Labor rights in Turkey: Trade Union Act, The Anatomy of a Lie – Kıvanç Eliaçık

This article is a free translation of the Turkish original (“Sendikalar Yasası: Bir Yalanın Anatomisi”) published in Bianet on July 18th, 2012. The author of the article, Kıvanç Eliaçık, is the director of the international relations office in DİSK, the Confederation of Progressive Trade Unions of Turkey.

If a trade union that collaborates with employers lost its mind and started a campaign called “We want slavery” demanding “We want to work 16 hours a day. No to salaries!” would the government take this proposal seriously?

The news-hound asks: “The new trade union act is on the way! The barriers will be taken down! If the actual number of their members is announced, many trade unions will be shut down! The bans on strikes are being abolished! What do you think about these issues?” This type of journalism would be an excellent example of government propaganda material rather than an interview.

In Turkey, a worker can be prevented from becoming a member of a union or even demanding rights by being fired, arrested and sometimes even murdered. Trade union acts prepared after the 12th September Military Intervention are still in effect. Labor courts function really slowly, and the simplest union activities are stopped violently. In such circumstances, we read some news saying the trade union act will be changed. It is promised that the changes will be in accordance with the ILO Agreements, which Turkey already has signed. Yet the reform in question is always being postponed.

It has been claimed that if the postponement of the reform is an iceberg, then the disagreements between workers' organizations and employers' organizations (or even between trade unions) is only the tip of it. Yet for ILO or UN agreements to be applied, you do not need a “consensus” among the parties. For example, if a trade union that collaborates with employers lost its mind and started a campaign called “We want slavery.” and demanding “We want to work 16 hours a day. No to salaries!” would the government take this proposal seriously?

The responsibility of the government is to guarantee basic human rights. The government; that never consults the workers about anything related to labor and that passes strongly controversial laws in a single day despite trade union opposition; appeals to “consultation” methods in order to stall the process, when it comes to trade unions act.

Those who do not bother to listen to ILO's advice and criticism want us to believe that there will be improvements in the law, at exactly the same time when they are prohibiting strikes in aviation and arresting trade unionists. It is not easy to believe that, because we have a dead body in front of us. We must perform an autopsy on the laws that have no use other than preventing the exercise of trade union rights.

Autopsy Results

Here are the results of the autopsy of the laws 2821 and 2822, which were prepared right after the 1980 military intervention in order to prevent trade union activities, to restrict collective agreements, and to prohibit strikes:

If a worker wants to join a trade union, the first step s/he must take is to go to a public notary and have the membership form approved. Turkish Airlines can fire its employees via "sms", but a worker cannot say "I'll go to join the trade union" to her/his employer. S/he has to get a half day off to be able to go to the notary, and a whole day if the factory is far away. S/he has to pay 47 TL to the notary for the approval of the form. While it is not needed to go to a notary when joining an association or a political party, one has to pay even to quit a trade union. Actually, quitting is even more expensive! If you want to change your trade union, you must pay 138 TL in total.

Your job is not finished when you have been to the notary. Let us suppose for the sake of argument that your employer was not aware of the situation and did not fire you, and that your reemployment lawsuit didn't take two years. You have two more obstructions against exercising your collective agreement rights. The workplace barrier and the sector barrier... Your trade union must have 10% of all the workers in your line of business. For instance, a metalworkers' union must have, among the 1.279.000 legally employed metalworkers countrywide, at least 127.900 members in order to be able to have the right to collective agreements. And then, the same union must have half of the workers in your workplace as members too.

When the boss hears of union activities, s/he fires union members and especially those who invite others to join a union, with a variety of excuses. An employee who has been working for ten years gets fired all of a sudden due to low performance. And all the employees with the same surname are laid off together with her/him... Someone who was hired only that day comes to your machine and insults you. If you respond, some inspector enters the stage and writes a report, and you are fired because you initiated a fight in the workplace. If none of these works, the boss closes down the factory and moves it to the adjacent land.

