Question

Describe the healthcare systems in Turkey in term of:

• Funding
• Future challenges regarding the healthcare system both financially and politically.
• Some of the positive and negative aspects of both public and private healthcare funding

Answer 1

The Turkish healthcare system is financed primarily by taxes (41%), followed by insurance premiums (31%), and out-of-pocket payments which comprises 28% of the total budget. The system is a combination of national health insurance and private health insurance. The coverage of compulsory health insurance provided by social security foundations is comprehensive. The private sector is small but growing rapidly, and complements rather than competes with the state system.

Future challenges for the Turkish health care system include-

1. Reorganizing and enforcing a referral system from primary to higher levels of care

2. Improving the supply of health care staff

3. Introducing and extending public hospital governance structures that aim to grant autonomous status to public hospitals

4. Improving patient rights.

Turkey has also made great advancements to improve access to quality health care services at all levels, with well documented impact on maternal and child health outcomes. Nevertheless, challenges remain in terms of integrating timely detection and continuous management of non-communicable diseases such as cardiovascular disease conditions, diabetes, and cancer. Although disease burden and treatment of communicable diseases have been efficiently managed by the healthcare system, the disease burden of non-communicable disease poses a significant threat to the healthcare system. The increasing difference economically between the rich and the poor has to be addressed politically for better health services in the country.

The implementation phase of the Turkish Health Transformation Program (HTP) began in 2003. The primary objectives of the HTP were the creation of a single-payer system; improved patient choice with regard to where to receive treatment; increased health insurance coverage for the poorest people; decreased infant, child, and maternal mortality rates; and increased patient satisfaction with health care services. This implementation changed the entire health care system. Following this, state and university hospitals became the major service providers. Social insurance contribution rates and premium levels are determined by the central government. The HTP affected all clinical and economic outcomes of health, including pharmaceutical sales, by improving access to health services.

A reimbursement policy was introduced where reimbursement was given for pharmaceuticals, which had a negative impact on value for both locally manufactured and imported pharmaceutical. Otherwise, overall the impact has been good.

Due to the overburdened public health care system where people had to wait in long queues, the private health care has provided good quality healthcare in Turkey. There is a substantial increase in medical tourism business in Turkey, with almost 178 thousand tourists visiting for health purposes in the first six months of 2018, due to turkey being one of the least costliest and better healthcare provider in Europe. This has led to an increase in overall productivity in private healthcare with increased money coming out through medical tourism.

Overall private health sector provides better and quicker health care as compared to public health sector although it is at a siginficantly increased cost. The negative impact has been as discussed here the cost. meaning it is not affordable for all the people and hence accessible to only a small proportion of the population. However, now most if the private hospitals have contracts with various insurance companies so it is now possible to receive treatment.