Europeanization of the Turkish Health Policy: A Historical Exploration

Abstract

          This study examines varying levels in the Europeanization of health policies by taking Turkey as an example country. The institutional adaptation of regulatory institutions in the field of health at both legal and actual levels is analysed in this context. This study puts forward that the Europeanization of Turkey’s health policy and health care system has a long history which goes back to the 19th century. On the other hand, this process has been accelerated by having a candidate status and starting the negotiation process. It has also underlined that the demands of the EU to formulate health plans and programs in Turkey by providing financial resources and organizing principles constitute the main vehicle of Europeanization. The materialization of the Europeanization of Turkish health policies is in two main channels direct channel (alignment with the acquis) and indirect channel (spill-over effect). In this point, it suggests that the Europeanization in health policy will be achieved when supports with strong institutional capacity. The study, then, explores both the process of Europeanization beyond Europe and its limits when it is obstructed by domestic politics, interests, and institutions.

Keywords

• Europeanization,Health Policy,Europeanization of Health Policy,Europeanization of Regulation,Europeanization of Turkish Health Policies

References

1. Abel-Smith, B., Mossialos, E. (1994). Cost containment and health care reform: a study of the European Union. Health Policy, 28,2, 89-132.
2. Abel-Smith B., Figueras J., Holland W., McKee M., Mossialos, E. (1995). Choices in Health Policy: An Agenda for the European Union. London: Dartmouth Publishing Company.
3. Ahmad, F. (1993). The Making of Modern Turkey. New York: Routledge. Aksakal, L.J., Hutt, P.B. (2003, Feb 24). The Sick Man and His Medicine: Public Health Reform in the Ottoman Empire and Egypt (2003 Third Year Paper). https://dash.harvard.edu/handle/1/10015270
4. Alakavuk, E.D., Helvacıoğlu, A.D. (2007, Feb 24). Role of EU Funds in Molding Attitudes toward EU Integration: The Case of Turkey. http://www.sgir.org/archive/turin/uploads/Alakavuk-the_role_of_eu_funds_in_molding_attitudes_eda_adh_revised.pdf
5. Andoura, S. (2006). European Union’s Capacity to Absorb Turkey. Studia Diplomatica, 59,23-34.
6. Arnold, H. (2007). Political Arguments Against Turkey’s Accession to the European Union. Internazionale Politik und Gesellschaf, 3,101-113.
7. Aybet, G. (2006). Turkey and the EU After the First Year of Negotiations: Reconciling Internal and External Policy Challenges. Security Dialogue, 37,529-549.
8. Aydın, E. (2002). Türkiye’de sağlık teşkilatlanması tarihi. Ankara: Naturel Yayınları.

9. Azzopardi-Muscat, N., Sorensen, K., Aluttis, C., Pace, R., Brand, H. (2016). Europeanisation of health systems: a qualitative study of domestic actors in a small state. BMC, 16,334.
10. Bahçecik, Ş. O. (2014). European Union twinning projects and the Turkish police: Looking beyond Europeanization. New Perspectives on Turkey, 51,69–96.
11. Börzel, T., Risse, T. (2000, Feb 18). When Europe Hits Home: Europeanization and Domestic Change. European Integration Online Papers (EIoP). http://eiop.or.at/eiop/texte/2000-015a.htm
12. Bulmer, S.J., Radaelli, C.M. (2004). The Europeanisation of National Policy? Queen's Papers on Europeanisation. Belfast: Queens University.
13. Calikoglu, E.O., Koycegiz, E. (2019). Tobacco Control Policies in Turkey in Terms of MPOWER. The Eurasian Journal of Medicine, 51,80-84.
14. Comas-Herrera, A. (1999). Is There Convergence in the Health Expenditures of the EU Member States? E. Mossialos and J. Le Grand (Eds). In Health Care and Cost Containment in the European Union. (pp:197-218). Aldershot: Ashgate.
15. Commission of the European Communities (2004a). Communication from the Commission to the Council and the European Parliament. 2004 Regular Report on Turkey’s progress towards accession, COM (2004) 656 final. Brussels: Office for Official Publications of the European Communities.
