Transforming Health Care in Turkey: Achievements and Controversy

As a result of an assessment conducted in December 2003, comprehensive health care reforms in Turkey started under the umbrella of “Transformation in Health Program.” Turkey's health system formerly relied upon a combination of three highly fragmented public insurance schemes along with the public provision of health care services. By all standards the system was considered laggard and underachieving. With a strong political commitment by the majority Justice and Development Party in power and financial support from the World Bank, Transformation in Health Program promised a people focused approach, pluralism, decentralization, and financial incentives and competitiveness. It also involved radical restructuring, such as the separation of the provision and financing of healthcare to achieve a higher degree of efficiencies and the introduction of universal health insurance and family medicine to integrate and streamline the delivery of primary and inpatient care. Despite remarkable improvements in health indicators in the last decade, the program is still surrounded by controversy and is not well received by major stakeholders such as the Turkish Medical Association, other health sector workforce organizations, and progressive groups. The purpose of this presentation is to describe and analyze achievements and controversies brought about by the Transformation in Health Program in Turkey. Current health system indicators will be compared with indicators before the program. The impact of the program on public health will be discussed. The role of the newly restructured Turkish Agency for Public Health (Turkiye Halk Sagligi Kurumu) will be assessed.