Out of Pocket Health Expenditures in Turkey in the Aftermath of the Reforms: Impact of Co-payments on Expenditures and Use of Health Services

In 2002 Turkey started to implement reforms in health care aiming to ease access and increase efficiency. Reforms increased insurance coverage and resulted in higher number of outpatient and inpatient treatments at both public and private hospitals. To reign in consequent increase in health expenditures, a series of co-payments were instituted. Along with that primary care services were reformed through a family-medicine system that provided free access. The aim was to channel patients to primary care and hence cut on costs of secondary care. This work aims to measure the impact of these two measures, introduction of co-payments at secondary care and ease of access to free primary care, on out-of-pocket expenditures and access/use of healthcare services. We find that while contributory payments resulted in higher OOP health expenditures, especially for lower income households, the impact was small and did not hinder access to healthcare services. Indeed, possibly due to easier access to primary care, inability to see a doctor became less prevalent. Adverse effect of the contributory payments have been limited and have largely been countered by the provision of a easily available primary care system.