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Access to Electronic Thesis Access to Electronic Thesis Author: Dilek Kilic Thesis title: Empirical Analysis of Health and Educational Attainment in Turkey Qualification: PhD This electronic thesis is protected by the Copyright, Designs and Patents Act 1988. No reproduction is permitted without consent of the author. It is also protected by the Creative Commons Licence allowing Attributions-Non-commercial-No derivatives. If this electronic thesis has been edited by the author it will be indicated as such on the title page and in the text. EMPIRICAL ANALYSIS OF HEALTH AND EDUCATIONAL ATTAINMENT IN TURKEY Dilek KILIC A thesis submitted to the University of Sheffield for the Degree of Doctor of Philosophy in the Department of Economics Date Submitted: June 2012 ABSTRACT The overall aim of this thesis is to examine and analyse three separate yet related issues in health and education that have been attracting increasing attention on the policy agenda in Turkey, especially over the recent decade. Public policy attention has particularly been devoted to issues such as financial protection against health care costs, decreasing the smoking prevalence rate and closing the gender gap in educational attainment. One of the main reasons behind the interest of policy makers in these areas may be attributed to need of the country to enhance human capital as well as to its aim to fulfill the requirements for EU membership. This provides the motivation for the empirical analyses presented in this thesis which investigate these issues in depth and, where relevant, provide policy implications. The first empirical study presented in Chapter 2 investigates the prevalence of ‘catastrophic’ out-of-pocket health care expenditure in Turkey and identifies the factors which are associated with its risk. The results indicate that poverty is an important barrier to seeking health care and that poverty is inversely associated with the risk of incurring catastrophic health expenditure. Chapter 3 examines the determinants of adult smoking propensity and intensity from a gender perspective. The findings of this chapter are twofold. First, the factors associated with smoking participation differ from the factors associated with the level of cigarette consumption. Second, the determinants of smoking behaviour are found to be different across males and females. The third empirical study is presented in Chapter 4 and aims to examine the educational attainment of girls and boys at the primary and secondary education levels. The findings indicate that the determinants of educational attainment and the potential factors that are associated with gender inequality differ by the level of education. 2 ACKNOWLEDGEMENTS First of all, I would like to express my deepest gratitude to both of my supervisors, Sarah Brown and Arne Risa Hole for their precious time, expert guidance and unwavering support. This thesis would not have been completed without their professionalism and encouragement. I am also grateful to Jennifer Roberts for her valuable comments and suggestions. I would like to thank Steven McIntosh for his help and interest during this process as well as his valuable suggestions and comments. My thanks also go to the Department of Economics of the University of Sheffield for the warm welcome and their help anytime I needed it. I would like to thank my family for their unconditional love and encouraging me in this tough process. I would also like to thank Selcen Turanli, who provided her unique friendship at every stage of this PhD process, for her unconditional support. I thank Selcen for many hours of patient listening and for her help and useful comments on this thesis. I would like express my thanks to my friends, Onur Yeni and Derya Guler Aydin for their warm support they gave over this time. My special thanks go to Sureyya and Metin Mehmet for their friendship and hospitality. Most of all, I would like to thank Seyfi Kilic, whose love and belief in me made this all possible, for his encouragement, sacrifices and understanding. 3 TABLE OF CONTENTS ABSTRACT ..................................................................................................................... 2 ACKNOWLEDGEMENTS ............................................................................................ 3 TABLE OF CONTENTS ................................................................................................ 4 LIST OF TABLES .......................................................................................................... 7 LIST OF FIGURES ...................................................................................................... 10 ABBREVIATIONS ....................................................................................................... 11 CHAPTER 1: INTRODUCTION ................................................................................ 13 1.1 Aims and Motivation of the Thesis ....................................................................... 13 1.3 Structure and Content of the Thesis ...................................................................... 17 1.3.1 Chapter 2 ......................................................................................................... 17 1.3.2 Chapter 3 ......................................................................................................... 18 1.3.3 Chapter 4 ......................................................................................................... 18 CHAPTER 2: THE DETERMINANTS OF ‘CATASTROPHIC’ OUT-OF- POCKET HEALTH CARE EXPENDITURE IN TURKEY .................................... 20 2.1 INTRODUCTION ................................................................................................. 20 2.2 THE TURKISH HEALTH CARE SYSTEM ....................................................... 24 2.3 LITERATURE REVIEW ...................................................................................... 31 2.3.1 Defining Catastrophic Health Expenditure ..................................................... 31 2.3.2 The Distribution of Catastrophic Health Expenditure .................................... 34 2.3.3 The Determinants of Catastrophic Health Expenditure .................................. 37 2.4 DATA AND METHODOLOGY .......................................................................... 43 2.4.1 Data ................................................................................................................. 43 2.4.2 Estimation Methods ........................................................................................ 44 2.4.3 Variable Construction and Definitions ........................................................... 50 2.4.4 Descriptive Statistics....................................................................................... 54 2.5 RESULTS .............................................................................................................. 61 2.5.1 Summary of the Key Findings ........................................................................ 67 2.6 CONCLUSION ..................................................................................................... 68 APPENDIX TO CHAPTER 2 ..................................................................................... 74 CHAPTER 3: GENDER DIFFERENCES IN CIGARETTE CONSUMPTION IN TURKEY ........................................................................................................................ 92 3.1 INTRODUCTION ................................................................................................. 92 3.2 SMOKING PREVALENCE AND TOBACCO CONTROL POLICIES IN TURKEY ..................................................................................................................... 96 4 3.2.1 Smoking Prevalence among Adults ................................................................ 96 3.2.2 Smoking Prevalence among Selected Occupational Groups .......................... 97 3.2.3 Youth Smoking Prevalence ............................................................................ 97 3.2.4 Gender Differences in Smoking Prevalence ................................................... 98 3.2.5 Tobacco Control Policies in Turkey ............................................................. 101 3.3 LITERATURE REVIEW .................................................................................... 103 3.3.1 Time Series Studies ...................................................................................... 103 3.3.2 Household and Individual Level Studies ...................................................... 104 3.3.2.1 The Double-Hurdle Model...................................................................... 106 3.3.2.2 The Zero-Inflated Model and the Two-Part/Hurdle Count Data Model . 108 3.3.3 Panel Data Studies ........................................................................................ 109 3.3.4 Studies on Different Aspects of Cigarette Demand ...................................... 109 3.3.5 Studies on the Cigarette Demand in Turkey ................................................. 110 3.4 DATA AND METHODOLOGY ........................................................................ 113 3.4.1 Data ............................................................................................................... 113 3.4.2 Estimation Methods ...................................................................................... 114 3.4.3 Variable Construction and Definitions ......................................................... 120 3.4.4 Descriptive
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