A Political Economy Analysis of Turkey's Health Transformation Program
2015
Bump, Jesse B. | Powers Sparkes, Susan
Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that overthe past decade have reshaped the health system. Understanding the political economy of this process isimportant for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and thedevelopment agencies that assist them. This report analyzes the historical context and complex political economychallenges of the reform. Our findings are based on stakeholder interviews and a review of literature. First, weidentified five contextual factors that were important in bringing health reform to the policy agenda in Turkey, andwere helpful in sustaining the reform during adoption and implementation: (1) a long history of reform plans andattempts; (2) fiscal pressure to reform the social sectors; (3) public support for health reform; (4) strong economicgrowth; and (5) favorable demographic conditions. Second, we assessed four political economy challenges centralto the reform and the strategies used by the Ministry of Health (MoH) to overcome them. First, the MoH built publicsupport for reform among the broad base of beneficiaries by focusing on highly visible and fast changes. Second,the MoH overcame well-organized interest group opposition to the reforms by splintering their support ordelegitimizing their views. Third, Turkey asserted its own domestic priorities over those of the IMF and World Bankin cases of direct conflict. Fourth, the MoH circumvented potential political and institutional opposition to the largeexpansion of benefits and coverage through a carefully sequenced adoption and implementation plan that could beexecuted mostly without requiring the support of other ministries. This analysis also highlights important trade-offsmade by the MoH with respect to the redistribution of resources, quality of care, financial sustainability, andphysician satisfaction, which will all have to be considered as Turkey enters its next phase of health systemdevelopment.
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