Yet another obstruction for trade unions is the requirement to operate only in legally defined sectors. The determination of which sector a particular workplace belongs to in takes years of lawsuits. For instance, a health union that registers cleaning staff can get an answer from the court that it cannot represent cleaning staff because they belong to the general services sector. Then, when the general services union registers the same workers, another judge (because by chance the actual judge is at hospital that day) can rule “That is a hospital, and therefore it shouldn't be general services but health services”, thus resetting everything.

Let us now come to the last item, the last option for the union but the first to come into mind when we hear trade unions: strike. Just as the only real medicine is aspirin, the only real union activity is going on strike. The workers block the doors of the factory and use their power coming from production, until the union gets the desired salary increase. When a popular labor peer is fired, a whisper around the machines turns the switches off or shifts down a gear in the production. When the country prepares for a war, the trade unions declare their demand for peace with a general strike.

In Turkey, on the other hand, strike is either totally forbidden in certain sectors, or when it is supposedly allowed, it is almost impossible. Only after a disagreement in the collective bargaining process can you go on a strike and you have to declare it 60 days in advance. In the meanwhile, your strike can be forbidden or postponed.

In a country where millions work without social security and where even those with social security live below the hunger limits, only 6 percent of all the waged employees have the right to collective agreement, due to the aforementioned laws. At the end of the day, under the advanced democracy title, we are face to face with a “Collective Labor Relations Law” which doesn't even have trade unions in its name. According to the news publicized by government sources, when the Social Security Institution records are considered, many trade unions will lose their authority. Instead of using an iron hand in a velvet glove, the government should account for maintaining the military intervention laws for years and for hundreds of thousands of workers who died in work accidents, who have been fired without compensation, and who have been living under the hunger limit.

Health Care Reforms in Turkey – 5: “The Final Declaration of the Grand Right-to-Health Assembly of Turkey”

As part of our responsibility of providing English information on Turkey with a political perspective that is compatible with our stance, we started a series of translations of news items and articles on the transformations in the health care system in Turkey. You can reach the previous items by following the Health Care Reforms in Turkey label. We conclude our series by a translation of the declaration of the Grand Right-to-Health Assembly of Turkey. This news item is translated from the Turkish original published on March 12^th in Istanbul Medical Chamber's website.

The Final Declaration of the Grand Right-to-Health Assembly of Turkey

The opening ceremony of the Grand Right-to-Health Assembly of Turkey (TBSHM) was held in Ankara on March 11^th, 2012, with the attendance of 38 Provincial Right-to-Health Assemblies and many professional associations, labor unions, political parties and patients' rights associations.

TBSHM voted and rejected

1- the contribution fees for health services,

2- the rejection of patients in hospitals who cannot afford the social security premiums,

3- the so-called “extra fees” in private hospitals,

4- the “exceptional health care services” which is just a manifestation of the ground zero for conscience, ethics and humanity,

5- the commercialization of even the emergency rooms under the title “green space regulations”,

6- the transformation of the Ministry of Health from a service provider to a health corporation by the Legislative Decree No. 663 on the Structure and Missions of the Health Ministry,

7- the public hospital unions that transform public hospitals into corporate hospitals,

8- the enormous robbery under the public-private partnership program, where the risk is taken by the state and the profit is taken by the national/foreign monopolies/consortiums,

9- public health budget being given as a present to private hospitals,

10- the commodification of health care services, the renouncement of the health sector to wild market mechanisms, and the privatization in health care.

Open to further suggestions and contributions, TBSHM decided its basic stance on health care as follows:

1- Health care is a birthright.

2- Health care services should be equal, accessible, quality and free for all.

3- All the health expenses should be covered through taxes, without any other contribution fees or health premiums.

4- It is an indispensable and essential duty of the state to provide public health care services that focus on public interest as opposed to profit.

5- All levels of the health organization should be open for participation.

6- Preventive health services should be prioritized in order to protect and improve physical, psychological and social health.

7- All public financial resources that are reserved for the health services should be used for the public health system.

8- Subcontracting in the health services should be prohibited.

9- The health employees should be provided with covered positions, salaries and retirement pensions sufficient to maintain a humane life, and union rights including the right to strike and the right to collective bargaining.

