Poverty effects of public health reforms in Turkey: A focus on out-of-pocket payments


JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol.27, no.1, pp.53-61, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 27 Issue: 1
  • Publication Date: 2021
  • Doi Number: 10.1111/jep.13383
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Psycinfo
  • Page Numbers: pp.53-61
  • Keywords: health financing inequity, health transformation program, out-of-pocket health expenditures, POLICY, CARE
  • Hacettepe University Affiliated: Yes


Rationale, aims, and objectives Expanded financial coverage is critical to fight against poverty through public health reforms in developing countries. This study explores inequity in public health financing reforms in Turkey between 2003 and 2015. Methods This paper has two parts. The first part examines inequity in health care financing in Turkey between 2003 and 2015. Gini, entropy (Theil and mean logarithmic deviation), and Atkinson indexes were calculated. In the second part of the paper, we investigated the degree of progressivity by using Kakwani index and Lorenz and concentration curves. Results We found a decreasing trend in terms of inequity. After major public health reforms and unification of the health financing system, it is seen that the distribution of out-of-pocket expenditure on health stands on the shoulders of vulnerable groups. Conclusions Study results provide a deep understanding of the effects of poverty on public health financing reforms on households in Turkey. To reduce out-of-pocket health spending inequities and to protect vulnerable groups from increasing the level of health expenditures, we suggest that the government enlarges health insurance coverage for the poor.