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

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

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

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

5. What Happened ?  of national income 19 % of the population gain < 1 $ per day Richest 1% gain 13.000 $ Poorest 1% gain 54 $  of unemployment 2,5 million – 12 % of the working age group

6. The Division of Health Budget Ministry of Health; 2004 70% of the budget is from indirect taxes

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

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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 80-83 National Security Council 83-87 87-9191-95 95-99 99-03 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 03-05 Foot Steps of Health Reform in Turkey 93 96 97 98 99 Transition of Health 87 04 Economic Crisis Revolving Fund PC Right Wing Right Wing- Left Wing Right Wing- Left Wing- Faschists Fundamen- talists 99 Social Security Law

16. 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

17. Deliveries Occured Outside of Health Facilities and PAR according to Residence Turkish Population and Health Surveys; 1983-2003

18. Deliveries Occured Outside of Health Facilities and PAR according to Demographic Regions Turkish Population and Health Surveys; 1983-2003

19. Deliveries Occured Outside of Health Facilities and PAR according to Mother’s Education Turkish Population and Health Surveys; 1993-2003

20. Deliveries Occured Outside of Health Facilities and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys; 1978-2003

21. Infant Mortality Rate and PAR according to Residence Turkish Population and Health Surveys; 1978-2003

22. Infant Mortality Rate and PAR according to Demographic Regions Turkish Population and Health Surveys; 1978-2003

23. Infant Mortality Rate and PAR according to Mother’s Education Turkish Population and Health Surveys; 1993-2003

24. Infant Mortality Rate and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys; 1978-2003

25. Undernourished Children (Weight for Age) and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys; 1993-2003

26. Unimmunized 12-23 months old children and PAR comparisons according to Residence, Demographic Region and Mother’s Education PAR (%) Turkish Population and Health Surveys; 1993-2003

27. Population per Health Center according to Geographic Regions 1996-2003 Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

28. Health Units without Midwife according to Geographic Regions 2000-2003 Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

29. Population per Midwife according to Geographic Regions 2000-2003 Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

30. Population per Physician according to Geographic Regions 2000-2003 Ministry of Health, Primary Health Care Yearbooks ; 2001, 2003 Two way variance analysis tukey test p<0.05

31. 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