From socialisation to privatisation of health services in Turkey (1960-2008)

Primary Health Care (PHC) services are public service since 1961, having been established by the law of socialization. It aimed to provide PHC services to everybody through approximately 6,000 health centres. This services is almost free of charge for the patients and is funded by the government. However in the last 25 years there have been rapid changes in health sector. The current Turkish government wants to change the socialization of health services which is called as Health Transformation Program. The main aim of this program is to encourage the private sector to play a larger role in the health care system and giving hospitals more financial autonomy without governmental supports. In 2005, the family physician pilot project started implementation and included 50 cities (60%) in 2008. In this program, family physicians are defined as private doctors who contract with the MOH. They will be renting their practices (offices) from the MOH in health centres. This means privatization at the primary level through family physicians. On the other hand health care expenditures are becoming higher. It’s estimated that health care expenditures was approximately 33 billion US Dollars in the year 2006 when it was only 10 billion USD in 2001. The proportion of GDP spent on health care expenditures more than doubled from 2.9% to 7.5% from 1985 to 2006. In 2006, health care expenditure created by public sources was 72% of total health care spending while out-of-pocket payments constituted 28%. On the other hand, occupational health services have been supplied by private physicians for a long time now. Finally, privatisation of the health sector is increasing every year and the government policies aim to supply the private health care sector with public resources and rapidly growing number of private facilities is concentrated in urban areas, exacerbating existing health inequities.