DARU Journal of Pharmaceutical Sciences

, Volume 27, Issue 2, pp 735–742 | Cite as

Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey

  • Selcen ÖztürkEmail author
  • Dilek Başar
  • İlhan Can Özen
  • Arbay Özden Çiftçi
Research article



Demographic and socio-economic factors determine pharmaceutical health care utilization for individuals. Prescription and non-prescription medicine use are expected to have different determinants. Even though prescription and non-prescription medicine use is being well researched for developed countries, there are only a few studies for developing countries.


This paper aims to analyze the socio-economic and individual characteristics that determine the use of prescription and non-prescription medicine. We examine the issue for the specific case of Turkey since Turkey’s health system has undertaken significant changes in the last two decades and especially after 2003 with the “Health Transformation Programme”.


Data from the nationally representative “Health Survey” are used in the analysis. The data set covers the 2008–2016 period with two-year intervals. Pooled multivariate logistic regression is employed to identify the underlying determinants of prescription and non-prescription medicine use.


When compared to 2008, non-prescription medicine use decreases until 2012, however, an increasing trend appears after 2012. For prescription medicine use, a decreasing trend emerges after 2012. Findings from the marginal effects indicate that for non-prescription medicine use, the highest effect stems from the health status. For prescription medicine use, the highest marginal effects arise from age, health and employment status indicating the importance of the need and predisposing factors.


Decreasing non-prescription medicine use largely depends on easier access to health care service utilization. Although having a health insurance has a positive relationship with prescription medicine use, there is still a problem for individuals living a rural area and heaving a lower income level since they are more likely to use non-prescription medicine.


Prescription medicine Non-prescription medicine Self-medication Socio-economic determinants Turkey 


Author contributions

SÖ and DB are responsible for study design. SÖ performed the data analysis. SÖ, DB, İCÖ and AÖÇ all contributed to writing and correcting the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Not applicable. The data that support the findings of this study are available from Turkish Statistical Institute but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

Consent for publication

All authors give consent for publication.