10- All administrative and financial restrictions that damage the professional independence of the health employees should be abolished. Circulating capital based on performance in the public sector and endorsement pressures in the private sector, which are against the nature of the health system, should be done away with.

Our assembly states its determination for a united struggle against destructive health care policies such as the new health reform, legislative decree No. 663 and public hospital unions.

Within this framework, it decided on

- the expansion of the existing Provincial Right-to-Health Assemblies and the foundation of new ones countrywide,

- proactive utilization and production of written and visual materials for the purpose of informing the public,

- the monitoring and periodical publication of unjust treatments,

- the organization of local and centralized activities to advocate the rights to accessible and quality health care in Turkey where there will be no premiums, contribution fees or extra fees, including petitions, referendums, meetings, strikes and protests in the Health Week (the week of March,14^th).

We invite all the workers, the people and the organizations to join “The United Struggle for Equal and Free Health Care for All”.

The Grand Right-to-Health Assembly of Turkey

Health Care Reforms in Turkey – 4: “The Proceedings in the Health Sector and The Emerging Risks” - Ayşe Buğra, Volkan Yılmaz (Part 2)

As part of our responsibility of providing English information on Turkey with a political perspective that is compatible with our stance, we started a series of translations of news items and articles on the transformations in the health care system in Turkey. This is the second and last part of the political analysis (“Sağlık'ta Alınan Yol ve Ortaya Çıkan Tehlikeler”), published in Bianet on August 8^th, 2011. The article, signed Ayşe Buğra and Volkan Yılmaz, discusses the long-term and middle-term consequences of the current policies, which have become more and more apparent in time.

An approach to introduce a health care reform in contravention of the medical doctors is doomed to failure especially with respect to protecting patient rights in the long run, and this long run might be a much nearer future than presumed.

[continuing from the first part]

Concerning the delivery of health care services, contemporary health care reform aims at creating a competitive market environment within which public, private and non-profit hospitals are expected to compete with one another in order to attract more patients.

In this respect, the legislated Public Hospitals Unions Law is expected to aggravate the already started commercialization of public hospitals by imposing them a market logic of governance through the introduction of hospital autonomy.

The founders of the contemporary health care reform emphasize that the reform agenda is not one of privatization. For instance, the objectives of public hospitals unions law are stated as follows: “The management of the public hospitals unions will in no way have profit orientation. It is aimed to form non-profit autonomous public institutions. The responsibility of the hospitals is to provide an extensive second step health service to the society and to attain high quality standards by securing financial sustainability.” [iii]

However this statement is hardly sufficient to eliminate the doubts about marketization and privatization. This is because; this model increases non-medical involvement in the administration of public hospitals and prioritizes income-outcome balances over health care needs of the society.

The current trend demonstrates the involvement of the private sector in the investments made in the domain of health care delivery increased. This may imply that the competition among all hospitals will produce results at the expense of public hospitals.

It can be concluded that this situation will bring about a structure where private organizations will have a more dominant role in the delivery of health care services.

Nevertheless, the mere fact that a hospital is successful in a market environment does not necessarily suggest that this hospital provides better health care services or vice versa.

It may very well be the case that the medical doctors spending more time with their patients, avoiding unnecessary diagnostic tests and examinations, applying surgical procedures only if it is essential, would not only get less salary but also would be accused of limiting the success of their hospitals.

Hospitals considered successful according to the market criteria will benefit more from public sources and be able to get larger amounts of contributory payments from the patients. These hospitals will thus be able to increase quality of their services since they will be able to invest in diagnostic and treatment technologies. Larger the amount of contributory payments they can charge, the richer segment of the society can access to these hospitals.

We would like to remind a rule of social policy studies: The more a specific social service exclusively serves the poor, the poorer the quality of this service will get.

This is because, the service providers of the poor have lesser resources and the low-income people are less capable of making their complaints heard.

Hence, it should be noted that while some of the inequalities arose from the former system are eliminated thanks to the current health care reform, the new system bears the risk of institutionalizing income related inequalities in access to health care.

