66
Figure 36: Maternal Mortality Ratio by Provinces (per 100,000 live births) in 2017.
Source: MoH 2018
The expansion of Turkey’s health system for UHC
The HTP have specifically focused on increasing access to health care services for all with an
implementation of both demand and supply-side reforms. “Driven by clear vision and strong
leadership, the first ten years of Turkey’s Health Transformation Programme have dramatically
expanded access to health care” (OECD, 2014a, p. 15). Much of the literature emphasises the strong
commitment and leadership as well as the systematic and analytical way in which the reforms where
prepared and implemented. For example, one of the initial initiatives of the MoH was to carry out a
diagnostic exercise with the aim to identify the root causes of Turkey’s poor health outcomes. This
would lay the basis for the reform design. To inform the design, literature studies on successful health
sector reforms in other countries, and study visits were carried out to identify relevant lessons for
Reduction of out-of-pocket expenditure through the HTP
Improvements on infrastructure for better accessibility to health centres and public transportation
reduced the out of pocket and catastrophic health expenditures significantly. By 2008, out-of-pocket
expenditures were on average 1.3 per cent lower, and in rural areas even 2.1 per cent. Catastrophic
expenditures were reduced by 0.9 per cent, and probability occurrence of catastrophic health
expenditure in rural areas declined by 1.2 per cent. In addition to infrastructure, other measures were
taken to reduce out-of-pocket expenditure:
 Reduction of VAT and thus prices for pharmaceuticals
 Green Card Scheme covering all health expenditure, including in- and outpatient services at health
centres and hospitals as well as outpatient prescription drugs
 Funding of health care system through taxes, premiums and contributions
 Definition of equity in finance and access to health services is based on the ability to pay
 Incentives to personnel to increase the number of professional staff between 2001 and 2011; e.g.
mobile outreach services are provided to those living in those areas. The payment of those
physicians is adjusted based on the socio-economic development of the area they practice and
those working in underserved areas receive a “service credit”
 Free health care provision for the population under 18 years old
Source: Giovanis and Ozdamar (2017)