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The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey

Giovanis, E and Ozdamar, O (2017) The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey. University Faculty of Economics & Administrative Sciences (Akdeniz İ.İ.B.F. Dergisi ), 36. pp. 71-102.


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The Turkish health care system has been subject to significant and critical changes and reforms since 2003. One of the most important reforms has been implemented in 2008 where the Green Card holders are entitled to the same services, without any fee, as those with public health insurance, such as the Emekli Sandığı, BAĞKUR, SSK. This study initially examines the characteristics of health insurance schemes, determinants of holding one of the health insurance schemes (public, private, green card, no-insurance) in Turkey. It further analyses the effect of 2008 reform on out of pocket expenditures (OOPEs). The study will be the first in the related literature analysing the effect of this reform especially on the OOPEs of green card holders. The analysis relies on a detailed micro-data level survey, TUİK Household Budget Survey, over the period 2002-2011 and employs a difference-in-difference approach using a pseudo-panel based on propensity score matching. Initial results show that individuals who have public insurance are less inclined to face out-of-pocket health expenditures compared to those without health insurance and the Green Card holders. However, the difference of the OOPEs between the public health insurees and green card holders is reduced after the implementation of the 2008 reform.

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