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Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey

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Abstract

Objective

To determine the prevalence of catastrophic health payments, examine the determinants of catastrophic expenditures, and assess the poverty impact of out-of-pocket (OOP) payments.

Methods

Data came from the 2004 to 2010 Household Budget Survey. Catastrophic health spending was defined by health payments as percentage of household consumption expenditures and capacity to pay at a set of thresholds. The poverty impact was evaluated by poverty head counts and poverty gaps before and after OOP health payments.

Results

The percentage of households that catastrophically spent their consumption expenditure and capacity to pay increased from 2004 to 2010, regardless of the threshold used. Households with a share of more than 40 % health spending in both consumption expenditure and capacity to pay accounted for less than 1 % across years. However, when a series of potential confounders were taken into account, the study found statistically significantly increased risk for the lowest threshold and decreased risk for the highest threshold in 2010 relative to the base year. Household income, size, education, senior and under 5-year-old members, health insurance, disabled members, payment for inpatient care and settlement were also statistically significant predictors of catastrophic health spending. Overall, poverty head counts were below 1 %. Poverty gaps reached a maximum of 0.098 %, with an overall increase in 2010 compared to 2004.

Conclusions

Catastrophe and poverty increased from 2004 to 2010. However, given that the realization of some recent policies will affect the financial burden of OOP payments on households, the findings of this study need to be replicated.

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Acknowledgments

Hacettepe University funded this study as a project for the years 2004–2008. The study was later completely redone to include the data for 2009 and 2010. We thank Hacettepe University for its support.

Conflict of interest

We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Department of Health Management, Faculty of Health Sciences, Acıbadem University, Istanbul, Turkey

    Hacer Özgen Narcı

  2. Department of Healthcare Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey

    İsmet Şahin & Hasan Hüseyin Yıldırım

Authors
  1. Hacer Özgen Narcı
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  2. İsmet Şahin
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  3. Hasan Hüseyin Yıldırım
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Corresponding author

Correspondence to Hacer Özgen Narcı.

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Özgen Narcı, H., Şahin, İ. & Yıldırım, H.H. Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey. Eur J Health Econ 16, 255–270 (2015). https://doi.org/10.1007/s10198-014-0570-z

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  • DOI: https://doi.org/10.1007/s10198-014-0570-z

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