16. Commission of the European Communities (2004b), Communication from the Commission to the Council and the European Parliament. Recommendation of the European Commission on Turkey’s progress towards accession, COM (2004) 656 final. Brussels: Office for Official Publications of the European Communities.
17. Commission of the European Communities (2005a). Turkey 2005 Progress Report. COM (2005) 561 final. Brussels: Office for Official Publications of the European Communities. Commission of the European Communities (2005b, Oct 3). Negotiating Framework for Turkey. https://ec.europa.eu/neighbourhood-enlargement/sites/near/files/pdf/turkey/st20002_05_tr_framedoc_en.pdf
18. Commission of the European Communities (2006). Amended Proposal for a Decision of the European Parliament and of the Council Establishing a Second Programme of
19. Community Action in the Field of Health (2007-2013) COM (2006) 236 final. Brussels: Office for Official Publications of the European Communities.
20. Commission of the European Communities (2006b). Communication from the Commission, Consultation Regarding Community Action on Health Services, COM (2006) 1195/4. Brussels: Office for Official Publications of the European Communities.
21. Commission of the European Communities (2007). Commission Staff Working Document. Turkey 2007 Progress Report. Accompanying the Communication from the Commission to the European Parliament and the Council Enlargement Strategy and Main Challenges 2008-2009. COM (2007) 663 final. Brussels: Office for Official Publications of the European Communities.
22. Civil Society Dialogue. (2020, Feb 24). About Our Programme. http://civilsocietydialogue.org/us/ Demetropoulou L. (2002). Europe and Balkans: Membership Aspiration, EU Involvement and Europeanization Capacity in South Eastern Europe. Southeast European Politics, 3,87-106.
23. Directorate for EU Affairs. (2019a, Feb 24). Current Situation. https://www.ab.gov.tr/current-situation_65_en.html
24. Directorate for EU Affairs. (2019b, Feb 24). Accession Negotitations. https://www.ab.gov.tr/accession-negotitations_37_en.html
25. Dole, C. (2004). In the Shadows of Medicine and Modernity: Medical Integration and Secular Histories of Religious Healing in Turkey. Culture, Medicine and Psychiatry, 28,255- 280.
26. EU Delegation of the European Commission to Turkey (2006, July 7). EU-Turkey Civil Society Dialogue. https://www.ab.gov.tr/48092_en.html
27. EU Delegation of the European Union to Turkey (2019a, Feb 24). Regular Reports on Turkey. https://www.avrupa.info.tr/en/regular-reports-turkey-744#
28. EU Delegation of the European Union to Turkey (2019b, Feb 24). How the IPA is implemented. https://www.avrupa.info.tr/en/how-ipa-implemented-24
29. EU Delegation of the European Union to Turkey (2019c, Feb 24). Instrument for Pre-Accession Assistance (IPA). https://www.avrupa.info.tr/en/instrument-pre-accession-assistance-ipa-880
30. EU Delegation of the European Union to Turkey. (2019d, Feb 24). EU Policy and Financial Cooperation. https://www.avrupa.info.tr/en/financial-cooperation-turkey-14
31. European Commission (2007). Understanding Enlargement. The European Union’s Enlargement Policy. European Communities. Brussels: Office for Official Publications of the European Communities.
32. European Commission (2019). Commission Staff Working Document, Turkey 2019 Report Accompanying the document Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions 2019 Communication on EU Enlargement Policy COM (2019) 260 final. Brussels: Office for Official Publications of the European Communities.
33. European Neighbourhood Policy and Enlargement Negotiations. (2019, Feb 24). Twinning. https://ec.europa.eu/neighbourhood-enlargement/tenders/twinning_en
34. Ergör, G., Öztek, Z. (2000). The development of national health policy in Turkey. World Health Organization Regional Publications, European Series, 86,194-208.
35. Featherstone, K. (2003). Introduction: In the Name of Europe. C. Radaelli and K. Featherstone (Eds). In the Politics of Europeanization: Theory and Analysis (pp: 3-26). Oxford: Oxford University Press.
