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Health Insurance In Turkey - Bülent EREN (2014)
- 1. Bulent EREN, M.D. Vice GM, Demir Hayat Sigorta Leader of Health Committee of Insurance Association Turkey
- 2. General Information 76 Million population, young but birth rate is decreasing, getting older 820.012 Million USD GDP 10.700 USD GDP per capita Insurance Sector; 68 Insurance and 2 Reinsurance Companies 61 Insurance and 1 Reinsurance Companies are active Life Companies 4 Pension Companies 18 Non-Life Companies 39 Health Branch Companies 33
- 3. Turkish Health System and Financing Turkish Health System Public Health Providers Private Health Providers (approx.500 hospitals) Finance Of Health Expenditures Social Security System Private Health Insurance Out of pocket
- 4. Change of Health Expenditures in Turkey Indicators of Health Expenditures 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Toplam sağlık harcaması(Milyon TL) Totalhealth expenditure (Million TL) 4 985 8 248 12 396 18 774 24 279 30 021 35 359 44 069 50 904 57 740 57 911 61 678 68 607 76 358 4,8 4,9 5,2 5,4 5,3 5,4 5,4 5,8 6,0 6,1 6,1 5,6 5,3 5,4 Kaynak:TÜİK,Sağlık Harcama İstatistikleri Source: TurkStat, Health Expenditure Statistics Toplam sağlık harcamasının,gayrisafi yurtiçihasılaya oranı(%) Proportion of totalhealth expenditure to gross domestic product (%)
- 5. Breakdown of Health Expenditures Sağlık Harcaması - Health Expenditure, 2012 (000 000 TL) Genel Toplam Toplam Merkezi Devlet Yerel Devlet Sosyal Güvenlik Toplam Hanehalkları Diğer1 General Total Total Central Government Local Government Social Security Total Household Other1 Toplam sağlık harcaması Total health expenditure 76.358 58.640 16.348 662 41.630 17.718 11.750 5.968 Cari sağlık harcaması Current health expenditure 72.820 55.611 14.428 531 40.652 17.209 11.484 5.726 Hastaneler Hospitals 32.801 29.609 7.359 59 22.191 3.192 1.670 1.522 Evde hemşirelik bakımı Nursing and residential care facilities 350 - - - - 350 - 350 Ayakta bakım sunanlar Providers of ambulatory health care 13.611 7.718 4.113 282 3.322 5.893 4.598 1.295 Perakende satış ve diğer tıbbi malzeme sunanlar Retail sale and other providers of medical goods 19.271 14.478 169 9 14.300 4.793 3.825 968 Halk sağlığı programlarının sunumu ve yönetimi Provision and administration of public health programs 2.522 2.522 2.443 79 - - - - Genel sağlık yönetimi ve sigorta General health administration and insurance 664 194 - - 194 470 - 470 Sınıflandırılamayan diğer kategori Not specified by kind 3.601 1.090 343 102 645 2.512 1.392 1.120 Yatırım - Investment 3.538 3.029 1.920 131 978 509 266 243 Genel Devlet - General Government Özel Sektör - Private Sector
