A random glance at newspaper headlines from the early 2000s is enough to highlight the transition. The headline for a short news item published in a Turkish daily on March 1, 2001 reads, “Story of father’s escape from hospital.” The story is about how the daughters of Hasan Demirci, who was kept hostage in hospital, for lack of a better word, for failing to pay for his surgery, escaped with the help of his daughters dressed in women’s clothing. Another story, published on Aug. 15, 2001, reads, “Pay the money, get the body” in its headline.
The story is about how the daughters of Hasan Demirci, who was kept hostage in hospital, for lack of a better word, for failing to pay for his surgery, escaped with the help of his daughters dressed in women’s clothing. Another story, published on Aug. 15, 2001, reads, “Pay the money, get the body” in its headline. The story is about a young man who died tragically after an accident and long hours of surgery. The Erzurum Aziziye Research Hospital refused to deliver the young man’s body to his family until they signed a promissory note. Another news item, from 2001, compares Turkey’s health care system to that of Germany by comparing two stories. In the first, a German hospital sends an ambulance helicopter to pick up a Turkish woman in labor who was at a location too far to reach any hospital in time for the delivery, while a hospital in Turkey refused to return a newborn to a family because the family couldn’t pay TL 250 for the services of the hospital’s delivery center. Another story, from 2001, points to a medication shortage crisis in Turkey, triggered by the Health Ministry’s new rates for pharmaceutical importers. According to this story, the importation of most prescription drugs came to a halt because of the ministry’s pricing policy. The story states that the crisis especially influenced patients suffering from critical conditions such as renal or heart disease.
The examples above are from the not-so-distant time of a decade earlier, standing as strong indicators of the transformation Turkey’s health care system has undergone. New policies emphasizing preventive medicine (the budget allocated for preventive medicine which stood at TL 1.5 billion in 1995 had risen to TL 6.5 billion as of 2011) and improvements in basic health care have contributed to the nation’s overall well being, in addition to major advancements in patient care, such as new hospitals and ambulance planes available in all provinces. In 2001 there were 540 state ambulances in Turkey. Today, there are 2,547 registered state ambulances, not including 134 snow ambulances, two ambulance planes, 18 ambulance helicopters and four marine ambulances.
Turkey has moved beyond many Western countries in terms of effectiveness and quality of its health care, which is more than conspicuous in the statistics regarding the health industry.
One of the most important changes Turkey has seen in its health system, as Kamuran Özden -- a bureaucrat of the Health Ministry of 25 years until very recently when he quit his position to run in the upcoming parliamentary elections -- pointed out during a visit to Samsun as part of his election campaign earlier this month, “Everybody can go and get treatment at the hospital of their choice in Turkey.” This was made possible thanks to a reform by the Justice and Development Party (AK Party) government that enabled private hospitals to serve patients covered under the state Social Security Institution (SGK), which was only accepted by state hospitals in the past.
“Now everybody in Turkey can get treated at the hospital of their choice without paying any fees. Everybody can make use of emergency health care and intensive care services. There are no longer problems with finding an ambulance. Medical air ambulances and planes can fly people to hospitals in the shortest time possible. Turkey has moved forward a century in health care in the past eight-and-a-half years,” Özden said.
Changing one step at a time
Perhaps the most important reform to improve the health care system was passed in 2003, when the government passed a new legislation making it illegal to refuse to release patients who can’t pay their medical bills. Not releasing a patient is not only problematic in ethical terms, but also might have serious health consequences, particularly for post-op patients who are at higher risk of contracting infection. Other reforms carried out in this year include making services offered by the 112 emergency hotline completely free, extending mobile health services in rural areas to wider regions and making state health insurance valid in private hospitals and medical centers. Also in 2003, new legislation introduced a bonus system based on the performance of medical personnel at Turkish hospitals that has encouraged most doctors to work a full day at their employer’s hospital, which in turn reduced the need for most patients to go to clinics run privately by individual doctors. The year after that also saw some significant reforms, when the government started to distribute iron and vitamin D supplements free of charge to patients in need. Furthermore in 2004, Cancer Screening and Education Centers (KETEMs) opened in all of Turkey’s 81 provinces. In another major step to universalize health care in the country, the state started paying the medical bills of those who got sick before they received green cards, which ensure free medical coverage for Turkish citizens residing in Turkey who have no social security and earn less than one-third of the minimum wage.
In 2005, all the state hospitals in the country were merged under a single roof, giving 35 million people under SGK coverage access to all of these hospitals. Also in this year, new legislation started allowing green card holders to go to any hospital of their choice, just as individuals covered by the SGK. Reforms passed in 2007 included dental coverage under the green card system. Also, the supply of drugs and medical equipment for patients under SGK coverage became completely free of charge in hospitals that signed protocols with the SGK. In 2008, all emergency and intensive care treatment became free at all state and private hospitals. A ban was introduced on extra fees billed to patients who are suffering from burns or cancer, newborns, organ transplant patients, patients with congenital anomalies, dialysis and heart surgery patients. Other improvements in this period include free health care for anyone affected by an epidemic disease or in work accidents regardless of their coverage status. The period until which a person insured by the SGK for the first time has to wait before they can make use of health services was reduced to 30 days from three months. The SGK also now covers the expenses of treatment abroad in cases where treatment in Turkey is not possible, thanks to another law passed in 2008. New legislation adopted in 2010 now allows green card holders to make use of private hospital emergency rooms and intensive care units free of charge.