Prof. Recep AKDAĞMorocco, March 2015

Unıversal Health Insurance and

Non-contributory people

TURKEY EXPERIENCE

Theory & Practice

HEALTH COVERAGE: COMPREHENSIVE STRATEGY

Implementation in UnisonEquity

Sustainability

Finance Provision

Social Determinants

Primary Care (Public)

Hospital (Public/ Private)

Central Regulation by MoH (With delegation)

Government Budget

Public Insurance (Single-Payer)

Necessary Benefit Package

Emergency Transport (Public)

2

Social Security Institution

Service Providers

Individuals

Government

Premiums &

Co-payments

State Contribution & Deficit Financing

Payment

Invoice

Health care

MoH Hospitals University Hospitals Private Hospitals Pharmacies

IMPLEMENTATION: UNIVERSAL HEALTH INSURANCE SYSTEM

3

Emergency Transport Primary Health Care

4

Universal Covers everyone with exceptions*

Comprehensive All needed care

Contribution based Bismarckian model

Compulsory Enforced by law

Authoritative body Social Security Institution

• Members of Parliament, • Members of Constitutional Court• Persons who receive health care services abroad • Members of foundation funds • Prisoners and detainees • Privates

*

IMPLEMENTATION: CHARACTERISTICS OF UNIVERSAL HEALTH INSURANCE

Health care services are provided by their institutions

 Health Insurance Coverage

Number

Holders of Compulsory Insurance 19.874.529

Pensioners 10.925.023

Dependents 33.028.458

Subsidized persons 9.049.208

Persons subject to means testing(non-working group) 3.607.839

Other Public Coverage out of UHI 1.210.847

Total Population in Turkey 77.695.904

IMPLEMENTATION: UNIVERSAL HEALTH INSURANCE STATISTICS

5

“ Without adequate public funding and government stewardship, health insurance mechanisms pose a threat rather than an

opportunity to the objectives of equity and universal access to health care.”

Health Insurance in low-income countries, Joint NGO Briefing Paper, May 2008

IMPLEMENTATION: IMPORTANCE OF PUBLIC FUNDING

6

PurposeTo determine who will and

how much premium will

be paid? Result

Premium

Amount, if paid,

Is determined

Service is rendered to the

poor.

MethodAverage income of the household

divided to the number of the family member. Income bracket

is set.

WHAT IS A MEANS TEST ?

Social Solidarity and Welfare Foundation

(SSWF)

(2) Income Test

Evaluation- Welfare Data Sys.- Household Eval.- Grading

(3) Per Capita

Income

SSWF Board of Trustees

(4)

Dec

isio

n fo

r In

com

e B

rack

et

SSI SSI(6) ProvisionHEALTH FACILITY

(7)

Hea

lth

ca

re s

ervi

ce

(1)

Ap

pli

cati

on

Premium amount if paid, notified

Payment Made

MEANS TESTING FLOW CHART

Who is covered by the means test?1. Citizens whose premiums are

fully paid by the government: Citizens whose per capita income in the household are less than 1/3

of the set monthly minimum subsistence wage.2. Citizens who pay their

premiums themselves: Individuals who are not covered by Universal

Health Insurance, but still have income and whose per capita

income in the household are more than 1/3 of minimum subsistence

wage.

WHO IS COVERED BY THE MEANS TEST?

INCOME CODE PER CAPITA INCOME INCOME BRACKETS

(USD) PREMIUM STATUS

I0If it is less than 1/3

of the monthly gross minimum

subsistence wage0 – 160 Premium paid

by government

I1If it is more than 1/3

of the monthly gross minimum

subsistence wage160.00 – over Premium paid

by the individual

PREMIUM PAYMENT BRACKETS

• “Individuals can go to appeal with a written petition, within 15 days of the premium payment notification approved by the local welfare foundation”.

• A final decision is made within 15 days of the submission of the petition.

APPEAL FOR MEANS TESTING DECISION

Number of the

Individuals whose

premium paid by the governmen

t

I0 7.600.925

NUMBER OF THE INDIVIDUALS

IMPLEMENTATION: BENEFIT PACKAGE EXCLUSIONS

• Any kind of health care services for aesthetic purposes

• Health care services not permitted or licensed by MoH

• Some of new treatment modalities

• Chronic sickness of foreign country citizens presenting with the diseases prior to their qualification for public health insurance

14

15

• Pharmaceuticals: 10%-20% for outpatient prescription, no co-payment for drugs that cure chronic diseases, no co-payment for inpatient prescription

• 5-12 TL for each outpatient visits at hospitals

(public- private) • No co-payment

– chronic illnesses and occupational diseases– emergency transport including air

ambulance– inpatient services

15

IMPLEMENTATION: CO-SHARING

16

• Private hospitals carry the right to ask patients for additional charges up to 90% of the prices listed on the Health Enforcement Notification (2012)

• Additional fee varies between 50% and 90% based on the class of private hospitals

• Exemptions for emergency treatment, intensive care and high-cost treatments

IMPLEMENTATION: EXTRA CHARGES IN PRIVATE HOSPITALS