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
- 183 Downloads
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.
KeywordsOut-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.
- 1.Turkey National Burden of Disease Study (2013). http://www.hips.hacettepe.edu.tr/UHYCSunumu_06122016.pdf. Accessed 15 June 2017
- 2.Turkey National Burden of Disease Study (2004). http://ekutuphane.tusak.gov.tr/kitaplar/turkiye_hastalik_yuku_calismasi.pdf. Accessed 10 June 2017
- 3.Ministry of Health of Turkey. Chronic Risk Factor and Disease Study (2013). http://thsk.saglik.gov.tr/Dosya/kronik_hastaliklar/tkh-final-raporu-tr.pdf. Accessed 10 June 2017
- 4.WHO (2013) Mental health financing and economics. Investing in mental health: evidence for action. http://www.who.int/mental_health/publications/financing_economics/en/. Accessed 10 June 2017
- 5.WHO. Health financing for universal coverage: financial protection. http://www.who.int/health_financing/topics/financial-protection/en/. Accessed 15 June 2017
- 6.Saxena S, Sharan P, Saraceno B (2003) Budget and financing of mental health services: baseline information on 89 countries from WHO’s project atlas. J Mental Health Policy Econ 6(3):135–143Google Scholar
- 7.OECD ilibrary. Health at a glance 2013. http://www.oecd-ilibrary.org/sites/health_glance-2013-sum-tr/index.html?itemId=/content/summary/health_glance-2013-sum-tr&mimeType=text/html. Accessed 10 June 2017
- 10.Tatar M Financing health care services: development of social health insurance in Turkey. http://www.acarindex.com/dosyalar/makale/acarindex-1423912001.pdf. Accessed 10 June 2017
- 11.Republic of Turkey. Social Security Institution. Social Security Reform. http://www.sgk.gov.tr/wps/portal/sgk/en/home-page/mainpage. Accessed 15 June 2017
- 12.Ozgen H Out-of-pocket payment in health services financing: what is it? Why is it important? http://dergipark.ulakbim.gov.tr/hacettepesid/article/view/5000046427/5000043609. Accessed 15 June 2017
- 13.Lurie IZ, Manheim LM, Dunlop DD (2009) Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions. J Mental Health Policy Econ 12(2):87–95Google Scholar
- 19.McKusick DR, Mark TL, King EC, Coffey RM, Genuardi J (2002) Trends in mental health insurance benefits and out-of-pocket spending. J Mental Health Policy Econ 5(2):71–78Google Scholar
- 21.Boratav K (2004) Class profiles in Istanbul and Anatolia, 2nd edn. İmge Publisher, AnkaraGoogle Scholar
- 22.OECD, Modified equivalence scale. http://www.oecd.org/eco/growth/OECD-Note-EquivalenceScales.pdf. Accessed 10 June 2017
- 25.Aycan S, Tuzun H. Ozkan S et al (2005) The healthcare expenditure of individuals presenting at some primary healthcare institutions in Ankara. Turk J Public Health 3(2):67–74Google Scholar
- 26.Pala K (2003) Out-of-pocket health expenditures in Gemlik. Toplum ve Hekim 18(4):279–288. http://www.belgelik.dr.tr/ToplumHekim/get.php?download_file=20030408.pdf. Accessed 15 June 2017
- 27.The Ministry of Health of Turkey. National Mental Health Policy 2006, Ankara. http://www.ihsandag.gen.tr/index_dosyalar/trnationalmentalhealthpolicy.pdf. Accessed 10 Sept 2017
- 28.Sulku SN, Bernard DM (2012) Financial burden of health care expenditures: Turkey. Iran Journal Public Health 41(3):48–64Google Scholar
- 31.Republic of Turkey. Social Security Institution. Statistical Yearbook. http://www.sgk.gov.tr/wps/portal/sgk/en/detail/statistics_new/statistical_yearbook. Accessed 20 June 2017
- 33.Republic of Turkey. Social Security Institution. Social Security System. http://www.sgk.gov.tr/wps/portal/sgk/en/detail/social_security_system Accessed 10 Nov 2017
- 34.Turkish Statistical Institute. Health Expenditure Statistics. http://www.turkstat.gov.tr/UstMenu.do?metod=kategorist. Accessed 15 June 2017
- 35.Gadit AA (2004) Out-of-Pocket expenditure for depression among patients attending private community psychiatric clinics in Pakistan. J Mental Health Policy Econ 7(1):23–28Google Scholar