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Exploring Patient Experiences of the Internal Market for Healthcare Provision in Turkey: Publicness under Pressure

Published online by Cambridge University Press:  02 June 2020

VOLKAN YILMAZ Open the ORCID record for VOLKAN YILMAZ [Opens in a new window]
VOLKAN YILMAZ*
Affiliation:
Associate Professor of Social Policy, Bogazici University, Director, Social Policy Forum Research Centre. Postal address: Bogazici University Social Policy Forum, Kuzey Kampus, KPARK No: 119, 34342, Istanbul/Turkey. email: vyilmaz@boun.edu.tr
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Abstract

The establishment of internal markets for healthcare provision in publicly-funded healthcare systems brings forth a number of new regulatory challenges. During the 2003 healthcare reform in Turkey, universal health coverage (UHC) was implemented concurrently with the establishment of an internal market for service provision, resulting in an increase in private sector activity. In this context, this paper explores how, in the Turkish case, the macro-level adoption of an internal market model for healthcare provision has shaped patient experiences at the micro-level in their ability to receive treatment in private hospitals offering publicly-funded services (PHOPS). It also examines the influence of the internal market on the realised publicness of healthcare services in Turkey. Data for the study were obtained from patient complaints that appeared on a private online platform and 20 patient interviews. These showed that patients sometimes face significant challenges, including pressure to make informal payments, when accessing their entitlements, which is evidence of the erosion of publicness in a hybrid healthcare system. These challenges emerge from information asymmetry between patients and providers; a large space for PHOPS to manoeuvre when deciding to register patients as insurance holders or private patients; and the ineffective public regulation of the internal market.

Keywords

healthcare policyhybrid healthcare systeminternal marketinformal paymentpublicnessregulationDiagnosis-related groups (DRGs)emergency services (ER)Health Transformation Program in Turkey (HTP)out-of-pocket (OOP)private health insurance (PHI)private hospitals offering publicly-funded services (PHOPS)public-private partnership (PPP)social health insurance (SHI)Social Security Institution of Turkey (SSI)universal health coverage (UHC)
Type
Article
Information
Journal of Social Policy , Volume 50 , Issue 3 , July 2021 , pp. 588 - 605
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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