General Overview of Health Sector in Turkey

General Overview of Health Sector in Turkey

The health services in Turkey were accepted as a service that shoul be provided by the government beginning from the establishment of Republic in 1923 till the year 1982. In consequence of the military coup that took place in 1980s and constitutional law change after that, in health system under the title of “Reform”, self-seeking policies were started to be followed in the way of service responsibility of the government.

The 1990s have been the years of rapid growth in the number of healthcare providers offering private services in Turkey and the development of healthcare field as a "marketplace" for private health insurance. The health sector in Turkey has grown about 3 times in the 20 years after 1980s, the share of the public sector in this growth has become increasingly determinant, the health expenditures of the social security institutions have become the motor in public health sector, and however, public health financing has become increasingly covered from the general off-budget sources. (Source: Turkey Health Report 2014, HASUDER)

Especially after the year 2002, in Turkey, on the one hand the total health expenditures increased on the other hand the private health sector was supported by opening the way for the social security institutions to purchase health services from the private sector. These changes, which were expressed in the name of "Health Reforms", were changed to "Health Transformation Program (SDP)" in 2003. SDP covers the policies laid in three main area which are the organization of health services, the financing of health services and the presentation of health services.

 

With the SDP, a social insurance has recently been established based on collection of premiums in the name of general health insurance (GSS). GSS mainly consists of three components: Basic warrant package, premium and user subscription fee. The basic warrant package (TTP) can be defined as the document that determines the scope of the health service which the citizen can benefit from. In GSS, it is required to pay a premium to have a right to get healthcare service. It is also made obligatory to pay the user subscription fee –contribution/share– during the period of benefitting from the health service.

Recently, significant initiatives under the name SDP and Public-Private Partnership (PPP-KÖO) have been proposed for the agenda. This partnership is based on the principle that the government establishes a long-term (up to 49 years) contractual relationship with a private company / company group.

The contract is about leasing the facility to the state in which the public service will be provided after completing the construction of the facility made by the private companies, the state pay rent to these companies as well as transfer the services outside the "core service" to be provided in these facilities. It is planned that all other health related facilities including the integrated health campus in the first place, including the additional buildings where the Ministry is obliged to construct and make it constructed, can be done by this method. These regulations have recently been changed to "City Hospital". (Source: Turkey Health Report 2014, HASUDER)

Health Sector with Graphics

The services provided through the inpatient treatment institutions have an important place among the whole of the health services. In Turkey, the number of inpatient treatment institutions and hospital beds are increasing regularly. Below, the charts about the institutions that provide healthcare services and their infrastructures in Turkey are presented.

Number of Hospitals by Years and by Sectors, Turkey

  Source: Directorate General for Health Services

In the year 2002, the total number of hospitals was 1156 and the number of private hospitals was 271 in total hospitals, while the number of hospitals in total hospitals was 1533 and the number of private hospitals was 562 and that of total hospitals was 37%.

Number of Hospital Beds by Years and Sectors, Turkey.

         Source: Directorate General for Health Services

 

In terms of the number of the hospital beds, the total number of hospital beds was 164,471 and the number of private hospitals was 13,387 in total hospitals in 2002, while according to the 2015 years’ data, the rate of total hospital beds was 209,648, the number of private hospitals was 43,645 and the rate of total hospitals was 21%.

Percentage of Quality Beds by Years and Sectors in Total Beds, (%),

 Source: Directorate General for Health Services

Note: Intensive care beds are not included.

According to the chart above, the ratio of qualified beds in total beds increased from 50% to 50% in state and university hospitals by the year of 2002 and 2015, while this rate increased up to 89% in private hospitals. Today, in private hospitals almost all of the total beds are qualified beds.

                     Distribution of Qualified Beds by Years and Sectors, (%), Turkey

          

             Source: Directorate General for Health Services

In the above chart, from 2002 until 2015, it can be observed that the number of qualified beds in the private sector have not changed by compared to the ratio in all sectors.

International Comparison of Number of Hospital Beds per 10,000 Person, 2014

Source: General Directorate of Health Services, EUROSTAT Database

  Note: Turkey data belongs to the year 2015.

When compared to the European countries, in the number of Hospital Beds per 10,000 patients, it was observed that Turkey is in the 22nd place and Germany is in the 1st place.

The number of applications to the healthcare institutions per capita in Turkey is increasing steadily. At the time of illness, first choice of health institutions determines the direction of the demand. A Life Satisfaction Survey is being conducted by TÜİK and the graphic of the health institutions that are applied in the first place at the time of illness is given below.

  First Applied Healthcare Institution at the times of Illness, 2015

 

With Social security

Without Social Security

Public Hospital

48.9

66.2

Family Doctor / Family Health Center

32.9

27.4

Private Hospital

13.1

4.3

University Hospital

3.5

1.9

Private Polyclinic / Medical Center

0.7

0.1

Institution Doctor

0.9

-

Private Practice

0.1

0.1

Source: TÜİK

According to the results of the year 2015, 48.9% of the individuals with social security in Turkey preferred state hospitals, whereas this rate was 66.2% for the individuals without any social security. The proportion of those who prefer social hospitals with private insurance is 13%; the rate of those without social security is 4%. The primary choice reason for private hospitals is the quality of service. Approximately 60% of those who preferred private hospitals, stated that they preferred the private hospitals due to their quality of service. The reasons for preferring state hospitals are as follows: 30% location closeness, 30% service quality, 30% obligation.

