Health Consequences of an Eclectic Social Security Regime: The Case of Turkey

Until 2004-2008 reforms, access to health care among separate pension schemes in Turkey was very stratified. A widely accepted ranking of health services of different pension schemes in Turkey (from best to worst) was Government Employees Retirement Fund (GERF), Social Insurance Institution (SII) for workers, Bağ-Kur (BK) for urban self-employed, BK for farmers, Green Card (a means-tested poverty relief scheme), and uncovered population with no formal right to access to hospital services. The reforms enacted between 2004 and 2008 had gradually eliminated the stratification in access to health care among separate schemes. Turkish Statistical Institute has tracked satisfaction with health services; but to our knowledge, our paper is the first attempt that tries to validate the above ranking empirically using an objective and cumulative measure. We chose age-standardized average age of death and mortality as outcome variables. We obtained the most comprehensive data for insurees of SII for the period 2000-2010, of BK for 2004-2010 (separately for urban self-employed and farmers), for GERF retirees for 2000-2010 and of Green Card old age pensioners for 2009-2010. GERF insurees have the highest age-standardized age of death as expected. Moreover, average age of death is converging for both sexes (especially for men) during the reform period. Also, Green Card beneficiaries have the highest mortality as expected. If the mortality prevailing for other insurees had held for Green Card insurees as well, the death toll would have been halved (from 64,062 to 31,700 in 2009 and from 57,100 to 30,735 for 2010) for old age pensioners in Green Card. Unfortunately we are unable to adjust our findings for income level and education so all the differences could not be attributed to stratified access to healthcare.