In addition, we would like to remind the readers of the possible threats that a market- oriented mentality might cause in the domain of health care expenditures. Once the profit orientation in the delivery of health care services is institutionalized, it is highly likely that health care expenditures will increase.

In the aftermath of the implementation of the contemporary health care, both the share of health care expenditures in the GDP and the amount of contributory payments have increased. [v] This increase is mainly due to the transfer of resources from public health insurance fund to private hospitals.

In the new health system, if the public budget will not be able to meet and continue to subsidize the health care expenditures, this may result in the restriction of medical services covered by the public health insurance and/or drastic increases in the rates of contributory payments made by the patients at the spot.

Possible restriction of the benefit package of the public health insurance would result in an increase in the citizens’ participation in private health insurance and possibly in out-of-pocket health care expenses of the citizens. Nevertheless, we would like to remind the readers that the larger the health care expenditures does not necessarily mean better health outcomes. [vi]

In this context, it may be useful to keep the example of American health system in mind. Public health care expenditures constitute a small portion of total health care expenditures in the U.S when it is compared to other advanced capitalist countries. Generally, total health care expenditures per capita in the U.S. is much larger than its counterparts. American health care system is known by its market friendliness. Nevertheless, health outcomes of Americans is the worst among the advanced capitalist countries.

We are quite lucky to have medical doctors who had not yet become entrepreneurial in their approaches to health care in Turkey. They have the advantage of experiencing the problems of the contemporary health care reform process, thus they are the first to alarm us about the possible negative implications of the reform.

The weakest side of this health care reform process has been the total exclusion of the medical doctors in general and Turkish Medical Association (TTB) in particular from the policy making process. Turkish Medical Association is an outlier due to its political stance for the institutionalization of an egalitarian health system rather than merely pursuing medical doctors’ professional interests as its counterparts generally do. This should be seen as an opportunity for Turkey.

An approach to introduce a health care reform in contravention of the medical doctors is doomed to failure especially with respect to protecting patient rights in the long run, and this long run might be a much nearer future than presumed.

It is for the benefit of all that the criticisms of the TTB on the contemporary health care reform in Turkey are taken seriously.

* Ayşe Buğra, Professor, Boğaziçi University, Social Policy Forum.

* Volkan Yılmaz, the School of Politics & International Studies, the University of Leeds.

This translation was read and edited by Volkan Yılmaz before publication in order to terminological coherency.

[iii] Sabahattin Aydın, Kamu Hastane Birliklerine Doğru, Sağlık Haber.
[iv] The private health investments, nearly negligible in 2003, has raised to 38% in all health investments between 2004-2007. Türk Tabipleri Birliği, 2011 Seçimlerine Giderken Türkiye'de Sağlık, s. 19.
[v] OECD Sağlık Verileri 2011.
[vi] OECD Health at a Glance 2009.
[vii] Bkz. OECD Sağlık Verileri 2011.

Health Care Reforms in Turkey – 3: “The Proceedings in the Health Sector and The Emerging Risks” - Ayşe Buğra, Volkan Yılmaz (Part 1)

As part of our responsibility of providing English information on Turkey with a political perspective that is compatible with our stance, we start a series of translations of news items and articles on the transformations in the health care system in Turkey. After the first two news items that introduced the current political situation, we continue our series with a political analysis (“Sağlık'ta Alınan Yol ve Ortaya Çıkan Tehlikeler”), published in Bianet on August 8^th, 2011. The article, signed Ayşe Buğra and Volkan Yılmaz, discusses the long-term and middle-term consequences of the current policies, which have become more and more apparent in time.

An approach to introduce a health care reform in contravention of the medical doctors is doomed to failure especially with respect to protecting patient rights in the long run, and this long run might be a much nearer future than presumed.

It has long been told that the Justice and Development Party (AKP) government's health care policies constituted probably the primary reason of its success in the last election, and that especially the poor were highly contented by these policies.

Yet, we know that the Turkish Medical Association (TTB), the medical doctors' institutional representative in Turkey, objected to these health care reform policies. Thus, on March 14^th [2011], TTB organized one of the most broadly participated and most vibrant demonstrations of the Republic's history in the domain of health care policies.

