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Sağlık Hizmetleri Finansmanında Cepten Harcama: Nedir? Neden Önemlidir?

Out-of-pocket Payment in Health Services Financing: What is it? Why is it Important?

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Abstract (2. Language): 
Out-of-pocket payments are used in several countries in varying magnitudes as a health financing tool. Being a significant financing source especially in low income countries, out-of-pocket payments have a potential to cause a number of serious adverse impacts for individuals and systems, as well as benefits. Therefore, out-of-pocket payments are one of the primary health financing problems of countries. In this article, definition and components of out-of-pocket paymentsare explainedand their impacts on a variety of aspects are presented along with debates on the ways to deal with those issues
Abstract (Original Language): 
Cepten harcamalar, birçok ülkede değişen boyutlarda sağlık sistemifinansman aracıolarak kullanılmaktadır.Özellikle düşük gelirli ülkeler açısından önemli bir finansman kaynağı olan cepten harcamalar, olumlu etkilerinin yanı sıra bireyler ve sağlık sistemi açısından birçok önemli sorun yaratma potansiyeline sahiptir. Bu nedenle, cepten harcamalar, ülkelerin temel finansman politikaları ile ilgili sorunlarından biridir. Bu makalede, cepten sağlık harcamasının tanımı, unsurları ve etkileri açıklanmakta ve cepten harcamaların etkileri ile baş edebilme yollarına ilişkin tartışmalar sunulmaktadır.
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REFERENCES

References: 

1. Asenso-okyere W. et al. (1998) Cost Recovery in Ghana: Are There Any
Changes in Health Care Seeking Behaviour? Health Policy and
Planning13(2): 181–188.
2. Austvoll-Dahlgren A. et al. (2008) Pharmaceutical Policies: Effects of
Cap and Co-payment on Rational Drug Use. Cochrane Database
Systems Review 23(1): CD007017.
3. Balabanova D. and McKee M. (2002) Understanding Informal Payments
for Health Care: The Example of Bulgaria. Health Policy62(3): 243-273.
4. Banthin J.S. and Bernard D.M. (2006) Changes in Financial Burdens for
Health Care. JAMA296: 2712-2719.
Sağlık Hizmetleri Finansmanında Cepten Harcama 219
5. Belli P. et al. (2002) Qualitative Study on Informal Payments for
Health Services in Georgia. HNP Discussion Paper. Washington DC:
World Bank.
6. Biritwum R.B. (1994) The Cost of Sustaining the Ghana’s “Cash and
Carry” System of Health Care Financing At A Rural Health Center. West
African Journal of Medicine13: 124-127.
7. Blas E. andLimbambala M.E. (2001) User-payment, Decentralization
and Health Service Utilization in Zambia. Health Policy and Planning
16(2): 19-28.
8. Bojalil R. and Calva J. (1994) Antibiotic Misuse in Diarrhea: A
Household Survey in A Mexican Community. Journal of Clinical
Epidemiology47(4): 147–156.
9. Briggs J. (2000) The Economic Consequences of Inadequate
Prescribing on Health Care Users and Providers: A Case Study in
San Cristobel, Mexico. Liverpool: Liverpool School of Tropical
Medicine.
10. Burnham G. et al. (2004)Discontinuation of Cost Sharing in Uganda.
Bulletin of the World Health Organization82(3): 187–195.
11. Castrol-Leal F. et al. (2000) Public Spending on Health Care in Africa:
Do the Poor Benefit? Bulletin of World Health Organization 78(1):66-74.
12. Chaudhuri A. and Roy K. (2008) Changes in Out of Pocket Payments for
Healthcare in Vietnam and Its Impact on Equity in Payments, 1992-2002.
Health PolicyElektronik Sürüm (www.sciencedirect.com) (Erişim tarihi
20 Ekim 2007).
13. Chiu Y. et al. (2007) Gifts, Bribes and Solicitions: Print Media and the
Social Construction of Informal Payments to Doctors in Taiwan. Social
Science and Medicine 64(3): 521-530.
14. Creese A. and Kutzin J. (1995) Lessons from Cost-recovery in Health.
WHO: Geneva.
Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2(2007) 220
15. Delcheva E. et al. (1997) Under-the-counter Payments for Health Care:
Evidence from Bulgaria. Health Policy42: 89-100.
16. Ensor T. (2004) Informal Payments for Health Care in Transition
Economies. Social Science and Medicine 58(2): 237-246.
17. Ensor T. and Savelyeva L. (1998) Informal Payments for Health Care in
the Former Soviet Union: Some Evidence from Kazakstan. Health
Policy and Planning13(1): 41-49.
18. Ensor T. and San P.B. (1996) Access and Payment for Health Care. The
Poor of Northern Vietnam. International Journal of Health Planning
and Management11(1): 69-83.
19. Falkingham J. (2004) Poverty, Out-of-pocket Payments and Access to
Health Care: Evidence from Tajikistan. Social Science & Medicine
58(2): 247-258.
20. Foster A. (1994) Poverty and Illness in Low-Income Rural Areas.
American Economic Review84(2): 216–220.
21. Fu W. (1999) Health Care for China’s Rural Poor. International Policy
Programme. Washington: World Bank.
22. Gaal P., Belli P., McKee M.and Szocska M.(2006) Informal Payments
for Health Care: Definitions, Distinctions, and Dilemmas. Journal of
Health Politics Policy and Law31(2): 251-293.
23. Gaal P., Evetovits T. and McKee M. (2006) Informal Payment for Health
Care: Evidence from Hungary. Health Policy77(1): 86-102.
24. Gaal P. and McKee M. (2005) Fee-for-service or Donation? Hungarian
Perspectives on Informal Payment for Health Care. Social Science and
Medicine 60(7): 1445-1457.
25. Garg C.C. and Karan A.K. (2005) Health and Millennium
Development Goal 1: Reducing out-of-pocket expenditures to reduce
income poverty -Evidence from India. EQUITAP Project: Working
Paper #15.
Sağlık Hizmetleri Finansmanında Cepten Harcama 221
26. Gemmill M.C. et al. (2008) What Impact Do Prescription Drug Charges
Have on Efficiency and Equity? Evidence from High-income Countries.
International Journal for Equity in Health7: 12-122.
27. Gilson L. and McIntyre D. (2005) Removing User Fees for Primary Care
in Africa: The Need for Careful Action. BMJ 331: 762-765.
28. Gottlieb S. (2000) Medical Bills Account for 40% of Bankruptcies. BMJ
320(7245): 1295.
29. Gotsadze G. et al. (2005) Health Care-Seeking Behaviour and Out-of-pocket Payments in Tbilisi, Georgia. Health Policy and Planning20(4):
232-242.
30. Gottret P. and Schieber G. (2006) Health Financing Revisited: A
Practitioner’s Guide. The World Bank, Washington D.C.
31. Gross D.J. et al. (1999) Out-of-pocket Health Spending by Poor and
Near-Poor Elderly Medicare Beneficiaries. Health Services Research
34(1 Pt 2): 241-254.
32. Himmelstein D.U. et al. (2005) Illness and Injury As Contributors to
Bankruptcy. Health Affairs Suppl Web Exclusives: W5-63-W5-73.
33. Hopkins S. and Cumming J. (2001) The Impact of Changes in Private
Health Expenditure on New Zealand Households. Health Policy58(3):
215–229.
34. Hotchkiss D.R. et al. (2005) Out-of-pocket Payments and Utilization of
Health Care Services in Albania: Evidence from Three Districts.Health
Policy75(1): 18–39.
35. Iyer A. and Sen G. (2000) Health Sector Changes and Health Equity in
the 1990s in India. In: Roghuram S. (ed.) Health and Equity: Technical
Report Series 1.8. Bangalore: HIVOS.
36. Jacobs B. and Price N. (2004) The Impact of the Introduction of User
Fees At A District Hospital in Cambodia. Health Policy and Planning
19(5): 310–321.
Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2(2007) 222
37. James C.D. et al. (2006) To Retain or Remove User Fees?: Reflections
on the Current Debate in Low-and Middle-income Countries. Applied
Health Economics and Health Policy 5(3): 137-153.
38. Kabir M.A. et al. (2000) Sickness Among the Urban Poor: A Barrier to
Livelihood Security. Journal of International Development12: 707–
722.
39. Kawabata K. et al. (2002) Preventing Impoverishment Through
Protection Against Catastrophic Health Expenditure. Bulletin of World
Health Organization80(8): 612.
40. Kipp W. et al. ( 2001) User Fees, Health Staff Incentives, and Service
Utilization in Kabarole District, Uganda. Bulletin of the World Health
Organization79(11): 1032–1037.
41. Le Grand A. et al. (1999) Intervention Research in Rational Use of
Drugs: A Review. Health Policy and Planning14: 89–102.
42. Lewis M. (2000) Who is Paying for Health Care in Eastern Europe
and Central Asia?Human Development Sector Unit, Europe and
Central Asia, Region, Washington, DC, The World Bank.
43. Liaropoulos L. and Tragakes E. (1998) Public/Private Financing in the
Greek Health Care System: Implications for Equity. Health Policy43:
153-169.
44. Liaropoulos L. et al. (2008) Informal Payments in Public Hospitals in
Greece. Health Policy87: 72–81.
45. Liu Y. ve diğerleri (2005) Türkiye’de Sağlık ve İlaç Harcamaları.
Sağlıkta Umut Vakfı.
46. Liu G.G. and Zhao Z. (2006) Urban Employee Health Insurance Reform
and the Impact on Out-of-pocket Payment in China. International
Journal of Health Planning and Management 21(3): 211-228.
Sağlık Hizmetleri Finansmanında Cepten Harcama 223
47. Mastilica M. and Bozikov J. (1999) Out-of-pocket Payments for Health
Care in Croatia: Implications for Equity. Croatian Medical Journal
40(2): 152-159.
48. Maynard A. and Dixon A. (2002) Private Health Insurance and Medical
Savings Accounts: Theory and Experience. Mossialos, E. et al. (eds.).
Funding Health Care: Options for Europe, pp:80-109. Buckingham &
Philadelphia: Open University Press.
49. McIntyre D. et al. (2006) What are the Economic Consequences for
Households of Illness and of Paying for Health Care in Low-and
Middle-Income Country Contexts? Social Science and Medicine62(4):
858-865.
50. McPake B. et al. (1999) Informal Economic Activities of Public Health
Workers in Uganda: Implications for Quality and Accessibility of Care.
Social Science and Medicine 49(7): 849–865.
51. Meuwissen L.E. (2002) Problems of Cost Recovery Implementation in
District Health Care: A Case Study from Niger. Health Policy and
Planning17(3): 304–313.
52. Mossialos E. and Dixon A. (2002) Funding Health Care: An
Introduction. Mossialos, E. et al. (eds.). Funding Health Care: Options
for Europe, pp:1-30. Buckingham & Philadelphia: Open University
Press.
53. Mwabu G. et al. (1995) User Charges in Government Health Facilities in
Kenya—Effect on Attendance and Revenue. Health Policy and
Planning10(2): 164–170.
54. Nahar S ve Costello AM (1998). The hidden cost of ‘free’ maternity care
in Dhaka, Bangladesh. Health Policy and Planning, 13(4): 417–422.
55. Nolan B. and Turbat V. (1995) Cost Recovery in Public Health
Services in Sub-Saharan Africa. Washington, DC, Economic
Development Institute of The World Bank.
Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2(2007) 224
56. O’Donnell O et al. (2008) Analyzing Health Equity Using Household
Survey Data: A Guide to Techniques and Their Implementation.
Washington, DC, USA: World Bank.
57. Öz E (2008) Ulusal Hanehalkı Cepten Sağlık Harcamalarının
Finansmanda Dikey Hakkaniyet Açısından Değerlendirilmesi.
Yayınlanmamış Doktora Tezi, Hacettepe Üniversitesi.
58. Özgen H. et al. Predictors of Informal Health Payments: The Example
from Turkey. Journal of Medical Systems(Baskıda).
59. Özgür S. ve diğerleri (2008) GAP Bölgesinde Halkın Sağlık
Kuruluşlarından Yararlanımı. Elektronik Sürüm.
(www.dicle.edu.tr/~halks/m10.9.htm ) (Erişim Tarihi, 20 Temmuz 2008).
60. Palmer D. et al. (1991) Striving for Quality in Health Care: An
Inquiry into Policy and Practice. Washington, DC: Health
Administration Press.
