Turkey’s health­care: a bad prog­no­sis By Mehmet Adıyok

Turkey’s health­care sys­tem has never been far from the coun­try’s agenda in re­cent years, whether thanks to the sec­tor’s role as a draw for pri­vate in­vest­ment or head­line­grab­bing re­marks by the prime min­is­ter. Less prom­i­nent, how­ever, has been the voice o

Turkish Review - - CONTENTS - Mehmet Adıyok Physi­cian

An assess­ment of the cur­rent sta­tus of Turkey’s health­care sys­tem from a prac­ti­tioner’s per­spec­tive.

When it comes to health­care, the Turk­ish me­dia’s fo­cus of late has been on Prime Min­is­ter Re­cep Tayyip Er­doğan’s views on the is­sues of abor­tion and cae­sar­ian sec­tion, as well as on re­cent face trans­plant pro­ce­dures. Re­gard­ing the for­mer, the premier stated: “I am a prime min­is­ter who is against births per­formed by ce­sarean sec­tion. I know that these are sys­tem­atic ef­forts and con­sti­tute steps to re­tard the growth of this coun­try’s pop­u­la­tion. I also know that these moves have the aim of procur­ing fi­nan­cial re­sources. These ef­forts are leav­ing the pop­u­la­tion stag­nant. I be­lieve that abor­tion is mur­der.” Mean­while, ear­lier in the year the Min­istry of Health was quick to comment on the trans­plant pro­ce­dures, say­ing that they had made the nec­es­sary leg­isla­tive amend­ments and that Turk­ish doc­tors had per­formed the surgery.

It is shame no one both­ered to put a mi­cro­phone in front of Turkey’s med­i­cal prac­ti­tion­ers and ask them what they had to say. Our health sys­tem has un­der­gone many dramatic changes over re­cent years. By and large, the pub­lic has been happy with these changes. Doc­tors, on the other hand, have been less wel­com­ing. Those among them who have at­tempted to voice their con­cerns have found them­selves the vic­tims of dis­in­for­ma­tion and ac­cu­sa­tions. But doc­tors have no prob­lem with the pub­lic re­ceiv­ing qual­ity health­care.

Doc­tors are high­light­ing a prob­lem with Turkey’s health­care sys­tem it­self. The con­cerns of the health­care sec­tor are now more closely re­lated to costs and profit mar­gins than to a healthy so­ci­ety and its fu­ture well­be­ing. While this cur­rently seems only to bother the prac­ti­tion­ers, it won’t be long be­fore it also raises ob­jec­tions among pa­tients.

The min­istry views Turk­ish Med­i­cal As­so­ci­a­tion (TTB) crit­i­cism in mat­ters re­lat­ing to the pro­fes­sion as “de­fi­ant po­lit­i­cal op­po­si­tion” and is un­will­ing to take se­ri­ously its views on health­care and pro­fes­sional rights. Con­se­quently, the con­cerns of doc­tors, as echoed by the TTB, are drowned out by govern­ment and cor­po­rate power. As with the par­ti­san me­dia, un­yield­ingly dis­parag­ing of the

govern­ment’s ev­ery move and re­fus­ing to ac­knowl­edge the pos­i­tives, the hos­tile at­ti­tude dis­played here to even the slight­est crit­i­cism is of no ben­e­fit to any­one.

This ar­ti­cle aims to present a sum­mary of the cur­rent prob­lems with the Turk­ish health­care sec­tor.

(1) In­crease in health­care spend­ing lags Turkey’s eco­nomic growth

Su­per­flu­ous pre­scrip­tions and un­nec­es­sary pro­ce­dures are cited as the cul­prits for in­creased per capita health­care spend­ing. Ac­cord­ing to Or­ga­ni­za­tion for Eco­nomic Co­op­er­a­tion and De­vel­op­ment (OECD) health sta­tis­tics1, av­er­age health spend­ing in the or­ga­ni­za­tion’s coun­tries is 9.5 per­cent.

The US leads the way in health­care spend­ing among OECD coun­tries, con­tribut­ing 17.4 per­cent of its an­nual GDP, fol­lowed by Hol­land in se­cond place with 12 per­cent, France with 11.8 per­cent, Ger­many with 11.6 per­cent and Turkey in last place with 6.1 per­cent.