There is a clear gap between the spirit of the medical doctors’ demonstration against the contemporary health care reform and the optimistic analyses about the positive social effects of the plan. This seems well worth an explanation.

And this explanation should take into account the historical background that fed into today's health care policies, contradictions within the current health care reform and the problems this reform may cause as well as its short-term positive effects in the lives of the citizens.

The former health care system of Turkey had quite important problems. In the former system, there were three public insurance schemes: one for civil servants, one for blue collar workers and one for the self-employed and the farmers. These three public insurance schemes collected different premium rates and provided their members with differential access to health care services.

In the former system, civil servants constituted the most advantaged group. In contrast to the satisfaction of civil servants with the former health system, blue collar workers and farmers could only get access to crowded public hospitals that provided low quality health care services.

In addition to the inequalities within public insurees, the former system excluded the informally employed and the unemployed (who do not have a formal worker or a pensioner family member), namely a large segment of the society most of which is poor.

In short, the former health care system failed to provide access to health care services, which is one of the fundamental social rights, on the basis of equal citizenship.

As the number of people excluded from the health care services drastically increased in the aftermath of the neoliberal restructuring of Turkey’s economy, the coalition government of center-right True Path Party (DYP) and center-left the Social Democratic Populist Party (SHP) decided to address this social problem.

DYP-SHP coalition government introduced the Green Card policy that provided the very poor with the access to inpatient health care services. Parliamentary debates on the legislative process of Green Card policy is quite interesting in that they shed light on the interpretations of citizenship and social rights in Turkey.[i]

Former Minister of Health Mr. Münif İslamoğlu from DYP put forward one of the most interesting arguments during the parliamentary debates.

Mr. İslamoğlu argued that health is a fundamental citizenship right and therefore a policy that requires citizens to prove that they are poor in order to access to health care services is unacceptable.

On the other hand, the proponents in DYP tried to convince İslamoğlu that Green Card policy would be a temporary solution. This policy would be replaced by a general health insurance policy which was to be implemented in the near future.

Despite the logic of the Green Card policy being contrary to the equal citizenship ideal, the Green Card policy can be regarded as an important development for Turkey’s welfare system since it has provided the poor with access to inpatient health care services.

The AKP government extended the benefit package of the Green Card that started to cover outpatient health care services as well as medications.

AKP eliminated the differences in benefit packages among three public insurance schemes and the Green Card scheme. All public insurees have become free to choose which public hospital they want to receive treatment from. Especially this part of the reform increased the quality of health care services so that blue collar workers, farmers and the poor could get access and it highly contributed to the social legitimacy of the AKP’s health care reform.

However, these positive developments are not enough to compensate the inherent problems of the AKP’s health care reform.

One of these inherent problems is the question of the soundness of financing the health system by premium payments rather than general taxation. Insistence upon public insurance based financing of health care is especially problematic due to the high prevalence of informal employment.

In addition to the possible difficulties in collecting the premium payments, the current health care reform keeps income means-testing intact and thereby the bifurcated citizenship status in the domain of health care.

Implementation of income means testing in the Green Card scheme has always included a certain level of discretion. Public officials have a strong suspicion about the applicant’s real and declared income levels. Current health care reform aggravates these problem-ridden aspects of the implementation of Green Card scheme. Increased suspicion of public officials against the Green Card applicants will result in the cancellation of the Green Cards, thus the denial of these citizens’ access to health care services.

Green Card scheme had always been open to the discretion of politicians as well. This became visible when a provincial administrator threatened Kurdish families to cancel their Green Cards if their children would continue to participate in demonstrations against the AKP government. Even though this provincial administrator could not realize his threat, this event once again demonstrated that the implementation of the Green Card scheme hardly corresponds to a rights-based social policy.

Secondly, the neoliberal approach of the contemporary health care reform manifests itself in its market-oriented approach to the production and delivery of health care services.

This is also observable in the introduction of performance-based premium as a significant pay mechanism for medical doctors.

