Increased and Deepened Inequalities; the Results of Health Reform Activities in Turkey Feride Sacaklioglu, Onur Hamzaoglu

Crisis of Capitalism 1970’s How capitalism gets rid of the Crisis? Wars Restructuralization of the state

Since 1980’s... World Bank imposes structural adaptation programs Washington Consensus between IMF and WB

The Aim of the World Bank Liberalization of trade Deregulation of banking system Privatization of public enterprises Tax reform Privatization of agriculture

What Happened ?  of national income 19 % of the population gain < 1 $ per day Richest 1% gain $ Poorest 1% gain 54 $  of unemployment 2,5 million – 12 % of the working age group

The Division of Health Budget Ministry of Health; % of the budget is from indirect taxes

Reorganization of Services according to Market Economy Municipalities Energy Transport Telecommunication Education Health Engineering services

Neo-liberal Change of Concepts... Health is... need versus right Access to health care is... personal responsibility versus public responsibility

And Health Reform... Limitation of public funds for health Increase of foreign capital support Privatization of health services Decentralization Contracts in public services Private health insurances Public finance techniques

What Health Reform Means?  the share of general budget in health finance  the share of insurance, out of pocket payment General Budget replaced by the revolving funds Patients become customers Customers buy the health service if they have money

What Health Reform Means? Division of service providers and the financers Creating a competition between this two bodies in order to get cheaper health service

What Health Reform Means? Health staff are forced to work Contract based Part-time Performance based Abuse of job descriptions Loosing social rights!

Health Services till late 70’s Health services given by public sector till the late 70’s in central and peripheral capitalist countries Socialization of Health Care Law ; 1961 Well defined, population based primary health care system Health was… Social right Public responsibility Free of charge in health centers

Organization of Health Care according to Socialization Full time Team work Continious professional development Population based Integration Referral system Intersectoral collaboration Priority given to prevention Home visits Community participation

80-83 National Security Council First Health Project Arbitration Act Second Health Project Health Master Plan Economic Crisis Incentives Supporting Private Sector Revolving Fund Hosp. Health Care Law Health Reform New Constitution Privatization of Hospitals Foot Steps of Health Reform in Turkey Transition of Health Economic Crisis Revolving Fund PC Right Wing Right Wing- Left Wing Right Wing- Left Wing- Faschists Fundamen- talists 99 Social Security Law

Reform... Active and passive privatization of health care Hospital care privatized gradually (1990’s) Cleaning Catering Health staff... Primary care privatized recently Outpatient care (since 2001) Family planning.... Inequalities in Health

Deliveries Occured Outside of Health Facilities and PAR according to Residence Turkish Population and Health Surveys;

Deliveries Occured Outside of Health Facilities and PAR according to Demographic Regions Turkish Population and Health Surveys;

Deliveries Occured Outside of Health Facilities and PAR according to Mother’s Education Turkish Population and Health Surveys;

Deliveries Occured Outside of Health Facilities and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys;

Infant Mortality Rate and PAR according to Residence Turkish Population and Health Surveys;

Infant Mortality Rate and PAR according to Demographic Regions Turkish Population and Health Surveys;

Infant Mortality Rate and PAR according to Mother’s Education Turkish Population and Health Surveys;

Infant Mortality Rate and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys;

Undernourished Children (Weight for Age) and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys;

Unimmunized months old children and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys;

Population per Health Center according to Geographic Regions Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

Health Units without Midwife according to Geographic Regions Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

Population per Midwife according to Geographic Regions Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

Population per Physician according to Geographic Regions Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

Conclusion Not only in Turkey Not only in health sector The attack to public sector must be discussed with a holistic approach Unless the economic policies, economic inequalities and privatization of health care changed, the inequalities in health will increase