61. Pannarunothai S. and Mills A. (1997) The Poor Pay More: Health-Related Inequality in Thailand. Social Science and Medicine44(12):
1781–1790.
62. Phadke A. (1996) The Quality of Prescribing in An Indian District.
National Medical Journal of India9(2): 60–65.
63. Prescott N. (1997) Poverty, Social Services and Safety Nets in
Vietnam.World Bank discussion paper no 376. Washington: World
Bank.
64. Rasell E. (1999) An Equitable Way to Pay for Universal Coverage.
International Journal of Health Services 29(1): 179-188.
65. Rice T. (1997) Can Markets Give Us the Health System We Want?
Journal of Health Politics, Policy and Law22(2): 383–426.
Sağlık Hizmetleri Finansmanında Cepten Harcama 225
66. Ruger J.P. and Kim H. (2007) Out-of-Pocket Healthcare Spending by the
Poor and Chronically Ill in the Republic of Korea. American Journal of
Public Health 97(5): 804-811.
67. Russell S. and Gilson L. (1997) User Fee Policies to Promote Health
Service Access for Poor: A Wolf in Sheep’s Clothing? International
Journal of Health Services27(2): 359–379.
68. Sağlık Bakanlığı, RSHMB, Hıfzıssıhha Mektebi Müdürlüğü (2006)
Türkiye Ulusal Hanehalkı Sağlık Harcamaları Araştırması 2002-2003. Yayın No: SB-HM-2005/09, Ankara.
69. Sağlık Bakanlığı (2007) Türkiye’de Sağlığa Bakış.Refik Saydam
Hıfzıssıhha Merkezi Başkanlığı, Hıfzıssıhha Mektebi Müdürlüğü,
Ankara.
70. Scitovsky A.A. and McCall N. (1977) Coinsurance and the Demand for
Physician Services: Four Years Later. Social Security Bulletin40(5):
19-27.
71. Segall M. et al. (2000) Health Care Seeking by the Poor in
Transitional Economies; The Case of Vietnam. Research report no 43.
Sussex: Institute of Development Studies.
72. Shahriari H. et al. (2001) Institutional Issues in Informal Health
Payments in Poland: Report on the Qualitative Part of the Study.
HNP Discussion Paper. Washington DC: World Bank.
73. Shen Y. and McFeeters J. (2006) Out-of-Pocket Health Spending
Between Low- and Higher-Income Populations: Who is at Risk of
Having High Expenses and High Burdens?Medical Care44(3): 200-209.
74. Shmueli A. et al. (2008) Financing the Package of Services During the
First Decade of the National Health Insurance Law in Israel: Trends and
Issues. Health PolicyElektronik Sürüm (www.sciencedirect.com)
(Erişim Tarihi 20 Haziran 2008).
Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2(2007) 226
75. Skarbinski J. et al. (2002) The Burden of Out-of-pocket Payments for
Health Care in Tbilisi, Republic of Georgia. JAMA287(8): 1043-1049.
76. Smith P.C. (2005) User Charges and Priority Setting in Health Care:
Balancing Equity and Efficiency. Journal of Health Economics24(5):
1018-1029.
77. Szende A. and Culyer A.J. (2006) The Inequity of Informal Payments for
Health Care: The Case of Hungary. Health Policy75(3): 262-271.
78. Tatar M. et al. (2007) Formal and Informal Household Spending on
Health: A Case Studyfrom Turkey. Health Affairs26(4): 1029-1039.
79. Tediosi F. et al. (2008). Access to Medicines and Out-of-pocket
Payments for Primary Care: Evidence from Family Medicine Users İn
Rural Tajikistan. BMC Health Services Research8: 109-118.
80. Thomason J. et al. (1994) User Charges for Rural Health Services in
Papua-New-Guinea. Social Science and Medicine39(8): 1105–1115.
81. Thompson R. and Xavier A. (2002) Unofficial Payments for Acute
State Hospital Care in Kazakhstan. A model of Physician Behaviour
With Price Discrimination and Vertical Service Differentiation.
LICOS Working Paper 124.
