Access to qualified healthcare has expanded significantly for Turkish people within the last two decades. Thanks to the Health Transformation Program of 2002, Turkey has managed to comprehensively transform its healthcare system. The country has successfully been implementing General Health Insurance since 2012, which shows great similarities both with the Beveridge model of the National Health Service (NHS) of the U.K. and the Affordable Care Act of the U.S. As a result of these steps, Turkey's per capita healthcare expenditure with current purchasing power parities (PPPs) has increased from $470 in 2002 to $1,088 in 2016 according to the Organization for Economic Cooperation and Development (OECD) statistics. Today, Turkey's healthcare model is being mentioned in literature as going "from laggard to leader in healthcare services."
The transformation was not just on the total amount of expenditure for healthcare but also at the mentality and quality of service provision: The important mechanisms that are being credited by professor Julian le Grand from the London School of Economics, "choice" (the right to choose the welfare provider such as doctor, hospital et cetera) and "voice" (to provide channels for welfare recipients to make their complaints and give feedback) are given to the patients. The infrastructures of all hospitals have been renewed, in addition to expanding qualified private investments (more than a thousand new private hospitals countrywide) in the healthcare sector. As a direct result of increasing the accessibility of qualified healthcare, there has been a significant decrease in mortality rates in the country. Turkey's average life expectancy at birth has risen to 80.7 years old for women and 75.3 for men by 2015, a a significant rise when compared 74.7 years old for women and 70.5 for men in 2002.
Concerns for sustainability of the healthcare model
The story told so far is quite an impressive achievement for the provision of healthcare services. Yet, there is another face of the medallion. There are serious concerns about sustainability and efficiency of this system for Turkey. Some analysts are presenting compelling evidence that excessive use of medical services, unnecessary use of medicine and welfare abuse are challenging the sustainability of the system.
A very significant discussion is on the number of consultations patients have annually. In 2002 a patient in Turkey was having in average of two doctor visits annually, which was the worst among OECD countries. The number of consultations an average patient is having annually has risen to 8.4 in 2015 according OECD data. Despite no recent reliable statistics for the following years, unofficial sources defend that this rate has already exceeded 10 in 2018. Considering the OECD average is 6.9 and the U.S. average is 4, Turkey's annual average patient visits are quite high. Official statistics don't give much of a clue about how many of these visits are necessary healthcare visits and how many of them are excessive. Yet, many commentators defend that many of these visits are undue. The Social Security Institution's (SGK) total healthcare expenses were calculated to be TL 68 billion ($14.7 billion) in 2016. The amount was budgeted to be TL 74 billion in 2017 but realized as TL 77 billion. The budget allocated for healthcare by the SGK is TL 84 billion for 2018. Another case of possible excess in healthcare services in Turkey is regarding medicine usage. Turkey is specifically problematic in the excessive use of antibiotics, painkillers and supplements. Turkey is the first among 42 countries in antibiotics consumption and second in the antimicrobial resistance among 22 countries. The SGK had a budget of up to TL 30 billion for medicine expenses in 2017. Many commentators have said that this budget contained a high amount of unnecessary and excessive usage.
Additionally, the healthcare model of the country is reactive rather than proactive. This means preventive healthcare services are very limited while the public is coping with the high costs of chronic diseases. For instance, very few measures are being taken to prevent people from becoming diabetic before becoming ill, but the SGK is paying for all of the expenses throughout a diabetic's life. Diabetes is quite a good example: While it is a preventable disease with very few financial costs to the public budget by just incentivizing people to live a healthy lifestyle, after the disease is diagnosed it costs immense amounts of healthcare expenses.
The generous healthcare system of Turkey is covering almost all chronic diseases throughout a patient's life and without an upper-limit, like diabetes, cancer, kidney diseases or cardiovascular diseases. Yet, a coherent and comprehensive preventive strategy is not being implemented countrywide to fight with these evils before they come up.
Despite impressive improvement in the healthcare services both in the public and private sectors, the sustainability of this generous model is raising great concern. The existing system needs to be realigned to be more based on preventive health services and being cost-efficient. Turkey's generous healthcare system requires transforming a mentality that does not finance illness, but rather protects and promotes health.
* Inspector at Republic of Turkey’s Social Security Institution