Background Out-of-pocket (OoP) health expenditures decrease the access of health services and cause health inequalities in Turkey. Particularly, OoP expenditures for mental health services and its determinants are neglected. The aim of this study is to explore the OoP health expenditures and its determinants among psychiatric patients in Dokuz Eylul University (DEU) Hospital in Izmir, Turkey.
Methods The study group of this cross-sectional research are the patients who attended to DEU Psychiatry Clinic during June 2014. During this period 191 patients were accessed out of 341 patients (56%). Rejection rate to participation was 33%. Dependent variable is OoP payments for prescription, medical tests and examinations. Independent variables are age, gender, education level, social class, health insurance, household income and the source for paying the costs. The persons in the study group are interviewed with a questionnaire face to face. Students t test, Mann Whitney U test and ANOVA is applied with SPSS for statistical analysis.
Results Sixty five percent of the study group were women and 35% were men. The mean age was 44.2. Fifty five percent were unemployed, 30% were white-collar workers, 8% were blue-collar workers. The mean household income was 1188.5$. Social insurance coverage was 98%. Fifty six percent of the patients were followed-up with the diagnosis of ‘bipolar disorder’, 23% with ‘anxiety disorder’ and 21% with ‘psychos’. All (100%) of the patients had OoP payments for their admission. The mean OoP payment was 6.7$ (examination 2.8$, prescription 2.2$, medical tests 1.6$). OoP payments were higher in patients without health insurance (45.8$) than others (4.8$) (p: 0.001). Twelve percent of patients used debit for OoP payments. OoP payments were higher in psychos (8.4$) and bipolar patients (6.7$) than anxiety patients (4.8$) (respectively p: 0.02 and p: 0.02). OoP payments were higher in patients paying with debit (10$) than paying with monthly income (6.2$) (p: 0.01). Sixtyone percent of the persons paying with debit were unemployed or precarious workers. There was not a difference in OoP payments according to household income, social class or education level (respectively p: 0.12, p: 0.27, p: 0.52).
Conclusion In this study, all of the patients paid OoP expenditures to access mental health services. Social insurance is the most important determinant in the amount of OoP, even more determinative than household income or social class. Therefore, in order to decrease health inequalities, policymakers should primarily focus on the coverage of social insurance.
- Out-of-pocket health expenditures
- social insurance
- psychiatric patients