Turkey’s health spend­ing as a per­cent­age of its GDP was 4.95 per­cent in 2000, 5.16 per­cent in 2001, 5.37 per­cent in 2004 and 6.04 per­cent in 2007. Be­tween 1999 and 2003, the av­er­age in­crease in health ex­pen­di­ture as a per­cent­age of the GDP was 3.91 per­cent. The rate of in­crease was re­ported as 2.45 per­cent be­tween 2003 and 2007. The drop in this rate is the most im­por­tant in­di­ca­tor of sav­ings that had al­ready been made on health­care by the govern­ment.

Health sta­tis­tics com­piled by the World Health Or­ga­ni­za­tion (WHO) put global spend­ing on health at $5.3 tril­lion; 60 per­cent of this comes from pub­lic in­sti­tu­tions. In Turkey a com­par­i­son be­tween the in­creas­ing num­ber of pa­tients re­ceiv­ing health ben­e­fits and the in­crease in health spend­ing clearly un­der­cuts the claim that health costs are on the rise. Achiev­ing an ideal level of health­care will not be pos­si­ble in Turkey un­less the bud­getary ex­pen­di­ture on health­care is in step with the in­crease in na­tional in­come.

(2) Doc­tors are re­quired only to pro­vide treat­ment and are in effect pre­vented from fur­ther­ing their skills and at­tend­ing con­fer­ences that might equip them with the skills to use the most re­cent treat­ment meth­ods avail­able

Heal­ing is among the old­est pro­fes­sions in the world. A doc­tor’s re­sources con­sist of their knowl­edge and ex­pe­ri­ence. While most of the changes be­ing made to the health­care sec­tor re­late di­rectly to treat­ment ser­vices, there ap­pears to be no ef­fort be­ing made to­ward de­vel­op­ing doc­tors’ skills or fa­cil­i­tat­ing their en­gage­ment with new sci­en­tific de­vel­op­ments. Cur­rently wages in the med­i­cal pro­fes­sion make it dif­fi­cult for doc­tors to at­tend sci­en­tific con­ven­tions us­ing their own means. Al­though there has re­cently been some sup­port for en­abling doc­tors’ par­tic­i­pa­tion in such con­ven­tions, dock­ing their work­ing cap­i­tal share and de­duct­ing va­ca­tion time for at­ten­dance has made this un­ten­able. Tout­ing Turkey’s mod­ern­iza­tion and de­vel­op­ment, its ris­ing GDP and its sta­tus as the world’s 17th ranked econ­omy while show­ing re­luc­tance in al­low­ing prac­ti­tion­ers to at­tend these sci­en­tific con­ven­tions is in­de­fen­si­ble at best. Most state hos­pi­tals cur­rently lack a li­brary and do not sub­scribe to sci­en­tific jour­nals. Where these are avail­able, they are grossly in­suf­fi­cient2.

(3) The per­for­mance sys­tem en­gen­ders low job sat­is­fac­tion and does lit­tle to help the pa­tient

The per­for­mance sys­tem in­cor­po­rates bell-curve grad­ing on a re­gional ba­sis. The doc­tor with the most points is ranked high­est in terms of per­for­mance, while those with lower scores are ranked in de­scend­ing or­der. This sys­tem is open to ex­ploita­tion and doc­tors are now be­ing made to com­pete for points. Nor are there clear stan­dards for doc­tors on the ba­sis of their field. Of­fi­cial state­ments have even (falsely) claimed that all doc­tors have been per­form­ing at the high­est level.

Pa­tients ini­tially wel­comed per­for­mance grad­ing, which aimed to re­duce wait­ing lists by hav­ing doc­tors work longer hours. They are now com­plain­ing about in­ad­e­quate treat­ment and poor med­i­cal at­ten­tion. As a re­sult, the num­ber of dis­sat­is­fied pa­tients and se­cond opin­ions are in­creas­ing daily.