36. Fişek, N. (1963). Türkiye’de Sağlık Hizmetlerinin Sosyalleştirilmesi Üzerinde Çalışmalar. Sağlık Dergisi, 37,3.
37. Fişek, N. (1964). Sağlık Hizmetlerinin Sosyalleştirilmesinin Tarihçesi ve Temel İlkeleri. Muş Sağlık Bülteni, 4.
38. Günal, A. (2008). Health and citizenship in Republican Turkey: An analysis of the socialization of health services in Republican historical context. Boğaziçi University, Institute of Social Sciences, Istanbul.
39. Grabbe, H. (2003). Europeanization Goes East: Power and Uncertainty in the EU Accession Process. K. Featherstone and C. Radaelli (Eds). In the Politics of Europeanization. (pp: 303-330). Oxford: Oxford University Press.
40. Grabbe, H. (2001). How Does Europeanization Affect CEE Governance? Conditionality, Diffusion and Diversity. Journal of European Public Policy, 8,1013-1031.
41. Greer, S.L. (2006a). Uninvited Europeanization: Neofunctionalism and the EU in Health Policy. Journal of European Public Policy, 13,134-152.
42. Greer, S.L. (2006b). Responding to Europe: Government, NHS and Stakeholder Responses to the EU Health Policy Challenge. London: The Nuffield Trust.
43. Greer, S.L. (2008). Choosing Paths in European Union Health Policy: A Political Analysis of a Critical Juncture. Journal of European Social Policy, 18,219-231.
44. Hix, S., Goetz, K. (2000). Introduction: European Integration and National Political Systems. West European Politics, 23,1-26.
45. İktisadi Kalkınma Vakfı. (2001). Avrupa Birliği Program ve Ajanslarına Aday Ülke Statüsüyel Türkiye’nin Katılımı. İstanbul: IKV Yayınları.
46. Keklik, S., Gultekin-Karakas, D. (2018). Anti-tobacco control industry strategies in Turkey. BMC Public Health, 18,1-16.
47. Kisa, A., Kavuncubasi, S., Ersoy, K. (2002). Is the Turkish Health Care System Ready to Be a Part of the European Union? Journal of Medical Systems, 26,89–95.
48. Kisa A., Younis M.Z., Kisa S. (2007). A Comparative Analysis of the European Union’s and Turkey’s Health Status: How Health-Care Services Might Affect Turkey’s Accession to the EU. Public Health Reports, 122,693-701.
49. Knill, C., Lehmkuhl, D. (1999). How Europe Matters. Different Mechanisms of Europeanization. European Integration Online Papers (EIoP), 3,1-19.
50. Kostera, T. (2007). Unwelcome Europeanization – The Development of European Cross-Border Patient Mobility. Université libre de Bruxelles, Institut d'Etudes Européennes, Brussels.
51. Kubicek, P. (2005). Turkish Accession to the European Union. Challenges and Opportunities. World Affairs, 168,67-78.
52. Lamping, W. (2005). European Integration and Health Policy. A Peculiar Relationship. M. Steffen (Ed.) In Health Governance in Europe. Issues, Challenges and Theories (pp: 18-48). Abingdon: Routledge.
53. Mair, P. (2004). The Europeanization Dimension. Journal of European Public Policy, 11,337-348.
54. Martinsen, D.S., Vrangbaek, K. (2008). The Europeanization of health Care Governance: Implementing the Market Imperatives of Europe. Public Administration, 86,169-184.
55. McKee, M., Mossialos, E. (2002). Health care and the European Union: Profound but uncertain consequences for national health systems. BMJ, 324,7344.
56. McKee, M., Dubois, C-A. (2004), Health Systems in Transition in Central and Eastern Europe. The Journal of the Royal College of Physicians of Edinburgh, 34305-312.
57. McLaren, L.M. (2000). Turkey’s Eventual Membership of the EU: Turkish Elite Perspectives on the Issue. Journal of Common Market Studies, 38117-129.
58. Mossialos, E., Permanand, G. (2000). Public health in the European Union: Making it relevant. London School of Economics and Political Science Discussion Paper No: 17. London: LSE.
59. Official Journal of the European Communities. (1963). Establishing an Association between the European Economic Community and Turkey, No L 361/29. Brussels: Office for Official Publications of the European Communities.
