Exploring Patient Experiences of the Internal Market for Healthcare Provision in Turkey: Publicness under Pressure

The establishment of internal markets for healthcare provision in publicly-funded healthcare systems brings forth a number of new regulatory challenges. During the 2003 healthcare reform in Turkey, universal health coverage (UHC) was implemented concurrently with the establishment of an internal market for service provision, resulting in an increase in private sector activity. In this context, this paper explores how, in the Turkish case, the macro-level adoption of an internal market model for healthcare provision has shaped patient experiences at the micro-level in their ability to receive treatment in private hospitals offering publicly-funded services (PHOPS). It also examines the influence of the internal market on the realised publicness of healthcare services in Turkey. Data for the study were obtained from patient complaints that appeared on a private online platform and 20 patient interviews. These showed that patients sometimes face significant challenges, including pressure to make informal payments, when accessing their entitlements, which is evidence of the erosion of publicness in a hybrid healthcare system. These challenges emerge from information asymmetry between patients and providers; a large space for PHOPS to manoeuvre when deciding to register patients as insurance holders or private patients; and the ineffective public regulation of the internal market

Turkish lesbian, gay, bisexual and/or trans persons’ perceptions of their own ageing: contesting the exclusionary care regime?

How do lesbian, gay, bisexual and/or trans persons imagine their own ageing in an exclusionary care regime? How does institutionalised exclusion constrain their ability to imagine ageing in a positive light? How, to what extent and by which means can they contest their exclusion from elderly care? This article presents an analysis of a mixed-methods study in Turkey that included 14 focus groups with 139 lesbian, gay, bisexual and/or trans persons in ten cities, and a nationwide online survey with 2,875 respondents. It offers the notion of an exclusionary care regime as a framework for studying care regimes through the lens of marginalised groups, specifically lesbian, gay, bisexual and/or trans persons. Taking Turkey as an example, the article demonstrates that an exclusionary care regime causes respondents to view ageing as a burden. In the absence of progressive socio-political change, lesbian, gay, bisexual and/or trans persons can think of contesting their exclusion from elderly care mostly through market- and asset-based solutions

A contextual policy analysis of a cash programme in a humanitarian setting: the case of the Emergency Social Safety Net in Turkey

The Emergency Social Safety Net (ESSN) programme, which was launched in 2016, has become the central element of the humanitarian response to the plight of Syrian refugees in Turkey and an instrument of European migration control policies. This paper offers a contextual analysis of this European Union-funded cash assistance scheme by examining the modes of interaction between its major assumptions and the broader humanitarian response in the context of Turkey. It finds that the ESSN comes with compromises on humanitarian principles and standards, amplifies the protection and assistance divide, and fails to address the realities of Turkey with respect to the country's housing and labour markets and weak protection framework. The paper concludes that a more inclusive approach to eligibility and higher transfer payments can contribute to the addressing of assistance needs provided that cash support is combined with robust protection programming and the implementation of sector-specific projects and policies

A contextual policy analysis of a cash programme in a humanitarian setting:the case of the Emergency Social Safety Net in Turkey

The Emergency Social Safety Net (ESSN) programme, which was launched in 2016, has become the central element of the humanitarian response to the plight of Syrian refugees in Turkey and an instrument of European migration control policies. This paper offers a contextual analysis of this European Union-funded cash assistance scheme by examining the modes of interaction between its major assumptions and the broader humanitarian response in the context of Turkey. It finds that the ESSN comes with compromises on humanitarian principles and standards, amplifies the protection and assistance divide, and fails to address the realities of Turkey with respect to the country's housing and labour markets and weak protection framework. The paper concludes that a more inclusive approach to eligibility and higher transfer payments can contribute to the addressing of assistance needs provided that cash support is combined with robust protection programming and the implementation of sector-specific projects and policies

Challenges to a Rights-Based Approach in Sexual Health Policy:A Comparative Study of Turkey and England