Al­though the re­quire­ment, as part of this assess­ment, for med­i­cal lec­tur­ers and doc­tors work full time may turn out to be a pos­i­tive de­vel­op­ment, it will be nec­es­sary to put in place the ad­di­tional in­fra­struc­ture re­quired for this and to al­low doc­tors who wish to work in the pri­vate sec­tor to do so. Given the choice, a pa­tient ap­ply­ing at a univer­sity clinic will nat­u­rally elect to be seen by a pro­fes­sor. How­ever, the work­ing hours of med­i­cal lec­tur­ers must be freed up so that the needs of pa­tients re­quir­ing such spe­cial­ized treat­ment can be met.

Fur­ther­more, lim­it­ing var­i­ous med­i­cal pro­ce­dures to train­ing hos­pi­tals has pre­vented them from be­ing car­ried out at spe­cial cen­ters, which are equipped to han­dle such cases. Hence, the field in which these trained in­di­vid­u­als can work has been marginal­ized.

(4) The So­cial Se­cu­rity In­sti­tu­tion (SGK) has mo­nop­o­lized the health­care sys­tem

A mo­nop­oly has been es­tab­lished with the trans­for­ma­tion of the SGK into a depart­ment that in­voices and over­sees 90 per­cent of the pro­ce­dures car­ried out at all pri­vate and state health fa­cil­i­ties. Seem­ingly no au­thor­ity ex­ists to field com­plaints against oc­ca­sional de­duc­tions that are made un­fairly. Any com­plainants who ap­ply in per­son are told to re­fer the mat­ter to the courts and ad­vised that “any quar­rel with the in­sti­tu­tion will be to their detri­ment,” thereby forc­ing them to forego their rights. In fact, the SGK has the right to de­lay pay­ment by three months to any health fa­cil­ity with which it has a stand­ing agree­ment. Is it any won­der peo­ple are so re­luc­tant to go to the courts?

An in­sti­tu­tion that pays you and then pro­ceeds to of­fer pre­mi­ums to au­di­tors re­spon­si­ble for over­see­ing your fa­cil­ity, based on de­duc­tions they have made from your fee, will in­evitably ex­ploit this state of af­fairs. There ex­ists no su­per­vi­sory au­thor­ity to ad­dress such griev­ances nor the slight­est in­di­ca­tion that there will be in the fu­ture. The SGK re­fuses to ac­knowl­edge cer­tain med­i­cal pro­ce­dures. A pro­ce­dure well-known to you and fre­quently car­ried out will not be bil­l­able if it is ab­sent from the SGK’s sched­ule of fees. As a re­sult, the pa­tient will be li­able to pay for the pro­ce­dure de­spite their in­sur­ance cov­er­age.

The SGK cur­rently keeps a record of all prac­ti­tion­ers is­su­ing pre­scrip­tions, to­gether with the drugs that they have pre­scribed. Also kept on record are the num­ber of pa­tients ex­am­ined and the names of the prac­ti­tion­ers who car­ried out the examinations, in ad­di­tion to the num­ber of tests re­quested and the names of those fil­ing the re­quest. Any doc­tor at­tempt­ing to abuse the process can eas­ily be sin­gled out. It is true that the SGK’s ef­forts to re­duce drug ex­pen­di­ture have been in­stru­men­tal in re­duc­ing a se­ri­ous bur­den on the state. How­ever, this has had hid­den con­se­quences. Some drugs, for in­stance, have been sud­denly dropped and taken out of pay­ment cov­er­age due to the man­u­fac­turer’s re­fusal to of­fer fur­ther dis­counts dur­ing that par­tic­u­lar year, de­spite hav­ing for­merly cut the price on sev­eral oc­ca­sions.

The SGK also in­volves it­self in mat­ters con­cern­ing doc­tors’ pro­fes­sions on eco­nomic grounds. The ma­jor­ity of these decisions are re­jected by the courts. For in­stance, lim­i­ta­tions im­posed by the SGK on the num­ber of drugs and dosages con­tained in a pre­scrip­tion have been over­turned by the courts and left to the dis­cre­tion of the prac­ti­tioner. An­nounce­ments re­lat­ing to these court rul­ings are made by the TTB and other pro­fes­sional or­ga­ni­za­tions, such as spe­cial­ist as­so­ci­a­tions, rather than the SGK it­self.