60. Official Journal of the European Communities. (2000). Charter of Fundamental Rights of the European Union. Official Journal of the European Communities. 2000/C 364/01, 1-22. Brussels: Office for Official Publications of the European Communities.
61. Official Journal of the European Communities. (2001). Council Decision of 8 March 2001 on the principles, priorities, intermediate objectives and conditions contained in the Accession Partnership with the Republic of Turkey, L 85/13. Brussels: Office for Official Publications of the European Communities.
62. Official Journal of the European Union (2008). Treaty of Lisbon Amending the Treaty on European Union and the Treaty Establishing the European Community, 2007/C 306/01. Official Journal of the European Union. C306, 50, 1-271. Brussels: Office for Official Publications of the European Communities.
63. Öniş, Z., Keyman, F. (2003). Helsinki, Copenhagen and Beyond: Challenges to the New Europe and the Turkish State. İstanbul: Koç University.
64. Öniş, Z. (2007). Conservative Globalists versus Defensive Nationalists: Political Parties and Paradoxes of Europeanization in Turkey. Journal of Southern Europe and the Balkans, 9,247-261.
65. Özbek, N. (2006). Cumhuriyet Türkiyesi’nde sosyal güvenlik ve sosyal politikalar. İstanbul: Tarih Vakfı.
66. Permanand, G., Mossialos, E. (2005). The Europeanization of Regulatory Policy in the EU Pharmaceutical Sector. M. Steffen (Ed.) In Health Governance in Europe: Issues, Challenges and Theories. (pp: 49-80). Abingdon: Routledge.
67. Pushkarev, N., Godfrey, N., Marschang, S., Massay-Kosubek, Z., Natsis, Y., Borg, A.M., Galli, V. (2019). EU Public Health Policies State of play, current and future challenges, Study for the Committee on the Environment, Public Health and Food Safety of the European Parliament, Policy Department for Economic, Scientific and Quality of Life Policies. Luxembourg: European Parliament.
68. Radaelli, C.M. (2003). The Europeanization of Public Policy. C. Radaelli, K. Featherstone (Eds). In the Politics of Europeanization: Theory and Analysis (pp: 49-80). Oxford: Oxford University Press.
69. Ramsey, L.E. (1999, March 24). How to Join the Club: Poland, Pre-accession and Agenda 2000. htpp://webjcli.ncl.ac.uk/1999/issue5/ramsey5.html
70. Savas, B. S., Karahan, Ö., Saka, Ö.R. (2002). Health care systems in transition: Turkey. S. Thomson, E. Mossialos (Eds). In European Observatory on Health Care Systems, 4, 4. Copenhagen: World Health Organization.
71. Schimmelfennig, F., Sedelmeier, U. (2019). The Europeanization of Eastern Europe: the external incentives model revisited. Journal of European Public Policy,1–20.
72. Sissenich, B. (2007). Building States without Society: The Transfer of EU Social Policy to Poland and Hungary. Maryland: Lexington Books.
73. Stawarska, R. (1999). EU enlargement from the Polish perspective. Journal of European Public Policy, 6,822–838.
74. Steffen, M., Lamping, W., Lehto, J. (2005), Introduction: the Europeanization of Health Policies. M. Steffen (Ed.), Health Governance in Europe Issues, Challenges and Theories. (pp: 1-17). Abington: Routledge.
75. Tatar, M. (1996). Community Participation in Health Care: the Turkish Case. Social Science and Medicine, 42, 1493-1500.
76. Tatar, M., Tatar, F. (1997). Primary Health Care in Turkey: A Passing Fashion? Health Policy and Planning, 12,224-233.
77. Tatar, M., Erigüç, G. (2001). Turkish healthcare reforms and reasons for failure. M. Tavakoli, H. Davies, M. Malek (Eds.), Health policy and economics: Strategic issues in health care management. (pp: 1-16). Abington: Routledge.
78. Tatar M., Mollahaliloğlu S, Şahin B, Aydın S, Maresso A., Hernández Quevedo C. (2011). Turkey: Health system review. Health Systems in Transition. Copenhagen: World Health Organization.
79. Tervonen-Gonçalve, L., Juhani, L. (2004). Transfer of Health for All policy – What, how and in which direction? A two-case study. Health Research Policy and Systems, 2,1-13.
