Asena Caner

An economic analysis of tobacco elimination policies in Turkey

OBJECTIVE We aim to evaluate the costs and benefits of various tobacco elimination policies, specifically, an immediate taxation option and eight tax-combined long-term cessation programs. METHODS We combine demographic projections for the period 2012-2050 with incidence and mortality rates of four major cigarette related diseases, price elasticity of cigarette demand and unit costs of nonprice measures to reduce demand in order to estimate the net present discounted values of policy alternatives. RESULTS The tax-combined cessation programs yield lower net costs to households and the society when they phase out smoking earlier. However, immediate taxation option is found to be superior, for both households and the society, to all tax-combined cessation programs irrespective of the duration of intervention. While all policies are estimated to yield significant reductions in the expected number of smoking related diseases and deaths, a class-based 20-year intervention is found to be the most effective program. CONCLUSIONS Although immediate taxation policy and tax-combined class-based 20-year intervention program emerge as the best tobacco elimination policies for the society, more research is needed on assessing the cost-effectiveness, applicability and social desirability of these alternatives and on designing additional policies to overcome their limitations.

Utilization of health-care services by young children: The aftermath of the Turkish Health Transformation Program

The Turkish Health Transformation Program, initiated in 2003, has identified achieving universal access to health care as 1 of its main tenets. To date, substantial progress has been made toward universal health coverage. Service utilization statistics display an upward trend. In this study, we use official and nationally representative microdata collected by the Turkish Health Research Surveys to examine young childrens (ages 0-5) utilization of health services. Children in this age group deserve special attention because adverse health conditions in early childhood are known to have long-time consequences. Policy makers regularly monitor statistics such as infant mortality rate and under-5 mortality rate. We conduct logistic regression analyses to explain the probabilities of being taken to a health institution, to a dentist, and being included in the newborn screening program. We use a rich set of explanatory variables that represent the socioeconomic status (SES) of the childs household. Contrary to our expectations and to the goals of universal health coverage is SES indicators such as the insurance ownership of the parent matter for utilization. Decomposition analyses confirm these findings and reveal that the increase in utilization should have been higher than observed. Children from low SES households should be given special attention and that research efforts should focus on identifying the barriers that still hinder childrens utilization of health-care services.