Politics around sexual health have been polarised in recent years, but the policy implications of this polarisation have not yet been examined in depth. Therefore, this article explores political challenges to a rights-based approach in sexual health policies in Turkey and England. Its focus is on two domains: The prevention and treatment of sexually transmitted infections (STI), and sexual health education. Drawing on an interpretive documentary analysis, this article reveals that although social attitudes to sexuality and the levels of overall alignment with a rights-based framework within the selected countries do differ, both face significant political challenges in putting a rights-based approach to sexual health into practice. While common political challenges include heightened domestic controversy regarding sexual health, the specific challenges take the forms of a broader conservative turn that undermines the autonomy of sexual health policy in Turkey (similar to the cases of Hungary and Poland), and neoliberal policy preferences coupled with local discretion and service fragmentation that create access inequities in England (similar to the case of Germany). This study concludes that implementing a rights-based approach is a complex political task requiring a nuanced approach that incorporates the political dimension

No Common Ground? Public Knowledge about Welfare Spending in Turkey and its Social Divisions

Social policy research examining citizens’ welfare knowledge, which offers a gateway to their understanding of the policy context, has remained limited. Adapting the opportunity–motivation–ability framework borrowed from the literature on political knowledge to welfare knowledge, this article offers an analysis of new data from a nationwide survey to explore Turkish society’s knowledge of the composition of public social spending. Corroborating earlier findings in the literature, the article maintains that most people in Turkey overestimate the relative size of social assistance spending for the poor. However, different from previous findings, the majority and most pensioners are also ill-informed about the rank of public spending on old-age pensions, the most widely used social benefit absorbing the largest share of welfare spending. The article provides evidence of the social division of welfare knowledge in Turkish society based mostly on three opportunity-related variables: city of residence, gender and income

Narrative power in electoral autocracies: The policy narrative behind the success of a pension movement

How did a pension movement construct its narrative around pension age, shaping its structure and content to influence policy change in an electoral autocracy? This article delves into the campaign of the Turkish pension movement, a single-issue movement self-identifying as “people stuck in the pension age barrier” [emeklilikte yaşa takılanlar (EYT) in Turkish], to analyze policy narratives in an electoral autocratic context. Employing the Narrative Policy Framework (NPF), this exploratory study dissects the Turkish pension movement's policy narrative through an examination of nearly 2100 tweets, selected from a total of 64,980 tweets posted between 2020 and 2023. It shows how, in 280 characters, the movement challenged the long-established pension age. The article reveals that the EYT movement positions itself as the hero, using a victim-centered injustice narrative with the villain often left vague, likely to preserve dialogue with the government. The movement emphasizes the diffused benefits of the moral of the story, portraying its constituency as larger than it is and its base of allies as wide as possible, reflecting the movement's strategic engagement with electoral politics. This study enhances the NPF literature by demonstrating how non-governmental actors construct influential narratives in electoral autocracies

Joe WHELAN, Hidden Voices: Lived Experiences in the Irish Welfare Space

What is it like to be poor and on benefits in an affluent democratic society in a context of permanent austerity and with the fading of redistributive politics? Based on in-depth interviews with 19 working-age people receiving different types of welfare payments in Ireland, Joe Whelan’s Hidden Voices: Lived Experiences in the Irish Welfare Space responds to this question, presenting a vivid picture of living a life on social welfare payments (both social insurance and assistance schemes) in ..

Health reform and new politics of health care in Turkey

The health care system in Turkey has undergone a transformation process since the Health Transformation Programme (HTP) launched in 2003 and significantly increased marketization in health care provision. This study asks the following questions: What political dynamics enabled the introduction of health care reform in Turkey? What kind of political conflicts did the reform generate? How and to whose benefit have these conflicts been resolved? As a historically grounded, single country case study, this study draws on 33 in-depth interviews conducted with major political actors who were involved in the HTP. This study concludes that the reform under consideration was a product of two factors: the World Bank’s pro-market approach to health reforms that became internalised in the health care bureaucracy in Turkey after the mid-1980s, and the controlled populism of the Justice and Development Party (the AK Party). With the introduction of the HTP, the power distribution upon which Turkey’s health care system is based has been changing in three ways. First, the Turkish Medical Association (TTB) lost its leverage in health care policies. Excluded from the reform process, the only success of the TTB was using judicial activism to block the government’s attempts to introduce a full time work requirement for medical doctors. Second, the reform gave birth to the emergence of a new political actor in health care politics, namely private health care provider organisations. Private health care provider organisations, which avoided confrontational discourse in their relations with the government due to the financial dependency of the sector on the state, succeeded in altering the legal and administrative limits that the reform put on their opportunities for capital accumulation. Finally, the transformation of the AK Party from a catchall party to a cartel party that undermines the electoral competition in Turkey might put the representation of the citizens’ interests on health care policies at risk