PERFORMANCE-BASED PAYMENTS IN THE TURKISH HEALTH SYSTEM
Gulbiye Yenimahalleli Yasar and Pinar Guven-Uslu
Over the past two decades, the health sector has been the focus of much policy reform, coinciding with shifting ideas worldwide regarding the welfare state and the role of the public and private sectors in healthcare financing and delivery (Lee, Buse, and Fustukian 2002). At the same time, the New Public Management paradigm has influenced a number of public policy changes around the world and has brought about increasing demands on healthcare organizations to deliver improvements on outcomes measures, which are defined and directed by central governments. The methods and approaches used to direct, control, and measure performance of healthcare professionals and organizations are diverse and numerous, ranging from management control systems to various organizational incentives (Walshe and Smith 2006).
A key aspect of healthcare management and of delivering improved healthcare services is the retention, training, and motivation of an appropriate healthcare workforce. How to do so is the subject of ongoing study. This chapter contributes to that literature by describing the recent performance management reforms in Turkey focused on both compensation of health professionals and hospital management.
The chapter is organized as follows. It starts with a brief history of recent reforms of the Turkish healthcare system, and then profiles healthcare services, facilities, and workforce in Turkey. This is followed by a historical development of the performance-based supplementary payment (PBSP) system. Then PBSP system performance measurements and models are presented. The chapter concludes with consequences of the PBSP system—impact on motivation, satisfaction and productivity of health personnel; impact on health services; and impact on utilization of resources.