(5) Dif­fer­ences in stan­dards be­tween pri­vate health in­sti­tu­tions and state in­sti­tu­tions

The ex­emp­tion of state health fa­cil­i­ties from the strin­gent stan­dards im­posed on pri­vate in­sti­tu­tions is a cause of worry for both pa­tients and their doc­tors.

Whereas pri­vate health in­sti­tu­tions are sub­ject to checks for the amount of time they de­vote to pa­tients, this prac­tice is un­heard of at state hos­pi­tals. While the 10 min­utes per pa­tient pol­icy is seem­ingly fa­vor­able, no one ap­pears able to ques­tion its ab­sence in state or univer­sity hos­pi­tals.

The govern­ment bears al­most none of the cost for examinations car­ried out at pri­vate hos­pi­tals. De­spite this, both the min­istry of health and the SGK are do­ing all they can to dis­cour­age pa­tients from ap­ply­ing to pri­vate hos­pi­tals (re­stric­tions on staff and pa­tients, changes to phys­i­cal con­di­tions, bizarre fines and penal­ties im­posed by the SGK).

(6) Doc­tors are un­able to live where they want: staff norms and com­pul­sory ser­vice

Curb­ing the free­dom of doc­tors to live and work where they please is among the gross­est vi­o­la­tions of their per­sonal rights. First, staff norms were im­ple­mented in the pri­vate sec­tor, re­strict­ing the num­ber of doc­tors able to work in a spe­cific field. This put doc­tors in the pri­vate sec­tor un­der the close su­per­vi­sion of the state, which as­sumed au­thor­ity over all their af­fairs without ac­tu­ally pay­ing them or pro­vid­ing any of the ad­van­tages en­joyed by an em­ployee of the state. (As a health prac­ti­tioner -- pri­vate sec­tor or not -you are only al­lowed to work where the state deems ap­pro­pri­ate. More­over, you are not al­lowed to re­quest a trans­fer based on spousal priv­i­lege.) A set of leg­isla­tive amend­ments was en­acted to pre­vent state doc­tors from switch­ing to the pri­vate sec­tor. Fees for examinations, tests and sur­gi­cal pro­ce­dures were cut dra­mat­i­cally in pri­vate hos­pi­tals, low­er­ing the in­come of doc­tors. Later, the in­tro­duc­tion of staff norms made the switch be­tween pri­vate hos­pi­tals just as dif­fi­cult as the cross­over from state to pub­lic hos­pi­tals. While all other sec­tors were be­com­ing lib­er­al­ized, pri­vate en­ter­prise came in­creas­ingly un­der state su­per­vi­sion. Pre­vi­ous spousal priv­i­leges were lifted for com­pul­sory ser­vice, with no one seem­ing to care for the fam­i­lies that were be­ing torn apart. Hun­dreds of mar­ried prac­ti­tion­ers were, for a cer­tain pe­riod, forced to live and work away from their chil­dren.

Trans­fers and ap­point­ments were restricted even af­ter com­pul­sory ser­vice had been com­pleted with re­quests be­ing made for ad­di­tional work. Such re­quests were found to be in vi­o­la­tion of the Con­sti­tu­tion.

(7) De­fen­sive medicine: The re­sult of ex­ag­ger­ated pa­tients’ rights and com­plaints

There’s noth­ing odd about eval­u­at­ing pa­tients’ com­plaints in or­der to en­sure their sat­is­fac­tion. How­ever, in prac­tice, dis­crim­i­na­tion against doc­tors has re­cently led to se­ri­ous losses in work­ing hours and fos­tered a tense work­ing en­vi­ron­ment, all in the name of keep­ing up ap­pear­ances.

The num­ber of mal­prac­tice suits has risen dra­mat­i­cally in re­cent years. The Foren­sic Science In­sti­tute re­ceived 12,000 mal­prac­tice cases in 2010, up from only 600 in 2005 (these fig­ures were ob­tained from the in­sti­tute). The 184 hot­line has made it eas­ier to file a com­plaint against a doc­tor, con­tribut­ing to the ris­ing num­ber of cases. How­ever, this may also be due to de­vel­op­ments in health­care that took place be­tween 2005 and 2010, bring­ing with it eas­ier ac­cess, but also a sys­tem that im­pacted pa­tient sat­is­fac­tion. An in­crease of 70 per­cent in pa­tient sat­is­fac­tion cou­pled with a 20-fold rise in the num­ber of com­plaints re­ceived by the Foren­sic Science In­sti­tute against med­i­cal pro­ce­dures also points to the need to fur­ther in­ves­ti­gate this mat­ter.

