Person: ALPANDA, Berna Tuncay
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Berna Tuncay
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ALPANDA
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ArticlePublication Metadata only Shelter from the storm: health service access and utilization among Syrian refugees in Turkey(Springer, 2022-11) Tuncay Alpanda, Berna; Özen, İ. C.; Bump, J. B.; Economics; ALPANDA, Berna TuncayAim: Since 2011, the conflict in Syria has led to the migration of 5.6 million refugees, mainly to neighbouring countries. By the start of 2019, over 3.5 million people had moved to Turkey to seek safety, meaning that Turkey is hosting the majority of these refugees. Most of them are today settled in urban and peri-urban locations. A large part of the health services of these populations had been cut before their move, leaving a significant population that had been unprotected and under-provided for. The Turkish health system has provided a cost-free way for these populations to use health services, especially public health services at the primary and secondary levels. The objective of this study was to identify the size and the geography of the health shock as a result of the Syrian influx, starting in 2011. The resulting health effects of the refugee integration and the resilience of the health system are also assessed. Subject and methods: We investigated the medical treatment given in public hospitals for the Syrian population for the years 2012–2014, at the primary and secondary health levels. We investigated 10,444,290 cases of health visits, 7,211,342 of them occurring at the secondary level and representing more than 70% of total applications. The overall coverage of the health system for the Syrian population is estimated to be 64%, with 115,000 live-births among Syrian refugees occurring in the same time period. Results: Since the influx of Syrian refugees, there has been a considerable shock to the regional part of the Turkish health system located closest to the Syrian border. From the Syrian refugee point of view, no significant over-crowding or lowered quality effect was observed in the health system. The Syrian refugee’s health demand was observed to be different from that of the Turkish average, as this population’s unique vulnerabilities and access evolution came to the fore. However, significant convergence was then observed in the health demand, as urgent needs were converted into more routine health requirements over time. Conclusion: This initial investigation of the Turkish health system after the Syrian integration underlies the case for a significant resilience being shown, especially in areas where it has been most severely tested.ArticlePublication Open Access Inequalities in the geographical distribution and workload of obstetrics and gynaecology specialists by gender in Turkey(World Health Organization, 2022-06) Erus, B.; Tuncay Alpanda, Berna; Economics; ALPANDA, Berna TuncayBackground: Women often have a preference for female obstetrics and gynaecology specialists (ob/gyns). Following the policy allowing physician selection by patients in Turkey, distribution of ob/gyns by gender across provinces has been an important indicator of access to healthcare. Aims: To analyse ob/gyns distribution by gender across provinces in Turkey, with emphasis on the relationship with conservativeness of the province and resulting physician workload. Methods: We measured the number of male and female ob/gyns by province in 2016 and the number of outpatient visits and deliveries performed by male and female ob/gyns in 2015. Pearson and Spearman correlation of the female ratio with votes for conservative parties was used to assess the distribution of ob/gyns. We then analysed the correlation with resulting workload of female ob/gyns and ran linear regressions of these variables controlling the number of ob/gyns in a province. Results: More conservative provinces, measured by the vote share for conservative political parties, have a higher ratio of female ob/gyns. Linear regression showed that a 1 percentage point (pp) increase in the vote share corresponded to a 0.69 pp increase in female ratio. For workload, a 1 pp higher female ratio resulted in a decrease in workload, measured as outpatient visits per female ob/gyn divided by that per male ob/gyn, by 0.014. Conclusion: Conservative provinces have more female ob/gyns, but other provinces compensate for that with higher female ob/gyn workload. High workload may have adverse health effects and result in lower quality of care.ArticlePublication Metadata only The effect of hosting 3.4 million refugees on native population mortality(Elsevier, 2021-12) Aygün, A.; Kırdar, M. G.; Tuncay Alpanda, Berna; Economics; ALPANDA, Berna TuncayAs of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was utterly broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives. We examine the effect of Syrian refugees on the health care resources in Turkey and on natives’ mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of an adverse effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the refugees’ pressure on the health care services in Turkey and the government's response to understand our findings on mortality outcomes.Book PartPublication Metadata only Relating dynamic test capacity, digital tracking of countries and COVID-19 Performance: A cross-country study(Peter Lang AG, 2022-10-05) Tuncay Alpanda, Berna; Özen, İ. C.; Economics; Ayhan, Fatih; Darıcı, Burak; ALPANDA, Berna TuncayN/AArticlePublication Open Access Understanding household healthcare expenditure can promote health policy reform(Cambridge University Press, 2023) Best, R.; Tuncay Alpanda, Berna; Economics; ALPANDA, Berna TuncayStudies of health care expenditure often exclude explanatory variables measuring wealth, despite the intuitive importance and policy relevance. We use the Household, Income and Labour Dynamics in Australia Survey to assess impacts of income and wealth on health expenditure. We investigate four different dependent variables related to health expenditure and use three main methodological approaches. These approaches include a first difference model and introduction of a lagged dependent variable into a cross-sectional context. The key findings include that wealth tends to be more important than income in identifying variation in health expenditure. This applies for health variables which are not directly linked to means testing, such as spending on health practitioners and for being unable to afford required medical treatment. In contrast, the paper includes no evidence of different impacts of income and wealth on spending on medicines, prescriptions or pharmaceuticals. The results motivate two novel policy innovations. One is the introduction of an asset test for determining rebate eligibility for private health insurance. The second is greater focus on asset testing, rather than income tests, for a wide range of general welfare payments that can be used for health expenditure. Australia's world-leading use of means testing can provide a test case for many countries.ArticlePublication Open Access Welfare and research and development incentive effects of uniform and differential pricing schemes(Springer, 2021-09-22) Gnecco, G.; Pammolli, F.; Tuncay Alpanda, Berna; Economics; ALPANDA, Berna TuncayThis paper is about the application of optimization methods to the analysis of three pricing schemes adopted by one manufacturer in a two-country model of production and trade. The analysis focuses on pricing schemes—one uniform pricing scheme, and two differential pricing schemes—for which there is no competition coming from the so-called parallel trade. This term denotes the practice of buying a patented product like a medicine in one market at one price, then re-selling it in a second so-called gray market at a higher price, on a parallel distribution chain where it competes with the official distribution chain. The adoption of pricing schemes under which parallel trade does not arise can prevent the occurrence of its well-documented negative effects. In the work, a comparison of the optimal solutions to the optimization problems modeling the three pricing schemes is performed. More specifically, conditions are found under which the two differential pricing schemes are more desirable from several points of view (e.g., incentive for the manufacturer to do Research and Development, product accessibility, global welfare) than the uniform pricing scheme. In particular, we prove that, compared to the uniform pricing scheme, the two differential pricing schemes increase the incentive for the manufacturer to invest in Research and Development. We also prove that they serve both countries under a larger range of values for the relative market size, making the product more accessible to consumers in the lower price country. Moreover, we provide a sufficient condition under which price discrimination is more efficient from a global welfare perspective than uniform pricing. The analysis applies in particular to the case of the European Single Market for medicines. Compared to other studies, our work takes into account also the possible presence in all the optimization problems of a positive constant marginal cost of production, showing that it can have non-negligible effects on the results of the analysis. As an important contribution, indeed, our analysis clarifies the conditions—which have been overlooked in the literature about the mechanisms adopted to prevent parallel trade occurrence—that allow/do not allow one to neglect the presence of this factor. Such conditions are related, e.g., to the comparison between the positive constant marginal cost of production, the parallel trade cost per-unit, and the maximal price that can be effectively charged to the consumers in the lower price country.