THE TRANSFORMATION OF HEALTH SERVICES AND EMPLOYMENT PATTERNS IN HEALTHCARE: THE IMPACT OF NEO-LIBERAL POLICIES
Abstract
This article examines the transformation of health services and employment patterns in Turkey under the influence of neo-liberal policies. Initiated in 2003, the Health Transformation Program (HTP) reshaped healthcare from public rights into a market-oriented service. Hospitals began to be managed with business logic, patients were redefined as customers, and health workers faced flexible and insecure forms of employment. The study analyzes the state-capital relationship and the guiding role of international organizations (World Bank, WHO) through historical and comparative methods. Findings suggest that while HTP increased life expectancy, it also exacerbated inequalities in healthcare access and deepened precarity among healthcare workers. City Hospitals, General Health Insurance, subcontracting practices, and performance-based payment systems are critically discussed within the framework of welfare state erosion and capital accumulation dynamics.
References
- Ağartan, T. İ. (2012). Health policies and neoliberal transformation in Turkey. Istanbul: İletişim Publications.
- Avaner, T., & Fedai, R. (2017). Digitalization in health services: Using information systems in health administration. Süleyman Demirel University Journal of Faculty of Economics and Administrative Sciences, 22(Special Issue Kayfor15), 1533–1542.
- Çelik, Y. (2016). Health reforms in Turkey: The impact of neoliberal policies. Ankara: NotaBene Publications.World Bank. (2022).
- Health statistics in Turkey. Retrieved from https://data.worldbank.org/World Bank. (2024). Life expectancy data in Turkey. Retrieved from https://data.worldbank.org/
- Öztürk, S. (2017). Flexible employment and subcontracting in healthcare. Çalışma ve Toplum, 52(1), 123–145.
- Sönmez, M. (2011). Neoliberal transformation and social policies in Turkey. Istanbul: İletişim Publications.
- Sönmez, M. (2023). Public-private partnerships and city hospitals in Turkey. Istanbul: Yordam Books.
- TOBB. (2017). Overview of the Turkish health sector. Retrieved from https://www.tobb.org.tr/saglik/20171229-tss-genel-bakis-tr.pdf
- World Health Organization (WHO). (2022). Global health expenditure database: Turkey country profile. Retrieved from https://www.who.int/
- Yenimahalleli Yaşar, G. (2015). The influence of international organizations on Turkey’s health policies. Journal of Public Administration and Policy, 3(2), 45–67.
- Yılmaz, V. (2019). The healthcare system in Turkey: Marketization and inequality. Istanbul: Boğaziçi University Press.
- Turkish Court of Accounts (Sayıştay). (2023). 2022 audit report of the Ministry of Health. Retrieved from https://www.sayistay.gov.tr/
Abstract
Bu makale, Türkiye’de sağlık hizmetlerinin ve sağlık alanındaki istihdam biçimlerinin neo-liberal politikaların etkisiyle geçirdiği dönüşümü incelemektedir. 2003 yılında uygulamaya konulan Sağlıkta Dönüşüm Programı (SDP), sağlık hizmetlerinin kamusal bir hak olmaktan çıkarılıp piyasa mantığına göre yeniden yapılandırılmasına neden olmuştur. Bu süreçte hastaneler işletme, hastalar müşteri, sağlık çalışanları ise esnek ve güvencesiz istihdam modellerinin öznesi hâline gelmiştir. Araştırma, devlet-sermaye ilişkileri ve uluslararası kuruluşların (Dünya Bankası, Dünya Sağlık Örgütü) yönlendirici rolünü tarihsel ve karşılaştırmalı yöntemlerle analiz etmektedir. Elde edilen bulgular, SDP’nin yaşam süresinde artış sağlamakla birlikte, sağlık hizmetlerine erişimde eşitsizlikleri derinleştirdiğini ve çalışanların güvencesizliğini artırdığını göstermektedir. Şehir Hastaneleri, Genel Sağlık Sigortası, taşeronlaşma ve performansa dayalı sistemler, sosyal devletin gerilemesi bağlamında ele alınmakta; sermaye birikim rejiminin sağlık politikaları üzerindeki etkileri ortaya konulmaktadır.
References
- Ağartan, T. İ. (2012). Health policies and neoliberal transformation in Turkey. Istanbul: İletişim Publications.
- Avaner, T., & Fedai, R. (2017). Digitalization in health services: Using information systems in health administration. Süleyman Demirel University Journal of Faculty of Economics and Administrative Sciences, 22(Special Issue Kayfor15), 1533–1542.
- Çelik, Y. (2016). Health reforms in Turkey: The impact of neoliberal policies. Ankara: NotaBene Publications.World Bank. (2022).
- Health statistics in Turkey. Retrieved from https://data.worldbank.org/World Bank. (2024). Life expectancy data in Turkey. Retrieved from https://data.worldbank.org/
- Öztürk, S. (2017). Flexible employment and subcontracting in healthcare. Çalışma ve Toplum, 52(1), 123–145.
- Sönmez, M. (2011). Neoliberal transformation and social policies in Turkey. Istanbul: İletişim Publications.
- Sönmez, M. (2023). Public-private partnerships and city hospitals in Turkey. Istanbul: Yordam Books.
- TOBB. (2017). Overview of the Turkish health sector. Retrieved from https://www.tobb.org.tr/saglik/20171229-tss-genel-bakis-tr.pdf
- World Health Organization (WHO). (2022). Global health expenditure database: Turkey country profile. Retrieved from https://www.who.int/
- Yenimahalleli Yaşar, G. (2015). The influence of international organizations on Turkey’s health policies. Journal of Public Administration and Policy, 3(2), 45–67.
- Yılmaz, V. (2019). The healthcare system in Turkey: Marketization and inequality. Istanbul: Boğaziçi University Press.
- Turkish Court of Accounts (Sayıştay). (2023). 2022 audit report of the Ministry of Health. Retrieved from https://www.sayistay.gov.tr/
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Rewiev |
| Authors | |
| Publication Date | August 25, 2025 |
| Submission Date | May 26, 2025 |
| Acceptance Date | July 14, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 2 |
