To scrap or not to scrap health plan for the poor

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To scrap or not to scrap health plan for the poor
Oluşturulma Tarihi: Haziran 27, 2009 00:00

ANKARA - More than 30 percent of the poorest people of working age do not have any kind of health coverage and nearly 20 percent of the entire population has no coverage. The future of a program that provides access to health care for the poorest strata of society is being pondered.

The state is considering ending its program for providing health care to the poor strata of society, increasing concern that a larger part of the population will be left helpless.

The Green Card program, currently in practice, has been in operation since 1992 and has provided health coverage for 10.2 million people. The coverage includes treatment costs for inpatient and outpatient care, pharmaceutical costs and the expenses of a mother and her newborn infant for up to 90 days. Those that apply for a Green Card need to document that they do not have social security or a monthly income or live in a household where someone has a monthly income surpassing one-third of the minimum wage. Since the program’s inception it has been debated about whether it has proved successful and if it was open to abuse.

Strengths and weaknesses

A report prepared by scholars at Istanbul’s Bahçeşehir University on the Green Card application analyzes the strengths and weaknesses of what it terms "the most costly social policy of Turkey." On one hand, out of 15 million people of working age from the lowest income group, 4.5 million, amounting to 30 percent, do not have any kind of health coverage. On the other hand, more than 21 percent of Green Card holders have incomes exceeding the maximum allowed. That adds up to 1.3 million people. According to the report, "There may be people in this group who met the income criteria at the time they received Green Cards and did not have the cards canceled when their incomes increased. Another part may have received the card by providing false information or through influential contacts."

A typical Green Card holder’s profile is defined as someone who "has no or very minimal education, is a member of a crowded family, is a home owner but with no central heating, does not own a car, or has an unregistered job." According to the home income survey of the Turkish Statistical Institute, or TurkStat, from 2006, there are two types of income data: household income and personal income. The Bahçeşehir report said Turkey’s average for annual personal income for people over 15 years of age was 5,946 Turkish Liras. The number dropped to 2,291 liras for Green Card holders over 15. These statistics point to Green Card holders being considerably poor by the Turkish average. However, personal income may not be reliable data to make comparisons and poverty analyses because a large number of people have their annual personal income totals as zero on the survey results because they do not work at a job and have no social security. When household incomes are also considered, the Turkey average for annual useable household income per individual is 8,564 liras while this household income for an average Green Card holder is 3,288 liras.

The report asks whether the cards are being distributed according to the established criteria. The report states that if looked at from the point of view that 82 percent of Green Card holders hail from the poorest strata of society, the program can be hailed as a success and that it has met its goals. However, the report continues by pointing out the existence of Green Card holders from the upper income groups and that shows there is abuse of the system.
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