A dead end job: Health service financing and some evidences for provision of sustainability in Turkey

RATIONALE: Turkey have fiscal limitations on how to manage and provide for the needs and demands of the population-there is high and increasing out-of-pocket and informal (under-the-table) payments, inefficiencies in the pooling of funds and the provision of care, and insufficient financial incentives to reach overall health care related goals such as financial sustainability.

AIM: The aim of the paper is to examine the health financing system of Turkey with a particular focus on financial sustainability and catastrophic-health-expenditures (CHE) as an indicator of out-of-pocket-payments.

METHODOLOGY: Descriptive statistics and ecological data is used to show the out-of-pocket and total expenditures. CHE is calculated by using the method of Ke Xu with national representative data derived from Turkish National Health Accounts Study.

RESULTS: Turkey spends a low amount of its resources on health care for a country with its level of economic development, although its spending has risen since 1998. Its total health expenditures increased from 4.8% to 7.6% of GDP from 1998 to 2003, and the latest spending figure is above the OECD average. Out-of-pocket-spending, made up 70% of private-spending on health-care in 2003 where 25% of it is informal payments. CHE findings showed that the proportion of households with CHE is calculated as 7.7% which is a high proportion compared to OECD countries. Impoverished households consist 2.8% of total.

CONCLUSION: Findings showed that, in order to built sustainability and fairness in a equitable and effective manner, it is necessary to improve tax collection systems; and  implement clear and modest cost-sharing as a means to moderate utilisation, raise revenues and help eradicate informal payments. Findings on impoverishment of the poor revealed the urgency of constructing a fair health finance system in Turkey by introducing interventions for access to services for more vulnerable-populations under the new universal health coverage system.