Obviously, one integrated HMIS system, based on harmonized and standardized data descriptions,

would be more efficient. A standardized national health information system provide nationwide

infrastructure for the efficient sharing of electronic health records is still in development. According

to ESC (2017), the system will allow patients, hospitals, clinics, medical faculties and laboratories to

record and track information regarding patients’ health. Furthermore, it is meant to track the

workforce and financial status of all institutions providing healthcare services, thus contributing e.g.

to evidence-based decision-making, accelerated information flow amongst e-health stakeholders,

increased efficiencies by disposing redundancies and coordinating health process, and the use of data

for scientific research. According to the government, all health institutions are expected to adopt the

electronic information sharing systems by 2023, with indicators in e-Health systems aimed at meeting

international standards (ESC, 2017).

Summary and Conclusions

Over the last decade, Turkey has made impressive advances in its health service system, including

coverage, much of which is due to its health transformation program (HTP) launched in 2003. The

program led to a number of crucial reforms increased health insurance coverage, expanded benefits,

reduced cost-sharing, and expanded the infrastructure, health human resources, and health services,

shaping its current health structure and contributing to its success. About 99% of the population (75.2

million) are covered by the universal health insurance (UHI) is administered by the Social Security

Institution (SSI). It is free for all citizens earning less than 279 TL

per month and beneficiaries of the

Green Card program - a non-contributory health insurance scheme, which is financed by the Ministry

of Finance. Citizens who earn more, pay premiums depending on their annual income. Both public and

private sector facilities provide health services, whereby the Ministry of Health acts as the main actor

and provides primary, secondary and tertiary care through its facilities across the country. A key

element of Turkey’s health system is the Family Medicine program, which was rolled out nationwide

by 2010. Health centres at the primary care level were replaced by community health centres (CHCs)

and family medicine centres, in which each patient is assigned a specific doctor. Family doctors are

mainly responsible for primary health care, preventive cure and guidance on healthy life styles.

The insurance program has increased access to healthcare of the poor significantly over the time by

reducing out-of-pocket expenditure and catastrophic health expenditures particularly amongst the

poor through their enrolment in the Green Card program. Previously the uninsured and poor and those

living in rural areas had 2.5 times higher catastrophic health expenditures before the implementation

of the UHI. Due to the HTP and UHI, the average life expectancy at birth increased from 72.5 years in

2002 to 78 years in 2017. Child and maternal health indicators, especially mortality rates, greatly

improved; maternal mortality rates dropped to about a sixth from 97 to 16 per 100,000 live births

between 2000 and 2015 and infant, neonatal and under-5 mortality rates in 2017 had dropped to a

fifth of their original values in 2000. It is suggested that such improvements came due to the

combination of increasing health insurance coverage, expanding benefits, and reducing cost-sharing

on the one hand, and expanding infrastructure, health human resources, and health services on the

other hand, were not restricted to richer parts of the population.

However, there are still differences between socio-economic income groups; with potential for further

improvements. Mortality rates, e.g. those of infants still differ significantly across urban and rural

areas, although such differences have decreased over time and are increasingly attributable to socio-

economic conditions and different education levels than lack of access to health services. 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. Learning from other experiences also influenced the sequencing of reforms in

Around 74 US$ on 31 December 2017.