From the year 2002 to 2015, almost a linear increase in the number of physicians per 100,000 people is observed in all sectors. In 2015, the number of physicians per 100,000 people was calculated to be 179.

                                                                           

International Comparison of the Total Number of Physicians per 100,000 People, 2014

Source: General Directorate of Health Services, Directorate General for Administrative Services, OECD Health

Data 2016

Note: Turkey data belongs to the year 2015.

In the above chart, the International Comparison of the Total Number of Physicians Decreased to  100,000 Disclosed by OECD (Economic Business Association and Development Organization) can be seen. In this comparison, Norway ranks first with 506 while Turkey with 179 ranks last. The OECD average is calculated as 339, it is seen that Turkey is below the average.

When you look at the situation of the sector in terms of Health Economics and Finance; in Turkey, total health spending has increased three times over the last 10 years.

 

Total Health Spending (Million TL)

The share of total health spending in Turkey in gross domestic product, which was 4.8% in 1999, increased to 6.1% in 2009. With a slight decline in the following years, declined to 5.2% in 2012 and rose to 5.4% in 2015. When the ratio of health expenditures to GDP is examined, it can be said that it has stabilized in the last five years.

The OECD average of the share of Current Health Expenditures in GDP was announced as 8.9%, which is below the share of the Turkey's.

 

The Rate of the Total Health Expenditure to GDP (%)

 

               Money Distribution of the Health Expenditure in Turkey (The Year 2012)

AREA WHERE MONEY COMES FROM (SOURCE OF THE MONEY)

AREA WHERE MONEY GOES (SOURCE OF THE MONEY)

 

Billion TL

%

 

Billion TL

%

SGK

44.1

57.7

SB HOSPITALS

24.4

32

GENERAL BUDGET

14.5

19

UNIVERSITY HOSPITALS

5.2

6.9

OTHER PUBLIC

0.2

0.3

PUBLIC 1ST STAGE

6.6

8.7

TOTAL PUBLIC

58.8

77

OTHER PUBLIC

0.9

1.2

 

 

 

TOTAL PUBLIC

39.3

51.1

 

OUT-OF-POCKET EXPENSE

15.7

20.5

PHARMACEUTICAL COMPANY/PHARMACY

22.3

29

PRIVATE SECTOR INVESTMENT

0.5

0.7

PRIVATE HOSPITALS

16.8

21.8

PRIVAT INSURANCE PRIM

1.4

1.8

PRIVATE INSURANCE

0.2

0.3

PRIVATE TOTAL

17.6

23

PRIVATE TOTAL

39.3

51.1

TOTAL HEALTH EXPENDITURE

76.4

100

TOTAL HEALTH EXPENDITURE

76.4

100

 

By examining the source of money in Turkey's health expenditures in the year 2012, it attracts attention that 77% of those were covered by public sources and 51% of those went to private sector.

Public and Private Health Expenditures per Person by the Numbers that Belong to the Year 2015, Reel, ₺, Turkey

In the above graph, it can be observed that the ratio of public health expenditures to private health expenditures per capita has increased with the figures of the year 2015.

 

AVERAGE UNIT SALES PRICES OF THE PROPERTIES THAT ARE APPROPRIATE FOR TRAINING-HEALTH PLANT CONSTRUCTION ON A DISTRICT BASIS

 

 

 

AVERAGE UNIT RENTAL PRICES OF THE PROPERTIES THAT ARE APPROPRIATE FOR TRAINING-HEALTH PLANT CONSTRUCTION ON A DISTRICT BASIS

 

Conclusion

In consideration with the historical process of the institutions providing health care services in Turkey and the years-long indicators presented and analyzed by various institutions, we are confronted with a health sector which has become a private sector market. Especially in the recent period, by means of the new policies introduced under the name of "Health Transformation Program" and Public-Private Collaboration system, incentives are observed to encourage the Private Sector.

The subjects, which are the core areas of SDP, the organization of health services, the financing of healthcare services and the delivery of health services, have been regulated by various laws in the last decade. By these laws, the public sector reaches to a position of the only regulator and supervisor in the healthcare sector, while the private sector takes the task of service delivery by the public-private collaboration.

By analyzing from a financial point of view, in healthcare sector’ monetary flow stream, a flow can be seen from the public (77% incoming fund) source to the private monetary (%51 transferring fund)

Turkey's demand for the healthcare sector is increasing day by day.

It is imperative to take precautions to ensure that the insufficiency of the qualifications in the sector and lack of infrastructure.

These reasons necessitate the well planned encouraging initiatives and effective use of this fund which is transferred to the private sector.

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