Determinants of Turkish households' out-of-pocket expenditures on three categories of health care services: A multivariate probit approach

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Demir A., Alkan Ö., Bilgic A., Florkowski W. J., Karaaslan A.

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, vol.37, no.4, pp.2303-2327, 2022 (SSCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 37 Issue: 4
  • Publication Date: 2022
  • Doi Number: 10.1002/hpm.3470
  • Journal Indexes: Social Sciences Citation Index (SSCI)
  • Page Numbers: pp.2303-2327
  • Keywords: household budget survey, inpatient services, multivariate probit, out-of-pocket expenditures, outpatient services, CHRONICALLY ILL, OLDER-PEOPLE, SOUTH-AFRICA, MEDICAL-CARE, PAYMENTS, TURKEY, INSURANCE, PROTECTION, COUNTRIES, PATTERNS
  • Ataturk University Affiliated: Yes


This study identifies the driving forces that contribute to the probabilities of incidence of out-of-pocket (OOP) expenditures by households in Turkey. Factors affecting the probability of OOP expenditures on medical products/devices/supplies (MP), outpatient services (OTS), and inpatient services (ITS) are examined using the Household Budget Survey data gathered by the Turkish Statistical Institute in 2018. The study applies the multivariate probit model. The incidence of OOP spending varied with 48.9% of the households reporting OOP expenditure on MP, 22.4% on OTS, and 25.4% on ITS. The largest probability changes were associated with household disposable annual income, household type and size, age category, and having private health insurance. Gender and marital status also influenced expenditures in some categories. Lifestyle choices had small and mixed effects, with smoking and alcohol consumption lowering the probability of OOP spending. From a policy standpoint, households with the lowest incomes, large households, and those where the household head was 'others' (retiree, student, housewife, not actively working, etc.) or had a condition preventing employment seemed to report OOP expenditures less frequently and may have chosen not to receive healthcare services, leading to the need for more healthcare services later.