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.