Three empirical essays on Turkish health care system

• Online Access: http://hdl.handle.net/2047/D20234697

First chapter abstract: In 2003, the Turkish government introduced a major health system reform, the Health Transformation Program (HTP), aimed at achieving Universal Health Coverage (UHC). HTP has helped to expand insurance coverage and health benefits for the uninsured population groups, which included low-income households and the unemployed, through the Green Card scheme, a non-contributory insurance funded by the government. The Green Card scheme expansion began in 2005 and increased rapidly after 2008 following the introduction of a new benefits package to cover an additional 13 million people. We examine the impact of the Green Card scheme on the utilization of outpatient, inpatient, specialist, and diagnostics services using the Turkish Health Survey data (2010), using a kinked regression discontinuity design. We take advantage of a sharp break in the availability of health insurance at a particular income level (minimum wage) to examine the causal impact of the Green Card scheme. Our results show that having a Green Card increases the fraction of people using outpatient services by 68-30 percentage points, inpatient visit by 34-59 percentage points, and specialist visit by 74-08 percentage points. Our findings suggest that a non-contributory program like Turkey's Green Card scheme could provide increased access to healthcare services by the poor and provide important lessons for countries which aim to introduce health programs targeting poor as part of a transition to UHC.