A Political Economy Analysis of Turkey's Health Transformation Program
Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have reshaped the health system. Understanding the political economy of this process is important for the future of Universal Health Coverage (UHC) in Turkey, and also fo...
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| Format: | Working Paper |
| Language: | English en_US |
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World Bank, Washington, DC
2015
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| Online Access: | http://documents.worldbank.org/curated/en/2014/07/24146871/political-economy-analysis-turkey s-health-transformation-program http://hdl.handle.net/10986/21716 |
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okr-10986-21716 |
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| recordtype |
oai_dc |
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Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
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World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English en_US |
| topic |
ABUSE ACADEMIC MEDICAL CENTERS ACCESS TO HEALTH SERVICES AGGRESSIVE AMBULANCE ANTENATAL CARE BUDGETARY CONTROL BULLETIN CAPACITY BUILDING CAPITATION CAPITATION SYSTEM CHILD HEALTH CHRONIC DISEASES CITIES CITIZEN CITIZENS CLINICIAN CLINICIANS COST CONTROL DEBT DELIVERY SYSTEM DEMAND FOR HEALTH DEMAND FOR HEALTH SERVICES DEVELOPMENT PLANNING DILUTION OF RESOURCES DISEASES DOMESTIC POLITICS ECONOMIC GROWTH ECONOMIC RESOURCES ELIGIBILITY DETERMINATIONS ENROLLEES ENTITLEMENT ENTITLEMENT PROGRAM EXISTING RESOURCES EXPENDITURES FAMILIES FAMILY PHYSICIAN FINANCIAL INCENTIVES FINANCIAL MARKETS FINANCIAL PRESSURE FINANCIAL PROTECTION FINANCIAL RISKS FORECASTS GLOBAL HEALTH HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE SYSTEM HEALTH COVERAGE HEALTH DELIVERY HEALTH DELIVERY SYSTEM HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH INDICATORS HEALTH INSURANCE HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH INSURANCE SYSTEM HEALTH ORGANIZATION HEALTH POLICY HEALTH PROFESSIONALS HEALTH PROJECTS HEALTH REFORM HEALTH REFORMS HEALTH RESEARCH HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HEALTH-CARE SYSTEM HEALTHCARE HEALTHCARE PROVIDERS HEALTHCARE SYSTEM HOSPITAL HOSPITAL ADMINISTRATORS HOSPITALS HUMAN RESOURCES ILL-HEALTH IMMUNIZATION INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INDUCED DEMAND INEQUITIES INSURANCE COVERAGE INSURANCE PREMIUM INSURANCE SCHEMES INTEGRATION LACK OF CAPACITY LAWS LOCAL AUTHORITIES MARGINAL COST MATERNAL HEALTH MATERNAL HEALTH SERVICES MEDICAL ASSOCIATION MEDICAL CENTERS MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL SCHOOL MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFERY MIDWIVES MINISTRY OF HEALTH MINISTRY OF LABOUR NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL SOVEREIGNTY NUMBER OF PEOPLE NURSES NUTRITION OUTPATIENT SERVICES OUTREACH ACTIVITIES PARTY PLATFORM PATIENT PATIENT SATISFACTION PATIENTS PHARMACISTS PHYSICIAN PHYSICIANS POLICY CHANGE POLICY DECISIONS POLICY DEVELOPMENT POLICY DISCUSSIONS POLICY GOALS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLITICAL OPPOSITION POLITICAL PARTIES POLITICAL POWER POLITICAL PROCESS POLITICAL SUPPORT POPULAR SUPPORT PREGNANT WOMEN PRIMARY CARE PRIVATE SECTOR PROFESSIONAL ASSOCIATIONS PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH SERVICES PROVISION OF SERVICES PUBLIC DISCOURSE PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH EXPENDITURES PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICE PUBLIC SUPPORT PURCHASER-PROVIDER SPLIT QUALITATIVE INFORMATION QUALITY ASSURANCE QUALITY CARE QUALITY OF CARE QUALITY OF SERVICES RESPECT RURAL AREAS SERIES OF MEETINGS SERVICE PROVISION SERVICE QUALITY SMALL WORLD SOCIAL INSURANCE SOCIAL POLICIES SOCIAL POLICY SOCIAL SECTOR SOCIAL SECTORS SOCIAL SECURITY SOCIAL SECURITY SYSTEMS STATE PLANNING TECHNICAL RESOURCES TRADE UNIONS TRAUMA TREATMENTS VISITS WORKERS WORKFORCE WORLD HEALTH ORGANIZATION |