(8) A symp­tom of the sys­tem: vi­o­lence against doc­tors

Some 56 per­cent of health­care work­ers have re­ported wit­ness­ing vi­o­lence in the work­place in the last year. Gen­eral prac­ti­tion­ers rank high­est with 66 per­cent. The num­ber of health­care work­ers claim­ing to have wit­nessed at least one act of vi­o­lence dur­ing their ca­reer is 96 per­cent.

In the past year, 45 per­cent of health­care pro­fes­sion­als were sub­jected to phys­i­cal vi­o­lence (women 58 per­cent, men 26 per­cent). Vi­o­lence also im­pacted 36 per­cent of spe­cial­ist doc­tors in that time­frame. This fig­ure is 45 per­cent for spe­cial­ist doc­tors ac­tive in state hos­pi­tals but drops to 5 per­cent for spe­cial­ist doc­tors work­ing in the pri­vate health sec­tor. The num­ber of gen­eral prac­ti­tion­ers sub­jected to vi­o­lence at least once in the last year comes in at 63 per­cent (women 69 per­cent, men 61 per­cent). The fig­ure is 55 per­cent among fam­ily prac­ti­tion­ers. A to­tal of 33 per­cent of res­i­dent doc­tors have had to

con­tend with vi­o­lent be­hav­ior in the last year, with women res­i­dents hav­ing to bear the brunt of at­tacks.

When we look at the na­ture of the vi­o­lence health­care work­ers have been sub­jected to we find that pro­fan­ity, in­sults, spit­ting and threats are the most com­mon, with 84 per­cent, fol­lowed by phys­i­cal at­tacks such as slap­ping, punch­ing, armed as­sault and sex­ual harass­ment.

Vi­o­lent be­hav­ior is most com­monly en­coun­tered in emer­gency wards, the med­i­cal worker’s own work­ing en­vi­ron­ment, clin­ics and in­pa­tients wards. Among these, emer­gency wards are the most com­mon for in­ci­dences of vi­o­lence with 23 per­cent. Mean­while 45 per­cent of health­care work­ers re­ported en­coun­ter­ing vi­o­lence dur­ing the dayshift.

The lead­ing causes of vi­o­lent be­hav­ior against doc­tors are the cur­rent health sys­tem and state­ments made by po­lit­i­cal lead­ers. That is, in­suf­fi­cient time al­lo­cated to pa­tients; over­crowd­ing in hos­pi­tals due to a lack of sup­port staff and the ab­sence of a re­fer­ral sys­tem; non-emer­gen­cies in emer­gency wards; and poor phys­i­cal con­di­tions. The po­lit­i­cal grand­stand­ing and in­sults against doc­tors by of­fi­cials are not only cast­ing as­per­sions on doc­tors, but also en­cour­ag­ing vi­o­lence against them.

Dwin­dling con­fi­dence in doc­tors is caus­ing pa­tients to shop around for se­cond opin­ions and stop­ping them from tak­ing their pre­scribed med­i­ca­tion. These fac­tors all play a role in ris­ing health costs, un­nec­es­sary drug pur­chases, grow­ing pa­tient num­bers and in­creas­ing vi­o­lence against doc­tors.

(9) The sys­tem of ‘chain re­fer­ral,’ widely used in many coun­tries to pre­vent hos­pi­tal over­crowd­ing, is not be­ing im­ple­mented due to pop­ulist con­cerns, de­spite com­plaints about doc­tor short­ages

The chain re­fer­ral sys­tem pre­vents pa­tients from ap­ply­ing to any hos­pi­tal at any given time and as of­ten as they like, while si­mul­ta­ne­ously en­abling many pa­tients to re­ceive treat­ment from their fam­ily prac­ti­tion­ers without hav­ing to ap­ply to spe­cial­ist clin­ics.