- 6. Gross Written Premiums and Gross Written Premiums Per Capita in USD Term Years Inflation Population (TL) (Million $) TL(%) $(%) TL*** $ TL(%) $(%) (%) (Million) 1981 22.851 203 502 4 45,5 1982 33.874 206 48,24 1,48 725 4 44,43 -1,13 27,00 46,7 1983 46.311 203 36,72 -1,46 967 4 33,29 -3,93 30,50 47,9 1984 85.288 231 84,16 13,79 1.737 5 79,66 11,01 50,30 49,1 1985 129.817 247 52,21 6,93 2.581 5 48,58 4,38 43,20 50,3 1986 191.510 281 47,52 13,77 3.726 5 44,37 11,33 29,60 51,4 1987 311.989 363 62,91 29,18 5.931 7 59,19 26,23 32,00 52,6 1988 572.082 401 83,37 10,47 10.653 7 79,61 8,21 68,30 53,7 1989 1.056.394 497 84,66 23,94 19.242 9 80,62 21,23 69,60 54,9 1990 2.211.100 710 109,31 42,86 39.414 13 104,83 39,80 53,10 56,1 1991 4.033.400 964 82,42 35,84 70 17 78,60 33,00 59,20 57,3 1992 8.171.400 1.187 102,59 23,10 139 20 98,10 20,37 61,40 58,6 1993 17.203.911 1.563 110,54 31,64 287 26 105,63 28,56 60,30 60,0 1994 31.729.591 1.066 84,43 -31,79 517 17 80,23 -33,34 149,90 61,4 1995 63.250.523 1.377 99,34 29,21 1.004 22 94,28 25,93 64,90 63,0 1996 128.167.862 1.535 102,64 11,43 1.984 24 97,62 11,28 84,90 64,6 1997 283.084.008 1.811 120,87 17,99 4.522 30 126,51 20,11 91,00 62,6 1998 549.736.978 2.119 94,20 17,01 8.485 33 91,08 15,13 54,30 64,8 1999 966.459.337 2.314 74,62 8,56 15 36 72,09 6,98 63,20 64,4 2000 1.774.577.979 2.847 83,62 22,99 27 44 81,01 21,25 32,66 65,3 2001 2.480.740.783 2.033 39,79 -28,59 37 31 37,86 -29,58 88,50 66,2 2002 3.650.727.900 2.426 47,16 19,61 54 36 45,17 17,99 30,80 67,1 2003 4.961.330.513 3.316 35,90 36,57 70 47 33,74 34,40 13,90 70,9 2004 6.621.024.600 4.656 33,45 59,52 92 65 31,38 38,23 11,10 72,0 2005 7.815.725.015 5.829 18,04 25,19 107 80 16,27 23,31 2,66 73,1 2006 9.666.022.056 6.713 23,69 15,15 131 91 22,34 13,91 11,58 73,9 2007 10.931.473.390 8.359 13,09 24,52 155 118 18,40 30,37 5,94 70,6 2008 11.779.475.057 9.061 7,76 8,40 165 127 6,38 7,02 8,11 71,5 2009 12.281.118.009 7.900 4,26 -12,81 169 109 2,68 -14,13 5,93 72,6 2010 14.129.895.725 9.418 15,05 19,21 192 128 13,34 17,51 8,87 73,7 2011 17.163.391.348 10.228 57,01 22,36 230 137 48,36 15,63 13,33 74,7 2012 19.828.688.642 11.062 15,53 8,15 262 146 14,15 6,86 2,45 75,6 2013 24.226.919.272 12.742 22,18 15,19 316 166 20,43 13,54 6,97 76,7 Increase of PremiumsGross Written Premiums Premiums Per Capita Increase of Premiums Per capita
- 7. Share of Insurance Branches by Gross Written Premiums (%) YEARS LAND VEHICLES HEALTH PUBLIC LIABILITY FIREAND NATURAL DISASTER GENERAL DAMAGES CREDIT LAND VEHICLES LIAB. OTHER NON-LIFE TOTAL LIFE 2008 24,20 11,26 1,98 15,52 6,85 0,35 17,51 8,96 86,62 13,38 2009 21,43 11,52 2,05 15,56 7,36 0,23 17,94 9,15 85,24 14,76 2010 22,06 12,07 2,32 14,01 7,03 0,23 18,02 8,77 84,50 15,50 2011 22,07 11,65 2,25 13,46 8,59 0,30 17,33 8,70 84,34 15,66 2012 22,87 11,23 2,12 13,34 8,79 0,37 19,86 7,73 86,31 13,69 2013 20,75 10,21 2,10 13,72 9,03 0,44 22,23 7,51 85,97 14,03