| spellingShingle |
ABUSE ACADEMIC MEDICAL CENTERS ACCESS TO HEALTH SERVICES AGGRESSIVE AMBULANCE ANTENATAL CARE BUDGETARY CONTROL BULLETIN CAPACITY BUILDING CAPITATION CAPITATION SYSTEM CHILD HEALTH CHRONIC DISEASES CITIES CITIZEN CITIZENS CLINICIAN CLINICIANS COST CONTROL DEBT DELIVERY SYSTEM DEMAND FOR HEALTH DEMAND FOR HEALTH SERVICES DEVELOPMENT PLANNING DILUTION OF RESOURCES DISEASES DOMESTIC POLITICS ECONOMIC GROWTH ECONOMIC RESOURCES ELIGIBILITY DETERMINATIONS ENROLLEES ENTITLEMENT ENTITLEMENT PROGRAM EXISTING RESOURCES EXPENDITURES FAMILIES FAMILY PHYSICIAN FINANCIAL INCENTIVES FINANCIAL MARKETS FINANCIAL PRESSURE FINANCIAL PROTECTION FINANCIAL RISKS FORECASTS GLOBAL HEALTH HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE SYSTEM HEALTH COVERAGE HEALTH DELIVERY HEALTH DELIVERY SYSTEM HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH INDICATORS HEALTH INSURANCE HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH INSURANCE SYSTEM HEALTH ORGANIZATION HEALTH POLICY HEALTH PROFESSIONALS HEALTH PROJECTS HEALTH REFORM HEALTH REFORMS HEALTH RESEARCH HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HEALTH-CARE SYSTEM HEALTHCARE HEALTHCARE PROVIDERS HEALTHCARE SYSTEM HOSPITAL HOSPITAL ADMINISTRATORS HOSPITALS HUMAN RESOURCES ILL-HEALTH IMMUNIZATION INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INDUCED DEMAND INEQUITIES INSURANCE COVERAGE INSURANCE PREMIUM INSURANCE SCHEMES INTEGRATION LACK OF CAPACITY LAWS LOCAL AUTHORITIES MARGINAL COST MATERNAL HEALTH MATERNAL HEALTH SERVICES MEDICAL ASSOCIATION MEDICAL CENTERS MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL SCHOOL MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFERY MIDWIVES MINISTRY OF HEALTH MINISTRY OF LABOUR NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL SOVEREIGNTY NUMBER OF PEOPLE NURSES NUTRITION OUTPATIENT SERVICES OUTREACH ACTIVITIES PARTY PLATFORM PATIENT PATIENT SATISFACTION PATIENTS PHARMACISTS PHYSICIAN PHYSICIANS POLICY CHANGE POLICY DECISIONS POLICY DEVELOPMENT POLICY DISCUSSIONS POLICY GOALS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLITICAL OPPOSITION POLITICAL PARTIES POLITICAL POWER POLITICAL PROCESS POLITICAL SUPPORT POPULAR SUPPORT PREGNANT WOMEN PRIMARY CARE PRIVATE SECTOR PROFESSIONAL ASSOCIATIONS PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH SERVICES PROVISION OF SERVICES PUBLIC DISCOURSE PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH EXPENDITURES PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICE PUBLIC SUPPORT PURCHASER-PROVIDER SPLIT QUALITATIVE INFORMATION QUALITY ASSURANCE QUALITY CARE QUALITY OF CARE QUALITY OF SERVICES RESPECT RURAL AREAS SERIES OF MEETINGS SERVICE PROVISION SERVICE QUALITY SMALL WORLD SOCIAL INSURANCE SOCIAL POLICIES SOCIAL POLICY SOCIAL SECTOR SOCIAL SECTORS SOCIAL SECURITY SOCIAL SECURITY SYSTEMS STATE PLANNING TECHNICAL RESOURCES TRADE UNIONS TRAUMA TREATMENTS VISITS WORKERS WORKFORCE WORLD HEALTH ORGANIZATION Bump, Jesse B. Powers Sparkes, Susan A Political Economy Analysis of Turkey's Health Transformation Program |
| geographic_facet |
Europe and Central Asia Turkey |
| description |
Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over
the past decade have reshaped the health system. Understanding the political economy of this process is
important for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and the
development agencies that assist them. This report analyzes the historical context and complex political economy
challenges of the reform. Our findings are based on stakeholder interviews and a review of literature. First, we
identified five contextual factors that were important in bringing health reform to the policy agenda in Turkey, and
were helpful in sustaining the reform during adoption and implementation: (1) a long history of reform plans and
attempts; (2) fiscal pressure to reform the social sectors; (3) public support for health reform; (4) strong economic
growth; and (5) favorable demographic conditions. Second, we assessed four political economy challenges central
to the reform and the strategies used by the Ministry of Health (MoH) to overcome them. First, the MoH built public
support 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 or
delegitimizing their views. Third, Turkey asserted its own domestic priorities over those of the IMF and World Bank
in cases of direct conflict. Fourth, the MoH circumvented potential political and institutional opposition to the large
expansion of benefits and coverage through a carefully sequenced adoption and implementation plan that could be
executed mostly without requiring the support of other ministries. This analysis also highlights important trade-offs
made by the MoH with respect to the redistribution of resources, quality of care, financial sustainability, and
physician satisfaction, which will all have to be considered as Turkey enters its next phase of health system
development. |
| format |
Working Paper |
| author |
Bump, Jesse B. Powers Sparkes, Susan |
| author_facet |
Bump, Jesse B. Powers Sparkes, Susan |
| author_sort |
Bump, Jesse B. |
| title |
A Political Economy Analysis of Turkey's Health Transformation Program |
| title_short |
A Political Economy Analysis of Turkey's Health Transformation Program |
| title_full |
A Political Economy Analysis of Turkey's Health Transformation Program |
| title_fullStr |
A Political Economy Analysis of Turkey's Health Transformation Program |
| title_full_unstemmed |
A Political Economy Analysis of Turkey's Health Transformation Program |
| title_sort |
political economy analysis of turkey's health transformation program |
| publisher |
World Bank, Washington, DC |
| publishDate |
2015 |
| url |
http://documents.worldbank.org/curated/en/2014/07/24146871/political-economy-analysis-turkey s-health-transformation-program http://hdl.handle.net/10986/21716 |
| _version_ |
1764449038079361024 |
| spelling |
okr-10986-217162021-04-23T14:04:04Z A Political Economy Analysis of Turkey's Health Transformation Program Bump, Jesse B. Powers Sparkes, Susan ABUSE ACADEMIC MEDICAL CENTERS ACCESS TO HEALTH SERVICES AGGRESSIVE AMBULANCE ANTENATAL CARE BUDGETARY CONTROL BULLETIN CAPACITY BUILDING CAPITATION CAPITATION SYSTEM CHILD HEALTH CHRONIC DISEASES CITIES CITIZEN CITIZENS CLINICIAN CLINICIANS COST CONTROL DEBT DELIVERY SYSTEM DEMAND FOR HEALTH DEMAND FOR HEALTH SERVICES DEVELOPMENT PLANNING DILUTION OF RESOURCES DISEASES DOMESTIC POLITICS ECONOMIC GROWTH ECONOMIC RESOURCES ELIGIBILITY DETERMINATIONS ENROLLEES ENTITLEMENT ENTITLEMENT PROGRAM EXISTING RESOURCES EXPENDITURES FAMILIES FAMILY PHYSICIAN FINANCIAL INCENTIVES FINANCIAL MARKETS FINANCIAL PRESSURE FINANCIAL PROTECTION FINANCIAL RISKS FORECASTS GLOBAL HEALTH HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE SYSTEM HEALTH COVERAGE HEALTH DELIVERY HEALTH DELIVERY SYSTEM HEALTH FINANCING HEALTH FINANCING SYSTEM HEALTH INDICATORS HEALTH INSURANCE HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH INSURANCE SYSTEM HEALTH ORGANIZATION HEALTH POLICY HEALTH PROFESSIONALS HEALTH PROJECTS HEALTH REFORM HEALTH REFORMS HEALTH RESEARCH HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HEALTH-CARE SYSTEM HEALTHCARE HEALTHCARE PROVIDERS HEALTHCARE SYSTEM HOSPITAL HOSPITAL ADMINISTRATORS HOSPITALS HUMAN RESOURCES ILL-HEALTH IMMUNIZATION INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INDUCED