Med­i­cal univer­sity lec­tur­ers, pri­vate prac­tices should be re­opened, and fees for pa­tients re­ferred to them by spe­cial­ists should be borne by the state. In the event other pa­tients pay their own way, spe­cial­ist doc­tors will be able to de­vote more time to pa­tients re­quir­ing spe­cial­ist at­ten­tion.

(10) Health tourism and med­i­cal la­bor

Doc­tors have lit­tle en­thu­si­asm for the no­tion of health tourism, a sub­ject that oc­ca­sion­ally crops up in the news me­dia. There are two rea­sons over­seas pa­tients flock to Turkey: the ser­vice is bet­ter and it is more af­ford­able. The pric­ing of most sup­plies con­forms to an in­ter­na­tional stan­dard, so what makes this op­tion af­ford­able is quite sim­ply the re­duc­tion in the cost of med­i­cal la­bor.

See­ing as how the fi­nal fee (in­clu­sive of all charges) charged for cer­tain sur­gi­cal pro­ce­dures in Turkey is barely enough to cover the doc­tor’s fee in cer­tain coun­tries, health tourism is noth­ing more than an ad­mis­sion that doc­tors are grossly un­der­paid in this coun­try.

The av­er­age an­nual in­come for a first stage doc­tor in the US is $161,000, whereas a se­cond stage spe­cial­ist earns an av­er­age an­nual in­come of $222,000. First stage doc­tors in Ger­many earn an av­er­age an­nual in­come of 80,000 eu­ros, while their se­cond stage spe­cial­ist coun­ter­parts make 85,000-125,000 eu­ros3.

There is no av­er­age for the fig­ures of­ten men­tioned in Turkey and of­fi­cial dis­clo­sures usu­ally tend to re­fer to the high­est pos­si­ble salary, mis­rep­re­sent­ing it as a stan­dard that ap­plies to all. The net monthly salary of a spe­cial­ist cur­rently stands at TL 1,800. With im­proved per­for­mance, this may in­crease by an ad­di­tional TL 3,500, al­though this is un­com­mon. The av­er­age monthly salary of a fam­ily prac­ti­tioner is around TL 4,000. ( These av­er­ages were cal­cu­lated in­for­mally from fig­ures dis­closed by sev­eral other doc­tors and are not of­fi­cial.)

The health min­is­ter has re­marked that this is un­ac­cept­able and that his min­istry is mak­ing ef­forts to rem­edy this in­con­sis­tency. The state­ment “en­sur­ing the im­ple­men­ta­tion and de­vel­op­ment of the med­i­cal pro­fes­sion for the bet­ter­ment of the pub­lic and the in­di­vid­ual” was struck from the ex­ist­ing leg­is­la­tion with the en­act­ment of Statu­tory De­cree 11- 663.

The sole pur­pose of re­mov­ing this state­ment is to pre­vent the ju­di­ciary from block­ing any law that does not sub­scribe to the good of the pub­lic and the in­di­vid­ual and to lay the le­gal ground­work for trans­form­ing health­care into a for- profit in­dus­try.

(11) Al­low­ing for­eign doc­tors to prac­tice is likely to do more harm than good at this junc­ture and will have reper­cus­sions for the per­sonal rights of doc­tors

Doc­tors are usu­ally al­lowed to travel and work over­seas, pro­vided that they are qual­i­fied and have the nec­es­sary lan­guage skills. In Turkey, how­ever, the ten­dency is quite dif­fer­ent, in­stead forc­ing doc­tors into com­pul­sory ser­vice to work un­der dif­fi­cult con­di­tions while leav­ing for­eign doc­tors free of any such obli­ga­tion, un­der­min­ing the claim that this pro­posed so­lu­tion will al­le­vi­ate doc­tor short­ages. Over­seas doc­tors need only speak a pass­able level of Turk­ish in or­der to se­cure em­ploy­ment. No in­quiries are made to pro­fes­sional or­ga­ni­za­tions in their coun­try of ori­gin to ob­tain in­for­ma­tion on their pro­fes­sional record. Doc­u­ments ob­tained from the Min­istry of Health and the rel­e­vant em­bassy, in­di­cat­ing that they are au­tho­rized to work, have been viewed as suf­fi­cient ev­i­dence of their em­ploy­ment cre­den­tials. There are cur­rently no laws to help di­rect over­seas doc­tors to work in health­care black spots. Over­seas doc­tors will not be sub­jected to com­pul­sory ser­vice. Only Turk­ish cit­i­zens will con­tinue to be li­able for three tours of duty at 300 to 600 days each in or­der to com­plete med­i­cal school, spe­cial­ist and sub-branch train­ing.

