GOVERNMENT RESPONSIVENESS: THE EXTENT OF EQUITY IN HEALTH SERVICES IN TURKEY

Abstract

Why is the objective of equity in the health sector significant? What is the relevance of equity, particularly in a medium-income country like Turkey, which has been ‘structurally adjusting’ for over three decades which planned to cut government expenditures by encouraging ‘cost-effectiveness’ and ‘efficiency’ in public services including the health sector? Has the health reform in Turkey since the early 1990s succeeded in ensuring its enhancement, despite an extensive discussion on equity? In this study, equity in the health sector in Turkey were analysed considering its basic dimensions including finance and provision. The Health Services Utilization Survey (HUS) conducted in 1992 was used us to show the extent of the problem of inequity in the health system in Turkey and the areas of intervention toward a more equitable health sector. This has been instrumental in understanding how and why equity can be relevant in enhancing the responsiveness of the government to the health care needs of the population. The analysis revealed that the inequity problem in Turkey was mainly from the inequalities in health insurance coverage and the geographical distribution of the health care resources. To overcome structural problems as well as inefficiencies in the health system, government started a series of reforms under the Health Transformation Project in 2003. The unification of the existing health insurance schemes and introduction of the universal health insurance to the whole population in 2008 was a prominent change in the health system. Our framework of analysis in this study can provide a basis for evaluating the effect of recent changes to the equity in health system in Turkey. A similar analysis will enable whether there has been any improvement in the health system in reaching its equity objective.