Letters Turkish healthcare reforms

“Transforming” our health by privatisation

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1959 (Published 29 March 2011) Cite this as: BMJ 2011;342:d1959
  1. Murat Civaner, associate professor
  1. 1Department of Medical Ethics, Uludag University School of Medicine, Bursa, 16059, Turkey
  1. mcivaner{at}gmail.com

Last month more than 30 000 healthcare workers protested on the streets of Ankara against the privatisation policies of the Ministry of Health. Organised by the Turkish Medical Association, the demonstration was the biggest in the republic’s history. Transforming doctors into commissioners (or to petit entrepreneurs as in Turkey), patients into customers, and healthcare services into a commodity are just a few outcomes of privatisation policies that conflict and erode professional values.

Your analysis on healthcare in Turkey may mislead readers.1 “Transformation in Health,” which the authors praise as a governmental achievement, is a World Bank project—a fact not mentioned in the article.2 Claims of “rampant absenteeism” and “unnecessary referrals” and that performance based payment “incentivises team work and sense of ownership of health facilities” need to be grounded by scientific evidence, as research shows the opposite.3

This BMJ article echoes the World Bank’s “Investment in Health” of 1993.4 It recommends the same treatment (privatisation, cost effectiveness, competition, decentralisation, performance based incentives, health insurance for covering a minimum package of essential services) for the same diagnosis (inefficiency, low productivity, low quality, exploding costs). Although its diagnosis, couched in terms from the business world, is fundamentally wrong, health services, especially in the developing world, have been commercialised for over 20 years.

As the authors state correctly, this is an “unfinished agenda.” According to the politicians, we will see more “public-private partnerships,” “health campuses” that gather health institutions outside the cities, new legislation for administering public hospitals by executive boards with members from companies, and more privatisation over the next years. To resist this metamorphosis of care givers we must object to privatisation policies as a whole. Defence of professional values and the right to healthcare provides us with solid grounds for developing justifiable objections.


Cite this as: BMJ 2011;342:d1959


  • Competing interests: None declared.