80. Toshkov, D. (2007). Transposition of EU Social Policy in the New Member States. Journal of European Social Policy, 17,335-348.
81. Trondal, J. (2002). The Europeanisation of Research and Higher Educational Policies: Some Reflections. Scandinavian Political Studies, 25,333-355.
82. The Ministry of Foreign Affairs (2016, Feb 24). Turkey’s National Action Plan for the EU Accession. https://www.ab.gov.tr/files/5%20Ekim/eylem_plani_ing_ic_sirali_internet_icin_tarandi.pdf
83. The Ministry of Health (1973). Sağlık Hizmetlerinde 50 Yıl. Ankara: The Ministry of Health.
84. The Ministry of Health (2000). Herkese Sağlık Hedefleri 21. Ankara: The Ministry of Health.
85. The Ministry of Health. (2003). Health Transformation Programme. Ankara: The Ministry of Health.
86. The Ministry of Health (2007a). 21 Hedef’te Türkiye: Sağlıkta Gelecek. Refik Saydam Hıfzıssıhha Merkezi Başkanlığı. Ankara: The Ministry of Health.
87. The Ministry of Health (2007b). AB Mevzuat Uyumu. Avrupa Birliği Koordinasyon Dairesi Başkanlığı. Ankara: The Ministry of Health.
88. The Ministry of Health (2007c). AB Mevzuatı Uyumu Kapsamında Yürütülen Projeler. Avrupa Birliği Koordinasyon Dairesi Başkanlığı. Ankara: The Ministry of Health.
89. The Ministry of Health (2012). Turkey Health Transformation Program Assessment Report (2003-2011), Ankara: The Ministry of Health.
90. The Ministry of the Interior (2020, Feb 24). Derneklerin Faaliyet Alanlarına Göre Dağılımı. https://www.siviltoplum.gov.tr/derneklerin-faaliyet-alanlarina-gore-dagilimi Turan, İ. (2007). Unstable Stability: Turkish Politics at the Crossroads? International Affairs. 83,2,319-338.
91. Töller, A. E. (2004) The Europeanization of Public Policies ‒ Understanding Idiosyncratic Mechanisms and Contingent Results, European Integration Online Papers (EIoP).
92. Turkish Atomic Energy Authority. (2020, Feb 24). Twinning Projects in Turkey. https://www.taek.gov.tr/en/twinning-project/home/227-what-is-a-twinning-project/1325-twinning-projects-in-turkey.html
93. Van der Meulen, B. (2002). Europeanization of Research and the Role of Universities: An Organizational-Cultural Perspective. The European Journal of Social Science Research, 15,341-355.
94. Van Elsuweg, P., Chamon, M. (2019, Feb 24). The meaning of 'association' under EU law - A study on the law and practice of EU association agreements, European Union. https://www.europarl.europa.eu/RegData/etudes/STUD/2019/608861/IPOL_STU(2019)608861_EN.pdf
95. Vink, M.P. (2002). Negative and Positive Integration in European Immigration Policies. European Integration Online Papers, 6,13.
96. Vink, M. P., Graziano, P. (2007) Challenges of a New Research Agenda. P. Graziano, M. P. Vink (Eds.), Europeanization: New Research Agendas (pp. 3–20), London: Palgrave.
97. Warleigh, A. (2001). ‘Europeanizing’ Civil Society: NGOs as Agents of Political Socialization. Journal of Common Market Studies, 39,619-639.
98. World Bank (2004). Project Appraisal Document on a Proposed Loan in the Amount of Euro 49.40 Million to the Republic of Turkey for a Health Transition Project in Support of the First Phase of the Program for Transformation in Health. Human Development Unit. Europe and Central Asia Region. Report No: 27717-TU. Copenhagen: World Health Organization.
99. World Health Organization (2013). WHO Report on the Global Tobacco Epidemic, 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship. Copenhagen: World Health Organization.
100. World Bank (2018, Feb 24). Turkish Health Transformation Program and Beyond. https://www.worldbank.org/en/results/2018/04/02/turkish-health-transformation-program-and-beyond
101. Yılmaz, V. (2017). The politics of healthcare reform in Turkey. London: Palgrave Macmillan.