City Hospitals: The Last Attire of Privatisation in the Turkish Health System

Year 2021, Issue: 6, 51 - 64, 31.12.2021

Ozan Karaçam

Abstract

As the health system has been sharply undergoing a series of changes in Turkey and the rest of the world, critical political and economic arguments are required to assess the capitalist relationships that exist behind the scenes of such changes. In this respect, the Health Transformation Program, implemented by the Justice and Development Party (AKP) since 2003, will be the focal point of the study. This research will also examine how the Public-Private Partnership (PPP) model has been penetrating the health system while leading the transformation in the provision of public services. The latest example of the privatisation of healthcare is the City Hospitals built under the PPP model as part of the second phase of the Health Transformation Program. The study comprehensively explores the City Hospitals’ legal, political, and economic context. The article, fundamentally, concluded that the City Hospitals continuing to be built by the Public-Private Partnership contracts do not mean the right to equal access to healthcare because these are the lucrative areas of investment and capital transfer for the contractor companies.

Keywords

Health Transformation Program, healthcare, neoliberalism, public-private partnership model, AKP

References

• 2U 1K Mühendislik ve Danışmanlık A.Ş. (2014). Ankara Etlik Entegre Sağlık Kampüsü Projesi Çevresel ve Sosyal Etki Değerlendirme Raporu. Ankara: 2U 1K Mühendislik.
• Abadie, R. (2008). Infrastructure finance: surviving the credit crunch. Talking Points.
• Abadie, R. (2014). Capital project and infrastructure spending: Outlook to 2025. PwC Public Sector Research Centre Publication.
• Anadolu Agency. (2020). Sağlık Bakanı Koca: Türkiye genelinde yatak doluluk oranı yüzde 51. https://www.aa.com.tr/tr/turkiye/saglik-bakani-koca-turkiye-genelinde-yatak-doluluk-orani-yuzde-51/1963372
• Baker, S., & Krawiec, K. D. (2005). Incomplete contracts in a complete contract world. Fla. St. UL Rev., 725 - 755.
• Belek, İ. (2016). Sağlığın Politik Ekonomisi: Sosyal Devletin Çöküşü. İstanbul: Yazılama Yayınevi.
• Boz, S. S. (2013). Kamu Özel İşbirliği (PPP) Modeli. İnönü Üniversitesi Hukuk Fakültesi Dergisi, 4(2), 277-332. Commission of European Communities. (2004). Green Paper: On Public-Private Partnerships and Community Law on Public. Brussels: Commission of Europen Communities.
• Çal, S. (2018). Kamu Özel Ortaklığı (KÖO) ve Kamu Hizmetlerinin Metalaştırılması. In K. Pala, Türkiye'de Sağlıkta Kamu Özel Ortaklığı Şehir Hastaneleri (Cilt 2, pp. 35-55). İstanbul: İletişim Yayıncılık.
• Dorlach, T. (2016). The Prospects of egalitarian capitalism in the global South: Turkish social neoliberalism in comparative perspective. Economy and Society, 44(4), 519-544.
• Emek, U. (2017). Sağlık Sektöründe Kamu-Özel İşbirliği Sözleşmeleri: Beklenti ve Gerçekleşme. Hacettepe Hukuk Fakültesi Dergisi, 7(1), 139-168.
• Emek, U. (2018). Şehir Hastanelerinde Paranın Değer Yaklaşımı. K. Pala içinde, Türkiye'de Sağlıkta Kamu Özel Ortaklığı Şehir Hastaneleri (Cilt 2, s. 71 - 99). İstanbul: İletişim Yayıncılık.
• Erbaş, Ö. (2021). Şehir Hastaneleri Altı Kaval Üstü Şişhane. Ankara: Dipnot Yayınları.
• EPEC. (2021). EPEC Market Data, European Investment Bank. https://data.eib.org/epec
• European Union. (2014). Health and Economics Analysis for an Evaluation of the Public Private Partnerships in Health Care Delivery across Europe.
• Hamilton, G., Kachkynbaeva, M., Wachsmuth, I., & Masaki, E. (2012). A preliminary reflection on the best practice in PPP in healthcare sector: A review of different ppp case studies and experiences. 25 September 2021, https://unece.org/fileadmin/DAM/ceci/images/ICoE/PPPHealthcareSector_DiscPaper.pdf
• Herman, C. (2010). The Marketisation of Health Care in Europe. L. Panitch, & C. Leys içinde, Morbid Symptoms: Health Under Capitalism (Cilt 46). Socialist Register.
