Turkey has a very complex health care system because of the existence of different plans and departments involved in this sector. All health care and related social welfare activities are coordinated by the Ministry of Health. Article 60 of the Turkish Constitution quotes: "Every individual is entitled to social security. The State takes the necessary measures to create this confidence and organizes the organization". Therefore, the Ministry is responsible to provide health care for the people and organize preventive health services, build and operate state hospitals, supervise private hospitals, train medical personnel, regulate the price of medical drugs nationwide, control drug production and all pharmacies.
Today, health care in Turkey is better compared to the past but still not reached at the expected quality, especially in most of the State hospitals in smaller cities. Private hospitals lately do a better job raising their quality of their physicians and medical equipment investing more money on this sector. Most of the hospitals and doctors are concentrated in the cities and big towns where there is more people and more profit, meanwhile there is little health service in the countryside and rural areas unfortunately. Besides state and private sector, also universities and Ministry of Defense establish and operate hospitals in the country.
The annual growth rate of GNP in Turkey is between 5-6 percent but the health expenditures is only between 3-5% of the GNP. The major funding sources of the state hospitals are; allocations from Government (83%), fees paid by insurers or individuals (12%), and some taxes on fuel and cigarettes (5%). University hospitals instead have two major source of funds; allocations from State budget through Higher Education Board (YOK) and self generated funds.
The social security system in Turkey is composed of three different major organizations;
- Social Insurance Institution (SGK)
- Social Security Institution for the Self-employed (Bag-Kur)
- Pension Fund for Civil Servants (Emekli Sandigi)
Government is trying to unify all these institutions under one roof. