Turkish Health System in Transition: Historical Background and Reform Experience
This dissertation studies the evolution of Turkey’s health care system within the context of the transformation of its welfare regime. It examines the struggles over the introduction and expansion of health insurance looking both at the power distribution among actors and the impact of political institutions on the formulation and implementation of policy decisions. It also takes into account the ‘international’ or ‘external’ dimension of policymaking, in terms of growing influence of international and regional organizations, increased pace of international communication of policy ideas as well as the rising importance of world economic patterns of trade and investment.
Turkish welfare regime can best be described in terms of an ‘inegalitarian corporatist’ system: it is corporatist in the sense that achieving income security through formal mechanisms is dependent on membership of occupationally-defined corporate groups and it is inegalitarian because this corporatist system systematically excludes a large segment of the population who are not employed in the formal sector. In order to meet the security needs of this latter group, a number of informal mechanisms has emerged which was largely based on community and family relationships.
This study examines the transformation of this inegalitarian-dual structure which accounts for the growing pressures of reform in the health care system. It argues that the shift towards universalism – a marked feature of the recent reform program, Health Transformation Project (HTP) - can only be explained as part of the changes in both the formal and informal components of the welfare system. While the growing needs and demands of a growing percentage of the population made it imperative for the ‘reformist’ Justice and Development Party leaders to initiate a reform process right after they formed the single-party government, their goals and strategies were significantly influenced by the previous reform initiatives as well as the global reform agenda that has been spreading like an epidemic. It is only through such a perspective that focuses on how particular national dynamics interact with diverse external pressures and actors that we can explain the creation of a reform program including universalist policies as well as market elements.