Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 2, pp 151–160 | Cite as

Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey

  • Duygu IslekEmail author
  • Bulent Kilic
  • Berna Binnur Akdede
Original Paper



The aim of this study is to explore the amount of OOP health expenditures and their determinants in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders in a psychiatry outpatient clinic of Turkey.


The study group was 191 patients who attended to the Psychiatry Outpatient Clinic in June 2014. All patients were previously diagnosed with either ‘bipolar disorder’, ‘anxiety disorder’ or ‘schizophrenia and other psychotic disorders’. The dependent variable was OOP expenditures for prescription, medical tests and examinations. Independent variables were age, gender, education, occupation, existence of social and/or private health insurance, equivalent household income and the financial resources. Student’s t test, Mann–Whitney U test, ANOVA and logistic regression methods were applied with SPSS 15.0 for analysis.


OOP expenditures per admission were higher in patients with schizophrenia and other psychotic disorders ($8.4) than those with anxiety disorders ($4.8) (p = 0.02). OOP expenditures were higher in patients paying with debit ($9.8) than paying with monthly income ($6.2) (p = 0.04). OOP expenditures were higher in patients without social health insurance ($45.8) than others ($4.8) (p = 0.003). There was not a difference in OOP expenditures with respect to equivalent household income level, occupational class or education level of the patients (respectively p: 0.90, p: 0.09, p: 0.52).


Patients who were diagnosed with ‘schizophrenia and other psychotic disorders’ were disadvantaged in paying significantly higher amounts for their treatment. A substantial group of these patients compulsorily payed with debit. Considering this financial burden, diagnosis of the patient should be prioritized in health insurance coverage.


Out-of-pocket health expenditures Bipolar disorder Anxiety disorder Schizophrenia and other psychotic disorder Social insurance Social determinants 


Compliance with ethical standards

Conflict of interest

All authors declare that there are no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Public HealthDokuz Eylul University, Faculty of MedicineIzmirTurkey
  2. 2.Department of PsychiatryDokuz Eylul University, Faculty of MedicineIzmirTurkey

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