Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms

The success of Turkey's inclusive health policies has served as a strategic tool for building progressivity and improving social welfare. The objective of this study is to examine the inequality trend in out of pocket (OOP) health expenditures in Turkey. Data from the Turkish Statistical Institute's Household Budget Survey conducted in 2015 and 2019 were used to measure inequalities in OOP total health, pharmaceutical and hospital expenditure variables across socioeconomic status. Decomposition analysis was conducted to identify the factors contributing to inequalities. The study findings demonstrate that OOP health expenditure is higher among the poor in Turkey. Evidence suggests that in Turkey inequalities in OOP health expenditures continue to persist. The results show that OOP health, pharmaceutical, and hospital expenditures increased from 2015 to 2019. The inequality index and curve approaches reveal that the pro-rich distribution of OOP health expenditures is remarkable from 2015 to 2019. The burden of OOP pharmaceutical and hospital services expenditures stands on the shoulders of poor households. Progressive universalism is essential to achieve poverty alleviation strategies and reduce inequality for egalitarian development.