Beginning in 2003, Turkey initiated aseries of reforms under the Health Transformation Program(HTP) that over the past decade have led to the achievementof universal health coverage (UHC). The progress of Turkey shealth system has few if any parallels in scope andspeed. Before the reforms, Turkey s aggregate healthindicators lagged behind those of OECD member states andother middle-income countries. The health financing systemwas fragmented, with four separate insurance schemes and a Green Cardprogram for the poor, each with distinctbenefits packages and access rules. Both the Ministry ofLabor and Social Security and Ministry of Health (MoH) wereproviders and financiers of the health system, and fourdifferent ministries were directly involved in public healthcare delivery. Turkey s reform efforts have impactedvirtually all aspects of the country s health system andhave resulted in the rapid expansion of the proportion ofthe population covered and of the services to which they areentitled. At the same time, financial protection hasimproved. For example, (i) insurance coverage increased from64 to 98 percent between 2002 and 2012; (ii) the share ofpregnant women having four antenatal care visits increasedfrom 54 to 82 percent between 2003 and 2010; and (iii)citizen satisfaction with health services increased from39.5 to 75.9 percent between 2003 and 2011. Despite dramaticimprovements there is still space for Turkey to continue toimprove its citizenshealth outcomes, and challenges lieahead for improving services beyond primary care. The maincriticism to reform has so far come from health sectorworkers; the future sustainability of reform will rely notonly on continued fiscal support to the health sector butalso the maintenence of service provider satisfaction.
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