title: Explaining inequalities in Health Care Utilization among Turkish adults: Findings from Health Survey 2008.
abstract: BACKGROUND
  Turkish health system showed major improvements in health outcomes since initiation of the Health Transition Programme (HTP) in 2003, however little is known regarding income-related inequalities in health care use. The aim of this study was to assess horizontal inequities in health care use in Turkey.
  
  
  METHODS
  We used the data from Turkish Health Survey 2008 with 14,655 respondents. We calculated concentration index (C) and horizontal inequity index (HI) to measure the socioeconomic inequalities in utilization of general practitioner (GP) care, specialist care, inpatient care, dental care and emergency care. Contributions of each factor to the observed inequality in health care utilization were assessed through decomposition method.
  
  
  RESULTS
  There was a significant pro-rich inequality in specialist care and oral health care utilization among individuals as indicated by positive values of HI (=0.1149) and HI (=0.1137), respectively. However, the poor were more likely to utilize emergency care (HI=-0.0461) and inpatient care (HI=-0.0731). GP care was also slightly pro-poor distributed (HI=-0.0042).
  
  
  CONCLUSIONS
  Pro-poor income-related inequalities in health care use were largely explained by greater health care need among low income groups, while non-need factors were the main determinants for pro-rich utilization (education, residence area). Inequalities in dental and specialist care linked to low income, low education level and rural areas should be given priority by decision makers to reduce the negative impact of utilization on health. Our results provide some evidence of inequity in 2008, after the introduction of HTP and provide a baseline against which the effects of the new reforms can be assessed.
authors.affiliation: Department of Public Health, Faculty of Medicine, Katip Celebi University, Izmir, Turkey. Electronic address: drmelihkaan@hotmail.com.
authors.forename: Kaan
authors.initials: K
authors.lastname: Sözmen
authors.affiliation: Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey. Electronic address: belgin.unal@deu.edu.tr.
authors.forename: Belgin
authors.initials: B
authors.lastname: Ünal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D014421:Turkey; D055815:Young Adult
keywords: Equality; Equity; Health care utilization; Horizontal inequity; Turkey