Regional Health Disparities in the Aftermath of Health System Reforms in Turkey

Abstract

Starting in 2003, Turkey introduced major health system reforms through the Health Transformation Program (HTP). The HTP aimed to address inequities in health care services across Turkey. This study explores whether regional disparities in several health care indicators persist ten years after the HTP. For this purpose, we use administrative records and individual-level data from the only regionally representative survey, Life Satisfaction Survey, undertaken by the Turkish Statistical Institute in 2013. First, the disadvantaged North-East, Middle-East, and South-East Anatolia regions experienced the most substantial increases in all health inputs and the odds of receiving the non-contributory Green Card insurance was also higher in these regions. Yet, there is still substantial disparity across regions in many health care access and satisfaction indicators. Especially, the disadvantaged regions still have lower utilization, lower satisfaction with healthcare, and lower subjective health scores in 2013 even after accounting for a wide range of control variables. While the HTP enabled the provision of a generous insurance benefits package, there is still room for progress in regional distribution of other major indicators such as subjective assessment of health, healthcare utilization, and satisfaction with health services. To further reduce health inequities across regions, the quality aspect of healthcare provision needs to be prioritized.