Health reform and new politics of health care in Turkey

The health care system in Turkey has undergone a transformation process since the Health Transformation Programme (HTP) launched in 2003 and significantly increased marketization in health care provision. This study asks the following questions: What political dynamics enabled the introduction of health care reform in Turkey? What kind of political conflicts did the reform generate? How and to whose benefit have these conflicts been resolved? As a historically grounded, single country case study, this study draws on 33 in-depth interviews conducted with major political actors who were involved in the HTP. This study concludes that the reform under consideration was a product of two factors: the World Bank’s pro-market approach to health reforms that became internalised in the health care bureaucracy in Turkey after the mid-1980s, and the controlled populism of the Justice and Development Party (the AK Party). With the introduction of the HTP, the power distribution upon which Turkey’s health care system is based has been changing in three ways. First, the Turkish Medical Association (TTB) lost its leverage in health care policies. Excluded from the reform process, the only success of the TTB was using judicial activism to block the government’s attempts to introduce a full time work requirement for medical doctors. Second, the reform gave birth to the emergence of a new political actor in health care politics, namely private health care provider organisations. Private health care provider organisations, which avoided confrontational discourse in their relations with the government due to the financial dependency of the sector on the state, succeeded in altering the legal and administrative limits that the reform put on their opportunities for capital accumulation. Finally, the transformation of the AK Party from a catchall party to a cartel party that undermines the electoral competition in Turkey might put the representation of the citizens’ interests on health care policies at risk.