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Turkey On The Way Of Universal Health Coverage Through The Health Transformation Program (2003-13)


  • Jesse Bump
  • Susan Sparkes
  • Mehtap Tatar
  • Yusuf Celik
  • Meltem Aran
  • Claudia Rokx


Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey?s health system has few ? if any ? parallels in scope and speed. Before the reforms, Turkey?s aggregate health indicators lagged behind those of OECD member states and other middle-income countries. The health financing system was fragmented, with four separate insurance schemes and a ?Green Card? program for the poor, each with distinct benefits packages and access rules. Both the Ministry of Labor and Social Security and Ministry of Health (MoH) were providers and financiers of the health system, and four different ministries were directly involved in public health care delivery. Turkey?s reform efforts have impacted virtually all aspects of the country?s health system and have resulted in the rapid expansion of the proportion of the population covered and of the services to which they are entitled. At the same time, financial protection has improved. For example, (i) insurance coverage increased from 64 to 98 percent between 2002 and 2012; (ii) the share of pregnant women having four antenatal care visits increased from 54 to 82 percent between 2003 and 2010; and (iii) citizen satisfaction with health services increased from 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic improvements there is still space for Turkey to continue to improve its citizens? health outcomes, and challenges lie ahead for improving services beyond primary care. The main criticism to reform has so far come from health sector workers; the future sustainability of reform will rely not only on continued fiscal support to the health sector but also the maintanence of service provider satisfaction.

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  • Jesse Bump & Susan Sparkes & Mehtap Tatar & Yusuf Celik & Meltem Aran & Claudia Rokx, 2014. "Turkey On The Way Of Universal Health Coverage Through The Health Transformation Program (2003-13)," Health, Nutrition and Population (HNP) Discussion Paper Series 93172, The World Bank.
  • Handle: RePEc:wbk:hnpdps:93172

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    References listed on IDEAS

    1. Immergut, Ellen M., 1990. "Institutions, Veto Points, and Policy Results: A Comparative Analysis of Health Care," Journal of Public Policy, Cambridge University Press, vol. 10(04), pages 391-416, October.
    2. World Bank, 2003. "Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 2. Background Papers," World Bank Other Operational Studies 14766, The World Bank.
    3. Akyuz, Yilmaz & Boratav, Korkut, 2003. "The Making of the Turkish Financial Crisis," World Development, Elsevier, vol. 31(9), pages 1549-1566, September.
    4. World Bank, 2003. "Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 1. Main Report," World Bank Other Operational Studies 14824, The World Bank.
    5. Aran, Meltem A. & Hentschel, Jesko S., 2012. "Protection in good and bad times ? the Turkish green card health program," Policy Research Working Paper Series 6178, The World Bank.
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    Cited by:

    1. Agartan, Tuba I., 2015. "Health workforce policy and Turkey's health care reform," Health Policy, Elsevier, vol. 119(12), pages 1621-1626.

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    access to health care; access to health care services; access to health services; administrative control; allocative efficiency; antenatal care; Capita Health Expenditure ... See More + child mortality; Childbirth; citizen; citizens; communicable diseases; deaths; Debt; delivery system; demand for health; demand for health services; doctors; Economic growth; economic resources; emergency vehicles; Employment; expenditures; financial protection; financing of health care; focus group discussions; fragmented financing system; General practitioners; Health Administration; Health Affairs; health care; Health Care Costs; health care delivery; health care expenditures; health care facilities; health care providers; health care sector; health care services; health care system; health centers; HEALTH COVERAGE; Health Data; health delivery; health delivery system; Health Expenditure; Health expenditure growth; Health Expenditure per capita; health expenditures; Health facilities; health finance; Health Financing; health financing system; health indicators; health infrastructure; health insurance; health insurance scheme; Health Insurance System; Health Organization; health outcomes; Health Planning; Health Policy; health posts; health professionals; Health Project; health reform; health reforms; health risks; health sector; health sector reform; health sector workers; health services; health spending; Health status; health status indicators; health supply; health system; Health System Efficiency; Health Systems; Health Systems in Transition; health workers; health workforce; Health-Care; Health-Care System; Health-Financing; Healthcare Spending; hospital autonomy; hospital beds; Hospital management; Hospital Sector; hospitals; HR; human development; human resources; illness; Immunization; income; income countries; income households; individual health; induced demand; infant; infant mortality; infant mortality rate; inservice training; insurance; insurance coverage; insurance schemes; integration; labor market; level of health spending; life =expectancy; life expectancy; life expectancy at birth; live births; local authorities; maternal health; maternal health services; medical centers; Medical Policy; medical school; medical specialties; medicines; Midwives; Ministry of Health; morbidity; mortality; National Health; National Health Insurance; National Health Policy; Newborn Health; nurses; Nutrition; old system; outpatient services; paradigm shift; paramedics; parliamentary seats; party platform; patient; patient care; Patient Cost; patient satisfaction; patients; pharmaceutical expenditures; pharmacists; pharmacy; physician; physicians; pocket payments; policy change; policy decisions; policy goals; Policy Research; political power; political turmoil; popular support; Pregnancy; pregnant women; prescription drugs; preventive health services; primary care; primary health care; primary health care facilities; private insurance; private pharmacies; private sector; private sectors; professional associations; progress; provision of health care; Public Expenditure; Public Health; public health care; public health expenditures; public health system; Public Hospital; Public Hospitals; public providers; public sector; public service; public support; purchaser-provider split; purchasing power; purchasing power parity; quality assurance; quality of care; quality of services; rural areas; scientific evidence; series of meetings; service delivery; service provider; service provision; service quality; service utilization; Social Insurance; Social Policy; Social Security; social security schemes; socioeconomic development; socioeconomic status; State Planning; supply of health care; Sustainable Development; Trade Unions; Under-five mortality; urban centers; workers;

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