Healthcare in Turkey: from laggard to leader

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7456 (Published 21 January 2011)
Cite this as: BMJ 2011;342:c7456

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  1. Enis Baris, director1,
  2. Salih Mollahaliloglu, head 2,
  3. Sabahattin Aydin, deputy undersecretary3
  1. 1Division of Country Health Systems, WHO Regional Office for Europe, Copenhagen, Denmark
  2. 2School of Public Health, Ministry of Health, Turkey
  3. 3Ministry of Health, Turkey
  1. Correspondence to: E Baris, The World Bank, Room H9-271, 1818 H Street NW, Washington, DC 20433, USA ebaris{at}worldbank.org

Enis Baris and colleagues observe that a political commitment to universal health coverage together with a significant investment in health has seen Turkey’s health indicators catch up and surpass other middle income countries

Less than a decade ago, the health system in Turkey was considered a laggard, not only relative to the rest of the Organisation for Economic Cooperation and Development (OECD) but to other high middle income countries. A major discrepancy existed between constitutional aspirations of equitable access to healthcare for all citizens and the reality on the ground. Health mattered, yet was seldom addressed on the political agenda. Today, the health system in Turkey is transformed, not quite to the point of favourable comparison with the rest of the OECD and most of the European Union, but fast closing the gap in health outcomes, responsiveness, and fair financing. We describe the Health Transformation Programme (HTP) launched in 2003, analyse the reasons behind its achievements, and share the lessons learnt.

An underachieving health system

Turkey’s health system was highly fragmented: it was governed by two ministries and financed and regulated through three separate statutory health insurance schemes. The system covered all of the employed population and a large proportion of the self employed, though with significant variations in the scope and depth of benefit packages. Direct and copayments at the point of service and subsidies from the state budget were the norm, and included the Green Card scheme, a health insurance plan for the poor, covering inpatient care for about 2.5 million people. Overall, about 65% of the population was covered. In 1998, Turkey spent 3.6% of its gross domestic product on healthcare, or about $295 per capita at purchasing power parity (£191; €220 at current exchange rates). About 40% of total health expenditure was private and out of pocket.1

Service provision …

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