BRIEF HISTORY OF RECENT REFORMS IN THE TURKISH HEALTHCARE SYSTEM
The 1980 coup detat in Turkey led to the introduction of structural adjustment and market-oriented reform policies. Since then the Turkish healthcare system has experienced a neo-liberal transformation (Hamzaoglu and Yavuz 2006; Pala 2007; Yenimahalleli Yasar 2008; Sonmez 2011; Yavuz and Ocek 2011). With funds from a World Bank loan in 1989, the State Planning Organisation explored health problems and their possible solutions. “The Plan suggested splitting the function of purchasing and provision, developing an internal market, implementing general health insurance, formulating a family medicine system at the primary health care level and giving autonomy to the state hospitals” (Tatar et al. 2011, 147).
A National Health Policy (NHP) document adopted these strategies in 1993 (Ministry of Health [MoH] 1993). However, despite some attempts to implement the targets of the NHP document and the continuing support from the World Bank, the program was interrupted by a change of government in 1993. A decade of political and economical instability followed (1993-2003) mainly due to the unstable coalition governments, and strong reactions to the reforms and objections from health-related professional organizations such as the Turkish Medical Association. As a result, the reform proposals remained as blueprints, with no steps for implementation.
In 2003, the Justice and Development Party took office and announced a health reform program, called the “Health Transformation Programme” (MoH 2003). The HTP reintroduced the reform proposals mentioned above with eleven components, including a new role for the Ministry of Health as a planner and controller; a general health insurance (GHI) system; reorganization of health service delivery via introduction of a family medicine scheme and autonomous hospitals; and human resources development of health personnel who are knowledgeable, skilled, and highly motivated (Akdag 2009 and 2011; MoH 2007a). The major areas of concern are improving health status, solving the problems of low coverage and low service quality, as well as improving governance and efficiency (Yenimahalleli Yasar 2011).