Working Paper: NBER ID: w21510
Authors: Resul Cesur; Pınar Mine Güneş; Erdal Tekin; Aydogan Ulker
Abstract: This paper examines the impact of universal, free, and easily accessible primary healthcare on population health as measured by age-specific mortality rates, focusing on a nationwide socialized medicine program implemented in Turkey. The Family Medicine Program (FMP), launched in 2005, assigns each Turkish citizen to a specific state-employed family physician who offers a wide range of primary healthcare services that are free-of-charge. Furthermore, these services are provided at family health centers, which operate on a walk-in basis and are located within the neighborhoods in close proximity to the patients. To identify the causal impact of the FMP, we exploit the variation in its introduction across provinces and over time. Our estimates indicate that the FMP caused the mortality rate to decrease by 25.6% among infants, 7.7% among the elderly, and 22.9% among children ages 1-4. These estimates translate into 2.6, 1.29, and 0.13 fewer deaths among infants, the elderly, and children ages 1-4, respectively. Furthermore, the effects appear to strengthen over time. We also show evidence to suggest that the FMP has contributed to an equalization of mortality across provinces. Finally, our calculations indicate that each family physician saves about 0.15, 0.46, and 0.005 lives among infants, the elderly, and children ages 1- 4 per province every year.
Keywords: universal healthcare; primary healthcare; mortality rates; Turkey; health policy
JEL Codes: I01; I11; I13; I14; I18; J13; J14
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Family Medicine Program (FMP) (I19) | Mortality rates (infants) (I14) |
| Family Medicine Program (FMP) (I19) | Mortality rates (elderly) (I12) |
| Family Medicine Program (FMP) (I19) | Mortality rates (children aged 1-4) (I12) |
| Family Medicine Program (FMP) (I19) | Equalization of mortality rates across provinces (I14) |
| Family Medicine Program (FMP) (I19) | Effectiveness over time (C41) |
| Family Physician (I11) | Lives saved among infants (J17) |
| Family Physician (I11) | Lives saved among elderly (J14) |
| Family Physician (I11) | Lives saved among children aged 1-4 (J17) |