The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equity in access to health services.Health expenditures have also increased in the past decades commensurate with income increases. Nonetheless, health policy in Turkey faces important challenges in further improving the health status of the population and enhancing the efficiency of the system.. Read More [pdf: 70KB]
1. Historical Overview of the Turkish Health System Prior to Recent Health Reforms
Prior to the launch of the recent reforms to the Turkish health system - the Health Transformation Programme -in 2003, the system was a combination of a national health service, providing limited health services free of charge to the population, and a number of social health insurance schemes covering formal sector workers and their dependents. There was also a social assistance programme for the poor and vulnerable. The historical development of this system is described in Annex 1.A1. This chapter describes the 2003 health system and its problems, prior to the introduction of the Health Transformation Programme. It focuses on pre-reform financing and coverage arrangements for the population, organisation of the health service delivery system, provider payment arrangements and resource allocation mechanisms, as well as the role of the government.
This chapter focuses on recent reforms to the health system in Turkey: the Health Transformation Programme (HTP) of the Ministry of Health, which includes the implementation of Universal Health Insurance (UHI). The HTP was conceived as a ten-year reform programme covering the period 2003-13. The reforms described here cover the period 2003-08.
3. The Performance of the Turkish Health System and its Determinants
In this chapter, an assessment is made of the performance of the Turkish health system and its determinants using an assessment framework agreed among OECD member countries. The "health system" is defined to include both medical care and the public health activities that are typically the responsibility of Ministries of Health."Performance" is assessed against the major goals of health policy: i) maximising health outcomes and responsiveness to consumers: ii) minimising costs, subject to attainment of these outcomes; and iii) pursuing equity in terms both of financial protection against unpredictable catastrophic medical care costs, and access to health services (Hurst, 2002). Assessing the performance of the Turkish health system against these goals entails: a) making a judgement on an "appropriate" level of spending on health care through time in the context of socio-economic and political economy factors; b) providing financial protection from unpredictable high health expenditures, and equity in access to health services; and c) securing value for money, or microeconomic efficiency, at the individual consumer and provider level. These are explained further in what follows.
4. Policy Challenges and Options for Further Reform
This chapter assesses Turkey's reform efforts in the context of the global evidence base on "successful" health-care reforms. It considers some contextual issues which will face the Turkish health system in the future. It makes an assessment of the Health Transformation Programme (HTP) and the steps needed to complete its implementation over the next five years. It considers some of the opportunities and challenges facing the health system in the longer term, and it offers alternative projections of costs based on likely future scenarios of economic growth, demographic/epidemiology changes, and increases in service use and provision. It identifies several critical areas for future health policy choices in Turkey. Finally, Box 4.2 puts forward key suggestions for meeting these challenges.
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