The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey

Cesur, Resul; Güneş, Pınar Mine; Tekin, Erdal; Ulker, Aydogan

doi:10.1016/j.jpubeco.2017.03.007

Cited by 58 publications

(57 citation statements)

References 46 publications

(60 reference statements)

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“…For example, physician pay is based on capitation. 10 A detailed description of the FMP can be found in Cesur et al (2017a).…”

Section: Brief History Of the Family Medicine Programmentioning

confidence: 99%

“…Given these considerations, our baseline approach to estimating the causal relationship between the FMP and birth rates is to follow Cesur et al (2017a) by implementing a differencein-differences strategy. This strategy exploits the temporal and spatial variation in the implementation of the FMP across Turkish provinces and can be expressed formally by the following regression equation:…”

Section: Estimation Strategymentioning

confidence: 99%

“…To capture the impact of confounding factors, equation (1) is supplemented with a series of additional variables. In particular, the δr*t represents region-by-year fixed effects, which would capture any common trends and shocks to birth rates that might occur either at the national or regional level (Cesur et al, 2017a). For example, any regional or nationwide investments made by the central government in an effort to improve health or economic conditions would be captured by these fixed effects.…”

Section: Estimation Strategymentioning

confidence: 99%

“…As a result of these improvements, there have been visible increases in patient satisfaction and healthcare utilization (Akturk et al, 2015;Baris et al, 2011;World Health Organization, 2008). Importantly, the program has helped to greatly reduce the mortality rates among infants and the elderly (Cesur et al, 2017a).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, the increased availability of family-planning services, such as contraceptives, reproductive-health services, and sexual education, might have led to either reduced childbearing or a shift in the timing of childbearing towards older ages, especially among women who lacked access to or awareness and knowledge of such services. Finally, because the FMP improved child health (Cesur et al 2017a), the reform might have induced a quantity-quality trade-off, which might have led to a reduction in fertility (Becker, 1960).…”

Section: Introductionmentioning

confidence: 99%

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Socialized Healthcare and Women’s Fertility Decisions

Cesur¹,

Güneş²,

Tekin³

et al. 2019

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte.This paper examines the effect of a nationwide healthcare reform implemented in Turkey on women's fertility decisions. The Family Medicine Program (FMP), introduced in 2005, provided a wide-range of primary healthcare services, free of charge, and achieved universal access by matching each citizen to a specific family physician, who operates at neighborhood clinics, called Family Health Centers, on a walk-in basis. Although reducing fertility was not specified among the goals of the reform, reproductive-health and family-planning services have been covered under the FMP. To establish causality, we exploit the staggered rollout of the FMP implementation across Turkish provinces over time using a difference-in-differences estimation strategy. Our estimates indicate that the FMP significantly reduced childbearing among both teenagers and women ages 20-29. These results can be explained by increased access to and reduced cost of reproductive-health and family-planning services. However, the patterns in which the program effect has evolved over time differs between the two groups of women in a way that provides additional insights about the mechanisms. For teenagers, the FMP had a direct effect on childbearing, reflected by an immediate and rapidly-increasing pattern, which is not surprising given the broad agreement about the negative consequences of teenage childbearing among government and public health officials, including those in Turkey. For women ages 20-29, however, the program had a gradual and slowly-increasing effect, which is consistent with an empowerment channel. This should be interpreted as an unintended consequence of the program because, if anything, Turkey is a country where the government's position is to encourage fertility behavior and discourage birth control practices among women at prime childbearing ages. JEL Classification:I13, J13

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“…For example, physician pay is based on capitation. 10 A detailed description of the FMP can be found in Cesur et al (2017a).…”

Section: Brief History Of the Family Medicine Programmentioning

confidence: 99%

Section: Estimation Strategymentioning

confidence: 99%

Section: Estimation Strategymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Socialized Healthcare and Women’s Fertility Decisions

Cesur¹,

Güneş²,

Tekin³

et al. 2019

Self Cite

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Health insurance and child mortality: Evidence from India

Aiyar,

Sunder

2024

Health Economics

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Although less than a third of the population in developing countries is covered by health insurance, the number has been on the rise. Many countries have implemented national insurance policies in the past decade. However, there is limited evidence on their impact on child mortality in low‐ and middle‐income contexts. Here we document the child mortality reducing effects of an at‐scale national level health insurance policy in India. The Rashtriya Swasthya Bima Yojana (RSBY), was rolled out across India between 2008 and 2013. Leveraging the temporal and spatial variation in program implementation, we demonstrate that it lowered infant mortality by 6% and child under five mortality by 5%. The effects are largely concentrated among urban poor households. In terms of mechanisms, we find that the program effects seem to be driven by increased usage of reproductive health services by mothers. We also demonstrate a rise in usage of complementary health services that were were not covered under the policy (such as child immunizations), which suggests that RSBY had significant positive spillover effects on health care usage.

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Utilization of health‐care services by young children: The aftermath of the Turkish Health Transformation Program

Caner

Karaoglan

Yaşar

2018

Health Planning & Management

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The Turkish Health Transformation Program, initiated in 2003, has identified achieving universal access to health care as 1 of its main tenets. To date, substantial progress has been made toward universal health coverage. Service utilization statistics display an upward trend. In this study, we use official and nationally representative microdata collected by the Turkish Health Research Surveys to examine young children's (ages 0-5) utilization of health services. Children in this age group deserve special attention because adverse health conditions in early childhood are known to have long-time consequences. Policy makers regularly monitor statistics such as infant mortality rate and under-5 mortality rate. We conduct logistic regression analyses to explain the probabilities of being taken to a health institution, to a dentist, and being included in the newborn screening program. We use a rich set of explanatory variables that represent the socioeconomic status (SES) of the child's household. Contrary to our expectations and to the goals of universal health coverage is SES indicators such as the insurance ownership of the parent matter for utilization. Decomposition analyses confirm these findings and reveal that the increase in utilization should have been higher than observed. Children from low SES households should be given special attention and that research efforts should focus on identifying the barriers that still hinder children's utilization of health-care services.

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The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey

Cited by 58 publications

References 46 publications

Socialized Healthcare and Women’s Fertility Decisions

Socialized Healthcare and Women’s Fertility Decisions

Health insurance and child mortality: Evidence from India

Utilization of health‐care services by young children: The aftermath of the Turkish Health Transformation Program

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