One should carefully consider what kind of incentive such a mechanism would initiate, when it bases the evaluation of the “activeness” of a doctor on the number of patients he/she sees monthly, the number of demanded diagnostic tests/examinations and the number of operations he/she carries out. [ii]

In this regard, we should not forget that the doctor-patient relationship should not be treated like any other market relation between vendors and purchasers. Relationship between doctor and patient should rather be a relation of mutual trust based on the medical ethics that assumes patient's well-being. Once this is neglected, the economic and vital consequences can be quite hard.

[to be continued]

* Ayşe Buğra, Professor, Boğaziçi University, Social Policy Forum.

* Volkan Yılmaz, the School of Politics & International Studies, the University of Leeds.

This translation was read and edited by Volkan Yılmaz before publication in order to terminological coherency.

[i] Ayşe Buğra, Kapitalizm, Yoksulluk ve Türkiye'de Sosyal Politika, İletişim Yayınları, p. 213-218
[ii] For instance a recent research based on hospitals shows that the promotion system significantly increased the number of examinations, operations and visits to the polyclinics.

Çağla Ünlütürk Ulutaş, Türkiye'de Sağlık Emek Sürecinin Dönüşümü, Nota Bene Yayınları, p. 318-337. 

Health Care Reforms in Turkey – 2: “İstanbul Right-to-Health Assembly founded against AKP's attacks on health services”

As part of our responsibility of providing English information on Turkey with a political perspective that is compatible with our stance, we start a series of translations of news items and articles on the transformations in the health care system in Turkey. The first item in this series discussed the overlooked effects of the reforms. This second news item (“AKP'nin sağlığa saldırılarına karşı İstanbul Sağlık Hakkı Meclisi kuruldu”), published in the soL news portal on February 28^th, gives a flavor of the steps taken by the opposition movement against these policies.

Medical employees and the people came together gathered to fight against AKP's health reforms. Several organizations gathered today [February 28^th] to declare the foundation of The Right-to Health Assembly of Istanbul. The Grand Right-to-Health Assembly of Turkey will be founded on March 11^th.¹

The medical employees and the people are gathering to fight against AKP's reforms on and the privatization of the health care system. Today [February 28^th], The Right-to-Health Assembly of Istanbul organized a public meeting to declare its foundation.

“Each step of the health care services have been commercialized.”

In the opening speech, Prof. Dr. Taner Gören (Turkish Medical Association – Istanbul branch) stated that the health services are given to the hands of the capital by the AKP government. He pointed out that the first step of health care is completely commercialized by the introduction of Family Health Centers and Family Practice Centers. Highlighting that these practices resulted in a decrease of quality, he added “Only two physicians are employed in these Family Practice Centers, they are considered to be supermen and made to do all kinds of work.”

“We came together to stop the new General Health Insurance policy.”

After Gören's opening, Ersoy Adıgüzel (Confederation of Public Laborers' Unions, Istanbul Branches Platform) read out the declaration of foundation on behalf of the supporter organizations and told that with the participation of trade unions, public laborers' unions, professional chambers, political parties, consumer associations, village societies, the unemployed, the women and the youth will come together to stop the new General Health Insurance Policy.

Everyone is included in the GHI except the MPs.

“In addition to the struggle lead by medical professional chambers and health laborers' unions, we, the representatives of the millions of patients, are determined to claim our rights to health.” said Adıgüzel, and emphasised that by January 1^st, 2012 everyone was imperatively included in the new GHI mechanism but the MPs and the members of the Supreme Court were excluded.

Remarking that the medical examination contribution fees and the medicament contribution margins are constantly increasing, Adıgüzel added that now everybody will have to pay an extra 35 TL contribution for the health services. He emphasized that with this regulation every citizen will be debted to the state, and reminded that the lower limit for it is determined to be an monthly income of 295 TL which cannot be considered as the starvation line, not to mention poverty line.

He finished the declaration by announcing that with the foundation of “The Grand Right-to-Health Assembly of Turkey” in Ankara on March 11^th, the people who defend their health and labor will confront those who want to sell out the rights for health.

Many organizations support the cause.

