Turkey lies at the intersection of Europe and Asia and has a population of over 83 million people. For the last few decades, Turkey has made great progress in transforming its healthcare system. Turkey began planning to reform its health care system in 1990, but it took 13 years for the country to achieve the political unity required to enact sweeping reforms. By 2002, Turkey faced a healthcare system plagued by inefficiencies and widespread dissatisfaction. Infant mortality rates were high and less than two-thirds of the population had health insurance. In response, the government started the Health Transformation Program (HTP) to completely overhaul the health system. Its main goal was to provide universal health coverage. There have since been improvements in patient satisfaction and health indicators have been steady, with infant and maternal mortality declining while life expectancy rises.
The HTP rapidly expanded health insurance coverage and access to healthcare services for all citizens, especially the poorest population groups. It also led to the establishment of a family physician scheme and a universal health insurance system, Genel Sa ğlık Sigortası (GSS). It combined several social security systems under one umbrella, the Social Security Institute (SSI). To provide universal health insurance coverage, the Green Card Program was created in 2008 and finalized in 2012. This program consolidated state insurance schemes and extended insurance coverage to all Turkish citizens, including making healthcare and medication free for all citizens under 18 years of age. One of the main parts of the HTP was the focus on family medicine. In 2003, Turkey piloted a primary health care reform that mandated all primary care paid for by state insurance had to be provided in a state-contracted Family Medicine Center. The program was a success and was later expanded. By 2012, around 99% of the population had health insurance.
Turkey finances health care services from multiple sources. Social health insurance contributions take the lead, followed by government sources, out-of-pocket payments and other private sources. Citizens in some vulnerable groups like pregnant women, veterans and tuberculosis patients do not have to pay any charges. Employers must register their employees with the health insurance fund and then income is automatically deducted from employees’ salary. Dependent family members are covered by the contributions paid by employed family members. The unemployed, elderly and people on long-term sickness or maternity leave do not have to make payments. Self-employed people must make their own contributions to the health insurance fund. Out-of-pocket payments was around 17% of total health care expenditure in 2008. Which was down about 10% from 2000. Before the HTP, hospitals could keep patients until the bill was paid. The number of households with catastrophic health costs was cut in half between 2000 and 2008.
There is also a large private healthcare sector. Private health services often offer shorter waiting lists and higher quality services. Most banks and insurance companies offer health plans, and contract with certain hospitals and doctors. Private healthcare has increased in Turkey in the last decade due to the long queues and personal service in state-run hospitals. Most private hospitals have contracts with various insurance companies so it is now possible to receive treatment that varies from the state. After increased competition from private hospitals, there has been a rise in the quality of state hospitals. There is a substantial medical tourism business in Turkey. In the first six months of 2018, about 178,000 tourists visited Turkey for health purposes. About 67% used private hospitals, 24% used public hospitals and 9% university hospitals. While Turkey has made great strides in its health care system, there are still areas for improvement. Family planning and reproductive health are not explicitly included in the HTP and coverage of these services remains poor. There is also still a big difference in the quality of care between urban and rural areas.