Pro­fes­sional or­ga­ni­za­tions are re­spon­si­ble for keep­ing doc­tors’ pro­fes­sional records in demo­cratic coun­tries. How­ever, these records are not re­quired for au­tho­riza­tion by the TTB. In­stead, a doc­u­ment ob­tained from an em­bassy or a con­sulate, prov­ing the ab­sence of any re­stric­tions to med­i­cal prac­tice, is ad­e­quate. Le­gal safe­guards that would en­able pro­fes­sional or­ga­ni­za­tions to vet doc­tors and im­pose penal­ties and re­ceive dam­ages in the event of pro­fes­sional mis­con­duct have not been in­tro­duced to en­sure the right to health­care.


(12) Crit­i­cism of the trans­for­ma­tions in the health sys­tem is not ide­ol­o­gist in na­ture

The min­is­ter of health gave a speech on 14 May in honor of Health Day. The min­is­ter’s ad­mis­sion that the re­tire­ment ben­e­fits of doc­tors were in­suf­fi­cient was quite ac­cu­rate. How­ever, the com­par­i­son he drew be­tween doc­tors’ in­comes and the min­i­mum wage, say­ing that “you should be thank­ful you’re not re­ceiv­ing the min­i­mum wage of TL 750,” was some­thing of a blun­der. His re­ac­tion to crit­i­cism, de­scrib­ing it as ide­o­log­i­cal and not con­ducive to solv­ing the prob­lem, wasn’t re­ceived well, but may in­di­cate that he un­der­stands that doc­tors have con­cerns and that there may be vi­able so­lu­tions for ad­dress­ing them. If only he had cho­sen to ad­dress the prob­lem in­stead of vil­i­fy­ing those who were in dis­agree­ment.

In sum­mary

There’s cur­rently an ef­fort to lend cre­dence to the idea that health costs are con­stantly ris­ing, de­spite the fact that Turkey ranks last among OECD coun­tries in its bud­getary con­tri­bu­tion to health. Turkey’s bud­get health ex­pen­di­ture lags be­hind the growth rate of its na­tional in­come. If we are in a phase of pros­per­ity, then our na­tion’s health should reap the ben­e­fits. It is a damn­ing in­dict­ment that the most sig­nif­i­cant fac­tors at­trib­ut­able to the 20-fold rise in the num­ber of com­plaints re­ceived by the Foren­sic Science In­sti­tute against med­i­cal pro­ce­dures, de­spite a 70 per­cent rise in pa­tient sat­is­fac­tion, and the es­ca­lat­ing vi­o­lence against doc­tors, in­clude the cur­rent health sys­tem and the Min­istry of Health’s doc­tors.

We are cur­rently fac­ing a Min­istry of Health that views each and ev­ery crit­i­cism made by the TTB as an ide­o­log­i­cal ruse. Doc­tors now find them­selves help­less due to the ease with which the TTB, the voice of the med­i­cal com­mu­nity, can so eas­ily be dis­missed as an “ide­o­log­i­cal” or­ga­ni­za­tion. Why aren’t the TTB, spe­cial­ist doc­tors as­so­ci­a­tions, pa­tients’ rights or­ga­ni­za­tions and the As­so­ci­a­tion of Phar­ma­cists con­sulted in mak­ing a joint de­ci­sion? Doc­tors are sel­dom sur­veyed for their opin­ion, let alone asked to con­sult on these is­sues.

Crit­i­cism of re­cent de­vel­op­ments in health is not tol­er­ated and is usu­ally branded an in­va­sion of the po­lit­i­cal arena. If to be crit­i­cal is to be po­lit­i­cal, then this should present no prob­lem in a demo­cratic so­ci­ety.


Around 3,000 health­care sec­tor work­ers and union­ists protest in Beyazıt, İs­tan­bul. Dec. 21, 2011

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