Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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):135–143

    Google 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

  8. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T (2007) Protecting households from catastrophic health spending. Health Aff 26(4):972–983. https://doi.org/10.1377/hlthaff.26.4.972

    Article  Google Scholar 

  9. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362(9378):111–117. https://doi.org/10.1016/S0140-6736(03)13861-5

    Article  PubMed  Google Scholar 

  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):87–95

    Google Scholar 

  14. Zuvekas SH, Selden TM (2010) Mental health and family out-of-pocket expenditure burdens. Med Care Res Rev MCRR 67(2):194–212. https://doi.org/10.1177/1077558709345499

    Article  PubMed  Google Scholar 

  15. Weich S, Lewis G (1998) Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain. J Epidemiol Community Health 52(1):8–14

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sareen J, Afifi TO, McMillan KA, Asmundson GJ (2011) Relationship between household income and mental disorders: findings from a population-based longitudinal study. Arch Gen Psychiatry 68(4):419–427. https://doi.org/10.1001/archgenpsychiatry.2011.15

    Article  PubMed  Google Scholar 

  17. Patel V, Kleinman A (2003) Poverty and common mental disorders in developing countries. Bull World Health Organ 81(8):609–615

    PubMed  PubMed Central  Google Scholar 

  18. Paul KI, Moser K (2009) Unemployment impairs mental health: meta-analyses. J Vocat Behav 74(3):264–282. https://doi.org/10.1016/j.jvb.2009.01.001

    Article  Google 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):71–78

    Google Scholar 

  20. Dusetzina SB, Farley JF, Weinberger M, Gaynes BN, Sleath B, Hansen RA (2012) Treatment use and costs among privately insured youths with diagnoses of bipolar disorder. Psychiatr Serv 63(10):1019–1025. https://doi.org/10.1176/appi.ps.201100516

    Article  PubMed  PubMed Central  Google Scholar 

  21. Boratav K (2004) Class profiles in Istanbul and Anatolia, 2nd edn. İmge Publisher, Ankara

    Google Scholar 

  22. OECD, Modified equivalence scale. http://www.oecd.org/eco/growth/OECD-Note-EquivalenceScales.pdf. Accessed 10 June 2017

  23. de Silva J, Hanwella R, de Silva VA (2012) Direct and indirect cost of schizophrenia in outpatients treated in a tertiary care psychiatry unit. Ceylon Med J 57(1):14–18. https://doi.org/10.4038/cmj.v57i1.4195

    Article  PubMed  Google Scholar 

  24. Lee IH, Chen PS, Yang YK, Liao YC, Lee YD, Yeh TL, Yeh LL, Cheng SH, Chu CL (2008) The functionality and economic costs of outpatients with schizophrenia in Taiwan. Psychiatry Res 158(3):306–315. https://doi.org/10.1016/j.psychres.2006.10.004

    Article  PubMed  Google Scholar 

  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):67–74

    Google 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):48–64

    Google Scholar 

  29. Yardim MS, Cilingiroglu N, Yardim N (2010) Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94(1):26–33. https://doi.org/10.1016/j.healthpol.2009.08.006

    Article  PubMed  Google Scholar 

  30. Sozmen K, Unal B (2013) Determinants of out of pocket health expenditure in Turkey. Eur J Public Health. https://doi.org/10.1093/eurpub/ckt123.151

    Google 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

  32. Jenkins R, Bhugra D, Bebbington P, Brugha T, Farrell M, Coid J, Fryers T, Weich S, Singleton N, Meltzer H (2008) Debt, income and mental disorder in the general population. Psychol Med 38(10):1485–1493. https://doi.org/10.1017/S0033291707002516

    Article  CAS  PubMed  Google Scholar 

  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):23–28

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

    Duygu Islek & Bulent Kilic

  2. Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

    Berna Binnur Akdede

Authors
  1. Duygu Islek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bulent Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Berna Binnur Akdede
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Duygu Islek.

Ethics declarations

Conflict of interest

All authors declare that there are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Islek, D., Kilic, B. & Akdede, B.B. 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. Soc Psychiatry Psychiatr Epidemiol 53, 151–160 (2018). https://doi.org/10.1007/s00127-017-1465-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-017-1465-y

Keywords

Search

Navigation