82. Tibaijuka A.K. (1997) AIDS and Economic Welfare in Peasant
Agriculture: Case Studies from Kagabiro Village, Kagera Region,
Tanzania. World Development25(6): 963–975.
83. Tipping G. (2000) The Social Impact of User Fees for Health Care on
Poor Households: Commissioned Report to the Ministry of Health,
Hanoi, Vietnam.
84. Tokat M. (1998) Türkiye Sağlık Harcamaları ve Finansmanı 1992-1996. Sağlık Bakanlığı, Sağlık Projesi Genel Koordinatörlüğü, Ankara.
85. Van de Ven WPMM (1983) Effects of Cost-sharing in Health Care.
Effective Health Care1: 47–58.
Sağlık Hizmetleri Finansmanında Cepten Harcama 227
86. Van Doorslaer E. et al. (2007). Catastrophic Payments for Health Care in
Asia. Health Economics16(11): 1159–1184.
87. Van Doorslaer E. et al. (2006) Effect of Health Payments on Poverty
Estimates in 11 Countries in Asia: An Analysis of Household Survey
Data. Lancet 368(14): 1357–64.
88. Van Doorslaer E. et al. (1999) The Redistributive Effect of Health Care
Finance in Twelve OECD Countries. Journal of Health Economics
18(3): 291-313.
89. Xu K. et al. (2007) Protecting Households From Catastrophic Health
Spending. Health Affairs Jul/Aug 26(4): 972-983.
90. Xu K. et al. (2006) Understanding the Impact of Eliminating User Fees:
Utilization and Catastrophic Health Expenditures in Uganda. Social
Science and Medicine62(4): 866–876.
91. Xu K. et al. (2003) Household Catastrophic Health Expenditure: A
Multicountry Analysis. Lancet 362(9378): 111–117.
92. Wagstaff A. and Van Doorslaer E. (2003) Catastrophe and
Impoverishment in Paying for Health Care: with Applications to Vietnam
1993–98. Health Economics 12(11): 921–933.
93. Wagstaff A. and Van Doorslaer E. (2001) Paying for Health Care:
Quantifying Fairness, Catastrophe and Impoverishment, with
Applications to Vietnam, 1993-98. (Policy Research Working Paper:
2715), The World Bank.
94. Wagstaff A. (2002) Reflections on and Alternatives to WHO's Fairness
ofFinancial Contribution Index. Health Economics11(2): 103-15.
95. Wagstaff A. (2001) Poverty and Health. Commission on
Macroeconomics and Health (CMH) Working Paper Series, (Paper No.
WG1: 5).
96. Walley J. et al. (2001) Public Health: An Action Guide to Improving
Health in Developing Countries. New York: Oxford University Press.
Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2(2007) 228
97. Whitehead M. et al. (2001) Equity and Health Sector Reforms: Can Low-income Countries Escape the Medical Poverty Trap? The Lancet
358(9284): 833–836.
98. WHO (2000). The World Health Report 2000, Health Systems:
Improving Performance.Geneva.
99. WHO (2004) What are The Equity, Efficiency, Cost Containment
and Choice Implications of Private Health-Care Funding in Western
Europe? WHO Regional Office for Europe’s Health Evidence Network
(HEN) Report.
100. WHO (2007). World Health Statistics.
101. Wilkes A. et al. (1997) Coping with the Costs of Severe Illness in
Rural China. IDS Working Paper 58.
102. Willis C.Y. and Leighton C. (1995) Protecting the Poor Under Cost
Recovery: the Role of Means Testing. Health Policy and Planning
10(3): 241-256.
103. Witter S. (2005) An Unnecessary Evil? User Fees for Health Care in
Low-income Countries.
(www.savethechildren.org.uk/scuk_cache/scuk/cache/cmsattach) (Erişim
tarihi 22 Temmuz 2008).
104. World Bank (2004) Republic of Tajikistan Health Sector Note. Main
Report. Human Development Unit, Europe and Central Asia Region,
Washington.
105. World Bank (1999) The Kyrgyz Republic: Participatory Poverty
Assessment, Prepared for the Global Synthesis Workshop Poverty
Programme. Washington: World Bank.
106. Wouters A.(1995) Improving Quality Through Cost Recovery in Niger.
Health Policy and Planning 10(3): 257-270.

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