayram Şahin
    • 1
  • Paolo Belli
    • 2
  • Mehtap Tatar
    • 1
  • Peter Berman
    • 3
  1. 1.Department of Health Care ManagementHacettepe UniversityAnkaraTurkey
  2. 2.World BankWashingtonUSA
  3. 3.World BankNew DelhiIndia

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