• Jin, H., & Rial, I. (2016). IMF Working Paper: Regulating Local Government Financing Vehicles and Public-Private Partnerships in China. International Monetary Fund.
• Khan, N. N., & Puthussery, S. (2019). Stakeholder perspectives on public-private partnership in health service delivery in Sindh province of Pakistan: a qualitative study. 26 September, 2021, https://uobrep.openrepository.com/bitstream/handle/10547/623215/Stakeholder+perspectives+on+public-private+partnership+.pdf?sequence=2
• Konuralp, E. (2020). Between neoliberal appetence and environmentalist reservations: the political economy of sustainable aviation. International Journal of Sustainable Aviation, 6(2), 134. doi:10.1504/IJSA.2020.110603
• Konuralp, E. ve Bicer, S. (2021). Putting the Neoliberal Transformation of Turkish Healthcare System and Its Problems into a Historical Perspective. Review of Radical Political Economics, 53(4). doi:10.1177/04866134211005083
• Kristensen, T., Olsen, K., Kilsmarkand, J., & Pedersen, K. M. (2008). Economies of Scale and Optimal Size of Hospitals: Emperical Results for Danish Public Hospitals. Syddansk Universitet.
• Marzieh Marahem, M. S. (2018). The Importance of Bed Occupancy Rate in Evaluate the Utilisation of Hospitals. Crescent Journal of Medical and Biological Sciences, 5(4), 270-271.
• McKee, M., Edwards, N., & Atun, R. (2006). Public-Private Partnerships for Hospitals. Bulletin of the World Health Organization, 84, 890-896.
• Mc Kinsey & Company. (2013). Infrastructure productivity: How to save $1 trillion a year. London: McKinsey Global Institute.
• Pala, K. (2017, January 26). Şehir Hastanelerinin Yüksek Maliyeti Gizleniyor. June 2, 2021 tarihinde https://bianet.org/bianet/siyaset/183006-sehir-hastanelerinin-yuksek-maliyeti-gizleniyor adresinden alındı
• Pala, K. (2018). Kamu Hastanelerinin Piyasalaştırılması ve Sağlık Alanında Kamu Özel Ortaklığı Modeli. In K. Pala, Türkiye'de Sağlıkta Kamu Özel Ortaklığı Şehir Hastaneleri (pp. 99-135). İstanbul: İletişim Yayıncılık.
• Roehrich, J. K., Lewis, M. A., & George, G. (2014). Are public-private partnerships a healthy option? A systematic literature review. Social science & medicine, 113, 110 - 119.
• Roh, C. Y., Moon, M. J., & Jung, K. (2013). Efficiency Disparities among Community Hospitals in Tennessee: Do Size, Location, Ownership, and Network Matter? Journal of Health Care for the Poor and Underserved, 1816 - 1834.
• Sönmez, M. (2017). Paran Kadar Sağlık, Türkiye'de Sağlığın Ticarileşmesi (3. Basım b.). İstanbul: Yordam Kitap.
• The Court of Account. (2019). The Ministry of Health 2018 Audit Report of the Court of Account. The Court of Accounts.
• The Presidency of Republic of Turkey Directorate of Strategy and Budget. (2021). Proje Sayılarının Sektörlere Göre Dağılımı. https://koi.sbb.gov.tr/
• The Republic of Turkey the Ministry of Health. (2019). Health Statistics Yearbook. (B. B. Başara, İ. S. Çağlar, A. Aygün, T. A. Özdemir, & B. Kulali, editors) https://dosyasb.saglik.gov.tr/Eklenti/40566,health-statistics-yearbook-2019pdf.pdf
• The Republic of Turkey the Ministry of Health. (2021). The Directorate-General for Health Investments. Retrieved from https://sygm.saglik.gov.tr/TR,33960/sehir-hastaneleri.html
• Turkish Medical Association. (2012). Soru ve Yanıtlarla Sağlıkta Kamu Özel Ortaklığı. Ankara: Türk Tabipler Birliği Yayını.
• Warsen, R., Greve, C., Klijn, E. H., Koppenjan, J. F., & Siemiatycki, M. (2020). How do professionals perceive the governance of public–private partnerships? Evidence from Canada, the Netherlands and Denmark. Public Administration, 98(1), 124-139.
• World Bank. (2014). Reference Guide Public-Private Partnerships, Version 2.0. Washington: World Bank Publications.
• Yeşiltaş, A. (2020). Sağlık Sektöründe Kamu Özel Ortaklığı: Şehir Hastaneleri Üzerine Bir Değerlendirme. Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi, 6(1), 15-28.
• Yılmaz, V. (2017). The Politics of Healtcare Reform in Turkey. Springer Nature.
• Yılmaz, V. (2020). Exploring Patient Experiences of the Internal Market for Healthcare Provision in Turkey: Publicness Under Pressure. Journal of Social Policy, 1-18.