Markets, modernisation and national interest: three faces of patient choice policy in Turkey

This article discusses three faces of patient choice policy in a developing country, Turkey. As part of its wider health transformation programme (HTP), Turkey has created a purchaser/provider system in which a single public purchaser channels funding to a range of public and private hospitals, and patients--in theory at least--are given significant freedoms to choose their hospital and physician. At the same time, marketisation has been softened by an emphasis on the creation of 'human-centred' services, resulting in a variety of initiatives to enhance patient rights and using a similar rhetoric to that employed in modernising 'third-way' reforms in countries such as the United Kingdom. We argue that neither markets nor modernisation fully explain the specifics of Turkish choice policy, which is also driven by the strong political imperative arising from Turkey's proximity to the European Union and its accession ambitions. Europeanisation represents an approach to markets softened by social solidarity, and gives the Turkish reforms a very different profile from neo-liberal reforms implemented in other middle income countries. However, in practice, medical workforce shortages, the uneven distribution of resources across the nation, and the lack of systematic information on provider outcomes limit the scope of choice for much of the population. In this situation, a planned allocation of resources to support equity of provision has advantages over a system where resource flows to providers are determined by individual patient choices.