  1. 1.
    Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973:95–124.PubMedCrossRefGoogle Scholar
  2. 2.
    Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Daban F, Pasarín MI, Rodríguez-Sanz M, García-Altés A, Villalbí JR, Zara C, et al. Social determinants of prescribed and non-prescribed medicine use. Int J Equity Health. 2010;9(1):12.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Dengler R, Roberts H. Adolescents' use of prescribed drugs and over-the-counter preparations. J Public Health. 1996;18(4):437–42.CrossRefGoogle Scholar
  5. 5.
    Simoni-Wastila L. The use of abusable prescription drugs: the role of gender. J Wom Health Gend Base Med. 2000;9(3):289–97.CrossRefGoogle Scholar
  6. 6.
    Johnson RE, Pope CR. Health status and social factors in nonprescribed drug use. Med Care. 1983:225–33.PubMedCrossRefGoogle Scholar
  7. 7.
    OECD, OECD.Stat (database). 2019. Accessed 10 August 2019.
  8. 8.
    IEIS. Turkish Pharmaceutical Market. 2018. Accessed 15 August 2019.
  9. 9.
    Daştan, İ., Çetinkaya, V. OECD Ülkeleri ve Türkiye’nin Sağlık Sistemleri, Sağlık Harcamaları ve Sağlık Göstergeleri Karşılaştırması. [Comparing Health Systems, Health Expenditures and Health Indicators in OECD Countries and Turkey] Sosyal Güvenlik Dergisi. 2015; 5(1): 104–134. Turkish.Google Scholar
  10. 10.
    OECD. OECD Health Data 2016: Comparative analysis of 30 countries. (Version: 15.06.2017). 2016; OECD, Paris.Google Scholar
  11. 11.
    Hone T, Gurol-Urganci I, Millett C, Başara B, Akdağ R, Atun R. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction. Health Policy Plan. 2017;32(1):57–67.PubMedCrossRefGoogle Scholar
  12. 12.
    Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, et al. Universal health coverage in Turkey: enhancement of equity. Lancet. 2013;382(9886):65–99.PubMedCrossRefGoogle Scholar
  13. 13.
    Stokes J, Gurol–Urganci I, Hone T, et al. Effect of health system reforms in Turkey on user satisfaction. J Glob Health. 2015;5(2):1–10.Google Scholar
  14. 14.
    Republic of Turkey, Social Security Institution. Social Security System. (Accessed: 15.03.2019).
  15. 15.
    Kartal N, Arısoy S. OTC Grubundaki ilaçların avantaj ve dezavantajlarının incelenmesi. [Examining the advantages and disadvantages of OTC drugs]. Health Care. 2017;4(4):314–21 Turkish.Google Scholar
  16. 16.
    Sağır M, Parlakpınar H. Akılcı İlaç Kullanımı. [Rational Drug Use]. Inonu University Journal of Health Sciences. 2014;3(2):32–5 Turkish.Google Scholar
  17. 17.
    Ilhan MN, Durukan E, Ilhan SÖ, Aksakal FN, Ozkan S, Bumin MA. Self-medication with antibiotics: questionnaire survey among primary care center attendants. Pharmacoepidemiol Drug Saf. 2009;18(12):1150–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Tobi H, Meijer WM, de Jong-van den Berg LTW, Tuinstra J. (2003). Socio-economic differences in prescription and OTC drug use in Dutch adolescents. Pharm World Sci. 2003;25(5):203–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Nielsen MW, Hansen EH, Rasmussen NK. Prescription and non-prescription medicine use in Denmark: association with socio-economic position. Eur J Clin Pharmacol. 2003:677–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Nordin M, Dackehag M, Gerdtham UG. Socioeconomic inequalities in drug utilization for Sweden: evidence form linked survey and register data. Soc Sci Med. 2013;77:106–17.PubMedCrossRefGoogle Scholar
  21. 21.
    Pappa E, Kontodimopoulos N, Papadopoulos AA, Tountas Y, Niakas D. Prescribed-drug utilization and polypharmacy in a general population in Greece: association with sociodemographic, health needs, health-services utilization, and lifestyle factors. Eur J Clin Pharmacol. 2011;67(2):185–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Grigoryan L, Burgerhof JG, Degener JE, et al. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study. Pharmacoepidem Drug Saf. 2007;16(11):1234–43.CrossRefGoogle Scholar
  23. 23.
    Du Y, Knopf H. Self-medication among children and adolescents in Germany: results of the National Health Survey for children and adolescents (KiGGS). Br J Clin Pharmacol. 2009;68(4):599–608.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Qato DM, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. Jama. 2008;300(24):2867–78.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Kantor ED, et al. Trends in prescription drug use among adults in the United States from 1999-2012. Jama. 2015;314(17):1818–30.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Andersen RM. A behavioural model of families’ use of health services. Chicago: University of Chicago; 1968.Google Scholar
  27. 27.
    Andersen RM. Revisiting the behavioural model and access to medical care: does it matter? J Health Soc Behav. 1995:1–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Al-Windi A. Determinants of medicine use in a Swedish primary health care population. Pharmacoepidemiol Drug Saf. 2005;14(1):47–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Makhlouf CO, Schulein M, Kasparian C, Ammar W. Medication use, gender, and socio-economic status in Lebanon: analysis of a national survey. J Med Liban. 2002;5–6(50):216–25.Google Scholar
  30. 30.
    Paulose-Ram R, Jonas BS, Orwig D, Safran MA. Prescription psychotropic medication use among the US adult population: results from the third National Health and Nutrition Examination Survey, 1988–1994. J Clin Epidemiol. 2004;3(57):309–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Mayer S, Österle A. Socioeconomic determinants of prescribed and non-prescribed medicine consumption in Austria. Eur J Pub Health. 2014;25(4):597–603.CrossRefGoogle Scholar
  32. 32.
    Vogler S, Österle A, Mayer S. Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries. Int J Equity Health. 2015;14(1):124.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Kickbusch IS. Health literacy: addressing the health and education divide. Health Prom Int. 2001;16(3):289–97.CrossRefGoogle Scholar
  34. 34.
    Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Prom Int. 2000;15(3):259–67.CrossRefGoogle Scholar
  35. 35.
    Bertakis, K. D., Azari, R., Helms, L. J. et al. Gender differences in the utilization of health care services. J Fam Pract. 2000; 49(2):147–152.Google Scholar
  36. 36.
    Gomberg ESL. Historical and political perspective: women and drug use. J Soc Issues. 1982;38(2):9–23.CrossRefGoogle Scholar
  37. 37.
    Stoehr G. P., et al. over-the-counter medication use in an older rural community: the Mo VIES project. J Am Geriatr Soc. 1997;45(2):158–65.PubMedCrossRefGoogle Scholar
  38. 38.
    Zhang F, Mamtani R, Scott FI, et al. Increasing use of prescription drugs in the United Kingdom. Pharmacoepidem Drug Saf. 2016;25(6):628–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Economics, Faculty of Administrative Sciences, Health Economics and Health Policy Research and Application CenterHacettepe UniversityAnkaraTurkey
  2. 2.Department of Economics, Faculty of Administrative SciencesMiddle East Technical UniversityAnkaraTurkey
  3. 3.Department of Pediatric Surgery, Faculty of Medicine, Health Economics and Health Policy Research and Application CenterHacettepe UniversityAnkaraTurkey

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