- 8. Marketing Channels BRANCH DIRECT TEAMS AGENCIES BANKS BROKERS TOTAL Accident 1,51% 49,12% 43,40% 5,97% 100,00% Health 13,99% 45,71% 11,21% 29,10% 100,00% Land Vehicles 0,55% 84,89% 8,07% 6,50% 100,00% Railway Vehicles 0,00% 100,00% 0,00% 0,00% 100,00% Transport 10,71% 56,05% 3,63% 29,61% 100,00% Fire & Nat. Disasters 9,99% 46,97% 26,31% 16,73% 100,00% General Damages 11,80% 47,25% 27,65% 13,30% 100,00% Land Vehicles Liability 1,09% 93,35% 1,28% 4,28% 100,00% NON-LIFE COMPANIES / BREAKDOWN OF PREMIUMS % OF MARKETING CHANNELS
- 9. Private Health Insurance Throughout Years Years WrıttenPr. Change % Insured Number Change % Earnedpr. Change % PaidClaims Change % Tech. Profit Change % Tech. Pr./ WrittenPr. C/P Ratio 2009 1.390.157.525 - 1.458.021 - 1.331.813.618 - 1.239.942.829 - -121.658.950 - -8,75 93,10 2010 1.675.377.354 20,52 1.666.023 14,27 1.577.582.588 18,45 1.354.550.161 9,24 -36.185.171 -70,26 -2,16 85,86 2011 1.962.821.974 17,16 2.549.216 53,01 1.709.794.705 8,38 1.436.729.973 6,07 12.537.219 134,65 0,64 81,43 2012 2.169.817.633 10,55 2.579.520 1,19 2.080.960.992 21,71 1.538.745.399 7,10 170.598.945 1.260,74 7,86 73,94 2013 2.398.077.778 10,52 2.788.611 8,11 2.294.622.525 10,27 1.759.895.366 14,37 88.112.130 -48,35 3,67 76,70 2009-2013 HEALTH BRANCH, WRITTEN PREMIUMS,PAID CLAIMS,TECHNICAL PROFIT AND C/P RATIO Years Health Branch Wr. Pr. Change % Non-Life Wr. Pr. Except Health Br. Change % 2009 1.390.157.525 6,52 9.084.208.246 2,09 2010 1.675.377.354 20,52 10.273.808.922 13,10 2011 1.962.821.974 17,16 12.516.284.682 21,83 2012 2.169.817.633 10,55 14.948.845.717 19,44 2013 2.398.077.778 10,52 18.434.327.386 23,32 2009-2013 HEALTH BRANCH AND OTHER NON-LIFE BRANCHES PREMIUM CHANGE
- 10. 93.10 85.86 81.43 73.94 76.70 -40,000,000 460,000,000 960,000,000 1,460,000,000 1,960,000,000 2,460,000,000 2,960,000,000 2009 2010 2011 2012 2013 % TL Health Branch Wr. Premium, Tech. Profit, H/P Alınan Prim Teknik Kar TeknikKar/ Alınan Prim (%) H/P
- 11. Health Branch Technical Results of Q2/2014 SİGORTA ŞİRKETLERİ HAYAT DIŞI BRANŞLARIN KONSOLİDE KAR ZARAR HESABI (TL) 01.01.2014-30.06.2014 HASTALIK-SAĞLIK 1.) TEKNİK GELİR 1.295.922.218 A.) YAZILAN PRİMLER (NET) 1.505.576.718 a.) Yazıl an Pri ml er (Brüt) 1.604.086.533 b.) Reas üröre Devredi l en Pri ml er (-) -98.509.815 c.) SGK'ya Aktarıl an Pri ml er (-) 0 B.) KAZANILMAMIŞ PRİMLER KARŞILIĞI (NET) (-) -1.283.981.898 a.) Kazanıl mamış Pri ml er Karşıl ığı (Brüt) (-) -1.359.596.473 b.) Kazanıl mamış Pri ml er Karşıl ığı (Reas .Payı) 75.614.575 c.) Kazanıl mamış Pri ml er Karşıl ığı (SGK.Payı) 0 C.) DEVREDEN KAZANILMAMIŞ PRİMLER KARŞILIĞI (NET) 992.013.419 a.) Devreden Kazanıl mamış Pri ml er Karşıl ığı (Brüt) 1.039.590.403 b.) Devreden Kazanıl mamış Pri ml er Karşıl ığı (Reas .Payı) (-) -47.576.984 c.) Devreden Kazanıl mamış Pri ml er Karşıl ığı (SGK.Payı) 0 D.) DEVAM EDEN RİSKLER KARŞILIĞI (NET) 0 a.) Devam Eden Ri s kl er Karşıl ığı (Brüt) 0 b.) Devam Eden Ri s kl er Karşıl ığı (Reas .Payı) (-) 0 E.) DEVREDEN DEVAM EDEN RİSKLER KARŞILIĞI(NET) 0 a.) Devreden Devam Eden Ri s kl er Karşıl ığı (Brüt) 0 b.) Devreden Devam Eden Ri s kl er Karşıl ığı (Reas .Payı) (-) 0 F.) TEKNİK OLMAYAN BÖLÜMDEN AKTARILAN YATIRIM GELİRLERİ 76.257.124 G.) DİĞER TEKNİK GELİRLER 4.890.856 H.) TAHAKKUK EDEN RÜCU VE SOVTAJ GELİRLERİ 1.165.999 2.) TEKNİK GİDER -1.318.482.484 A.) ÖDENEN HASARLAR (NET) (-) -997.557.734 a.) Ödenen Has arl ar (Brüt) (-) -1.045.462.028 b.) Ödenen Has arl ar (Reas . Payı) 47.904.293 B.) MUALLAK HASARLAR KARŞILIĞI (NET) (-) -131.497.610 a.) Mual l ak Has arl ar Karşıl ığı (Brüt) (-) -147.104.743 b.) Mual l ak Has arl ar Karşıl ığı (Reas . Payı) 15.607.134 C.) DEVREDEN MUALLAK HASARLAR KARŞILIĞI (NET) 115.319.180 a.) Devreden Mual l ak Has arl ar Karşıl ığı (Brüt) 128.664.886 b.) Devreden Mual l ak Has arl ar Karşıl ığı (Reas .Payı) (-) -13.345.707 D.) MATEMATİK KARŞILIK (NET) (-) 0 a.) Matemati k Karşıl ığı (Brüt) (-) 0 b.) Matemati k Karşıl ığı (Reas . Payı) 0 E.) DEVREDEN MATEMATİK KARŞILIĞI (NET) 0 a.) Devreden Matemati k Karşıl ığı (Brüt) 0 b.) Devreden Matemati k Karşıl ığı (Reas . Payı) (-) 0 F.) İKRAMİYE VE İNDİRİMLER KARŞILIĞINDA DEĞİŞİM 2.118.776 G.) DİĞER TEKNİK KARŞILIKLARDA DEĞİŞİM (-) -97.527 H.) FAALİYET GİDERLERİ (-) -297.788.495 I.) DİĞER TEKNİK GİDERLER -8.979.074 3.) TEKNİK KAR/ZARAR -22.560.266 TEKNİK KAR/ZARAR ORANI [3/(1.A+1.B+1.C)] -1,9%
- 12. Problems / Threats of Health Insurance Market 16,94 USD Health premium production per capita Health branch premium increase less than general market growth since 2011 Market share of health branch decreasing Premium per insured decreasing Income inadequacy Comprehensive social security Superstitious belief (God saves and protects) Compact new products (emergency , hospital daily compensation) Population is getting older Treatment expenses growing
- 13. Opportunities Social security and health providers system is going to privatized Social security and private health providers agreements, co-payments, additional charges, uncovered services Public hospitals are going to charge their services for self payers Social security system financial gap is growing, unsustainable Insurance penetration is low GDP per capita is increasing, income adequacy will be achieved Growing health expenses Health expenditures per capita reached 767 USD/year and increasing Life expectation at birth is increrasing New technologies in health sector
- 14. THANK YOU All figures , charts and graphics Undersecretariat of Treasury Insurance Association Of Turkey Turkish Statistical Institute