Universal Health Coverage with Private Options: The Politics of Turkey’s 2008 Health Reform

Abstract

Over the past decades, countries across the Global South have been adopting expansionary health reforms and are increasingly doing so under the banner of promoting universal health coverage. But countries have taken notably different approaches regarding the inclusion of private actors in their expanding healthcare systems. In this article, we explore the political causes and consequences of partial privatization in the context of healthcare expansion. We conduct a case study of Turkey’s 2008 health reform, which coupled substantial coverage expansion with the introduction of private options in provision and financing—and has since been branded as a global “success story” of achieving universal health coverage. Specifically, we seek to explain why Turkey introduced private options with its expansionary health reform and what kind of policy feedback effects this has triggered. We find that private options were incorporated into the reform as the result of persistent business lobbying and pro-market changes in the leadership of the health ministry and not because of any international coercion, e.g., by the World Bank. The introduction of these private options has since led to the growth of private hospital and insurance markets and the political entrenchment of partial privatization.