title: What have health care reforms achieved in Turkey? An appraisal of the "Health Transformation Programme".
abstract: Poor health status indicators, low quality care, inequity in the access to health services and inefficiency due to fragmented health financing and provision have long been problems in Turkey's health system. To address these problems a radical reform process known as the Health Transformation Programme (HTP) was initiated in 2003. The health sector reforms in Turkey are considered to have been among the most successful of middle-income countries undergoing reform. Numerous articles have been published that review these reforms in terms of, variously, financial sustainability, efficiency, equity and quality. Evidence suggests that Turkey has indeed made significant progress, yet these achievements are uneven among its regions, and their long-term financial sustainability is unresolved due to structural problems in employment. As yet, there is no comprehensive evidence-based analysis of how far the stated reform objectives have been achieved. This article reviews the empirical evidence regarding the outcomes of the HTP during 10 years of its implementation. Strengthening the strategic purchasing function of the Social Security Institution (SSI) should be a priority. Overall performance can be improved by linking resource allocation to provider performance. More emphasis on prevention rather than treatment, with an effective referral chain, can also bring better outcomes, greater efficiency gains and contribute to sustainability.
authors.affiliation: Department of International Entrepreneurship, TOBB University of Economics and Technology, Söğütözü Cad No: 43, Söğütözü, Ankara 06560, Turkey. Electronic address: zgokem@etu.edu.tr.
authors.forename: Zeynep Güldem
authors.initials: ZG
authors.lastname: Ökem
authors.affiliation: Department of Management, Başkent University, Bağlıca Kampüsü Eskişehir Yolu 20. Km Bağlıca, Ankara 06810, Turkey. Electronic address: mcakar@baskent.edu.tr.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Çakar
mesh_terms: D017598:Efficiency, Organizational; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D019981:Health Care Sector / Q000191:economics / Q000458:organization & administration; D006304:Health Status; D006801:Humans; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D014421:Turkey
keywords: Efficiency; Equity; Evidence-based evaluation; Financial sustainability; General/social health insurance; Health Transformation Programme; Healthcare reforms; Quality; Turkey