ABSTRACT
This study presents a methodology to predict the child poverty impact of COVID-19 that can be readily applied in other country contexts where similar household data are available-and illustrates this case using data from Turkey. Using Household Budget Survey 2018, the microsimulation model estimates the impact of labour income loss on household expenditures, considering that some types of jobs/sectors may be more vulnerable than others to the COVID-19 shock. Labour income loss is estimated to lead to reductions in monthly household expenditure using an income elasticity model, and expenditure-based child poverty is found to increase in Turkey by 4.9-9.3 percentage points (depending on shock severity) from a base level of 15.4%. Among the hypothetical cash transfer scenarios considered, the universal child grant for 0-17 years old children was found to have the highest child poverty reduction impact overall, while schemes targeting the bottom 20-30% of households are more cost-effective in terms of poverty reduction. The microsimulation model set out in this paper can be readily replicated in countries where similar Household Budget Surveys are available.
Cette étude présente une méthodologie pour prédire l'impact de la COVID-19 sur la pauvreté infantile et que l'on peut aisément appliquer dans d'autres pays où des données similaires sur les ménages sont disponibles. L'étude illustre ce point en utilisant des données venant de Turquie. À l'aide de l'Enquête sur le budget des ménages de 2018, le modèle de microsimulation estime l'impact de la perte de revenus professionnels sur les dépenses des ménages, en prenant en compte le fait que certains types d'emplois/secteurs peuvent être plus vulnérables que d'autres au choc provoqué par la COVID-19. On estime que la perte de revenus professionnels entraîne des réductions au niveau des dépenses mensuelles des ménages, selon un modèle d'élasticité du revenu, et que la pauvreté infantile sur la base des dépenses - augmente en Turquie entre 4,9 à 9,3 points de pourcentage (en fonction de la gravité du choc) à partir d'un niveau de base de 15,4 %. Parmi les scénarios hypothétiques de transferts monétaires envisagés, l'allocation universelle pour les enfants de 0 à 17 ans s'est avérée être la mesure qui a l'impact global le plus important sur la réduction de la pauvreté des enfants, tandis que les programmes ciblant les 20 à 30 % des ménages les plus pauvres sont les plus coût-efficaces en terme de réduction de la pauvreté. Le modèle de microsimulation présenté dans cet article peut être facilement reproduit dans les pays où des enquêtes similaires sur le budget des ménages sont disponibles.
ABSTRACT
Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services).