DEMAND INEQUITIES INSURANCE COVERAGE INSURANCE PREMIUM INSURANCE SCHEMES INTEGRATION LACK OF CAPACITY LAWS LOCAL AUTHORITIES MARGINAL COST MATERNAL HEALTH MATERNAL HEALTH SERVICES MEDICAL ASSOCIATION MEDICAL CENTERS MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL SCHOOL MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFERY MIDWIVES MINISTRY OF HEALTH MINISTRY OF LABOUR NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL SOVEREIGNTY NUMBER OF PEOPLE NURSES NUTRITION OUTPATIENT SERVICES OUTREACH ACTIVITIES PARTY PLATFORM PATIENT PATIENT SATISFACTION PATIENTS PHARMACISTS PHYSICIAN PHYSICIANS POLICY CHANGE POLICY DECISIONS POLICY DEVELOPMENT POLICY DISCUSSIONS POLICY GOALS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLITICAL OPPOSITION POLITICAL PARTIES POLITICAL POWER POLITICAL PROCESS POLITICAL SUPPORT POPULAR SUPPORT PREGNANT WOMEN PRIMARY CARE PRIVATE SECTOR PROFESSIONAL ASSOCIATIONS PROGRESS PROVIDER PAYMENT PROVISION OF HEALTH SERVICES PROVISION OF SERVICES PUBLIC DISCOURSE PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC HEALTH EXPENDITURES PUBLIC HEALTH SYSTEM PUBLIC HOSPITALS PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SERVICE PUBLIC SUPPORT PURCHASER-PROVIDER SPLIT QUALITATIVE INFORMATION QUALITY ASSURANCE QUALITY CARE QUALITY OF CARE QUALITY OF SERVICES RESPECT RURAL AREAS SERIES OF MEETINGS SERVICE PROVISION SERVICE QUALITY SMALL WORLD SOCIAL INSURANCE SOCIAL POLICIES SOCIAL POLICY SOCIAL SECTOR SOCIAL SECTORS SOCIAL SECURITY SOCIAL SECURITY SYSTEMS STATE PLANNING TECHNICAL RESOURCES TRADE UNIONS TRAUMA TREATMENTS VISITS WORKERS WORKFORCE WORLD HEALTH ORGANIZATION Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have reshaped the health system. Understanding the political economy of this process is important for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and the development agencies that assist them. This report analyzes the historical context and complex political economy challenges of the reform. Our findings are based on stakeholder interviews and a review of literature. First, we identified five contextual factors that were important in bringing health reform to the policy agenda in Turkey, and were helpful in sustaining the reform during adoption and implementation: (1) a long history of reform plans and attempts; (2) fiscal pressure to reform the social sectors; (3) public support for health reform; (4) strong economic growth; and (5) favorable demographic conditions. Second, we assessed four political economy challenges central to the reform and the strategies used by the Ministry of Health (MoH) to overcome them. First, the MoH built public support 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 or delegitimizing their views. Third, Turkey asserted its own domestic priorities over those of the IMF and World Bank in cases of direct conflict. Fourth, the MoH circumvented potential political and institutional opposition to the large expansion of benefits and coverage through a carefully sequenced adoption and implementation plan that could be executed mostly without requiring the support of other ministries. This analysis also highlights important trade-offs made by the MoH with respect to the redistribution of resources, quality of care, financial sustainability, and physician satisfaction, which will all have to be considered as Turkey enters its next phase of health system development. 2015-04-08T22:14:14Z 2015-04-08T22:14:14Z 2014-07 Working Paper http://documents.worldbank.org/curated/en/2014/07/24146871/political-economy-analysis-turkey s-health-transformation-program http://hdl.handle.net/10986/21716 English en_US CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research Publications & Research :: Working Paper Europe and Central Asia Turkey |