Does the unification of health financing affect the distribution pattern of out-of-pocket health expenses in Turkey?

Turkey has implemented health reforms for over a decade and has taken significant steps toward unifying health financing. This study investigated the financial burden associated with out-of-pocket (OOP) expenditures under universal health coverage, using national 2003-2015 household budget data from the Turkish Statistical Institute. Progress was evaluated using Kakwani-Suits indices and Lorenz concentration curves. The results indicate that overall, more than a decade after its unification, redistribution of wealth in the Turkish health financing system has benefitted the wealthy but not the poor. Both curve and index approaches (Kakwani index 2003 = -0.50; 2015 = -0.44) reveal an increasingly regressive pattern of OOP health expenditures. The effective use of fiscal space and good political leadership are essential for the successful continuation of reforms to combat poverty in Turkey.