Some of the organizations who take part in The Right-to-Health Assembly of Istanbul are as follows: Istanbul Medical Chamber, Istanbul Pharmacists Chamber, Istanbul Dental Chamber, The Chamber of Veterinary Surgeons – Istanbul, Confedaration of Progressive Trade Unions of Turkey (DISK), Confedaration of Public Laborers' Unions (KESK) – Istanbul Branches Platform, Confedaration of Turkish Trade Unions (Türk-İş) 1. Region Branch, Union of Chamber of Turkish Engineers and Architects (TMMOB) Istanbul Provincial Coordination Council, Health and Social Service Employees Union (SES), Freedom and Solidarity Party (ÖDP), The Community Centers (Halkevleri), Communist Party of Turkey (TKP), Labour Party (EMEP), Socialist Party of the Oppressed (ESP), and Pir Sultan Abdal Cultural Association.

1  We will translate their declaration as part of our article series.

Health Care Reforms in Turkey – 1: “Before AKP, After AKP: The Health Services”

As part of our responsibility of providing English information on Turkey with a political perspective that is compatible with our stance, we start a series of translations of news items and articles on the transformations in the health care system in Turkey. In this first news item (“Sağlıkta AKP'den öncesi ve sonrası”), published in the soL news portal on February 29^th, the ignored and/or overlooked sides of the effects of the health care reforms are summarized.

The AKP¹ government has been claiming at having made a revolution in the health services. Yet, if we look closely to that “revolution”, we note prescription fees, patient shares, bed fees, equivalent medicine costs and the paid health centers, none of which existed prior to AKP. We present: before and after AKP in health services...

The recently published brochure “Before AKP, After AKP: The Health Services” by the Grand Right-to-Health Assembly of Turkey demonstrates how health services became payment-based during AKP's rule. The brochure provides many striking examples of this transformation.

Outpatient clinic patient shares arrived with AKP

When the AKP government introduced the patient share mechanisms, it was declared that for patients with social insurance the share would be just 2 TL². But in time it reached 40 TL.

Before AKP, the patients with social insurance, state employees and pensionists were utilizing public hospitals and university hospitals for free, and also they were paying no fees to utilize the private, agreement hospitals. But the AKP rule set off a new tariff system in which the prices for family physicians (that replaced health centers) became at least 4 TL, for public and university hospitals at least 12 TL, and for private universities 18 TL plus the additional costs. Similarly, for the same services, the middle-income families used to pay 3.10 TL and the pensionists thereof 1.55 TL.

Patient shares are increasing

Before the General Health Insurance Policy was launched, it was announced that patients with social insurance would pay the same amount of money and that there will be no extra fees. However, 11 new items of payments appeared already. Some of them are as follows:

• Prescription fee is introduced: 3 TL up to 3 medicines, and 1 TL for each additional.
• Family physicians used to provide free services, now it's at least 4 TL.
• The emergency services were free; now it is at least 12 TL for public hospitals, and 18 TL plus extra costs in private hospitals.
• There is an extra fee of 5 TL in case a patient wants a second examination in 10 days. For the moment, there is no limit for the equivalent medicine costs.
• There was no extra fee for inpatient treatment, but now a single room costs 90 TL/day and a double room 45 TL/day.

You can avoid sanguineous operations if and only if you are rich enough.

Another item the AKP government introduced is the “exceptional health services”. If a patient wants to take a service classified as such, s/he has to pay in advance three times the cost of that operation, in cash.

For instance, a patient who wants an operation for the displacement of gallstones has to pay 2160 TL in cash to the hospital. Otherwise s/he should be assent to have a surgery that involves the cutting of the abdominal region from top to bottom.

A new loot: Public-Private partnerships

One of the last steps for the commercialization of the health sector will be the public-private partnership. Within this framework, city hospitals will be built, the state will provide the land and pay the rent, but the private company who makes the construction will benefit.

The private company will get a rent from the state for 25 years, and will also have the privilege to run the parking lot, the cafeterias and the ambulance services.

1  AKP (Adalet ve Kalkınma Partisi): The Justice and Development Party. The governing political party since 2002.

2  TL stands for the Turkish currency, Turkish Lira. When this news item was translated, the approximate exchange rates were $1=1.8 TL and €1=2.3 TL.