The book under review is written by Volkan Yılmaz, who is an academician specializing in social politics. Volkan Yılmaz the author takes on the challenge of providing a comprehensive analysis of the political dynamics of the HTP. Methodologically, the book is a case study based on a single country. It examines the political dynamics of Turkish HTP between 2003 and 2013. Empirically overlays the change in healthcare financing with interpretations of politics. Whilst describing the new configuration of power, it also draws on different approaches to healthcare systems. The main focus is the transformation in healthcare system since 2003.
Yılmaz a detailed overview of the historical legacy of Turkey’s healthcare system against the background of Turkish politics. The Politics of Healthcare Reform in Turkey presents theoretical framework of institutionalist approaches along with their motivations, values, ideas and ideologies. It explores national, regional and global actors of social policy makers, which expands the social policy literature. What were the political dynamics that enabled the introduction of healthcare reform in Turkey? What political conflicts did the reform generate? How and to whose benefit have these conflicts been resolved? are the questions the study answers throughout the book.
Yılmaz shapes the book into nine, well-researched academic chapters starting with “The New Politics of Healthcare in Turkey” and ending with “Private Healthcare Provider Organisations as New Actors in the Politics of Healthcare.” Each chapter has its own introduction and conclusion, provides critical facts understanding the historical legacy of Turkey’s health care system against the background of Turkish politics. Chapter 1 introduces the author’s methodological premises. Here, Yılmaz presents a delicate overview of the political dynamics enabled the introduction of the HTP in Turkey. The chapter situates a comparative framework. Chapter 2 offers different perspectives on the study of healthcare politics and presents the historical foundations of Turkey’s healthcare policy. Chapter 3 addresses the historical legacy of the healthcare system, Turkey’s healthcare system and its development process. Chapter 4 has four sections. Its main objective is to describe the HTP within the healthcare reforms in other emerging market economies. Chapter 5 investigates the World Bank (WB) in Turkey’s healthcare reforms, what extent it has been influential in the process. Chapter 6 examines the Justice and Development Party (AK Party) impact on healthcare reform. Chapter 7 discusses the role of the Turkish Medical Association (TTB) in Turkish healthcare reform. It explores the dynamics of the conflict between the AK Party and the TTB, which is the largest doctors’ organization in Turkey. Chapter 8 examines how the inclusion of private hospitals evolved into the public health insurance plan. In the last chapter, Yılmaz analyzes the changes in the power dynamics between the various actors in Turkey’s healthcare system.
At the very beginning of the book, Yılmaz mentions that healthcare is associated with citizenship rights and manifest in the public health approach.
It can be said that functioning of the TTB organization tries to retain its own characteristics (p. 179). According to Pierson, goverments can only introduce radical reforms if they face serious economic crisis.
It would be fair to say that the revolution in Turkish healthcare system is one the biggest achievements of the AK Party government since 2002. The AK Party government launched the HTP in 2003 goals updating the Ministry of Health as a monitoring body, bringing public health insurance under a general umbrella, increasing human resources in healthcare facilities and introducing quality measures (Chapter 4). HTP made the Social Security Institution (Sosyal Güvenlik Kurumu - SGK) the single payer of healthcare services and included private hospitals in the public health insurance plan (p. 169).
Yılmaz identifies the tensions and components within the health reform program by exploring how key actors in Turkey tried to shape the reforms. He helps us to understand the reform’s universal elements and analyses to explain how this specific health reform package fits in with the governing AK Party’s political program (p. 149). Yılmaz mentions that global ideas in healthcare shape the Turkish reform (p. 123). Indeed the Turkish case shares important elements within the health sector worldwide. Turkish governments have worked with the WB on healthcare policy issues since 1990, which makes the WB a key player in Turkey’s heathcare policy.
In conclusion, Yılmaz expresses his views by saying that at the beginning of the healthcare reform process, private healthcare providers in Turkey failed to succeed in realising their demands (p. 259). Although Yılmaz’s analysis brings up good examples of health reforms as a complex political process, it does not go so far on global perspective in policy making. Actors such as TTB, the private health sector and SGK could have been systematically explored.
Overall, The Politics of Healthcare Reform in Turkey is a well-structured useful contribution to understanding the roots of Turkey’s healthcare policies. It takes its rightful place among theoretical approaches to global social policy and policy diffusion. Researchers, policy makers, scholars and students, whose fields of research embrace international social policy, health system, health policy, political and economic history would benefit from this analysis.
Endnote
1. Pierson, Paul, “The New Politics of the Welfare State,” World Politics, Volume 48, No. 2 (1996).
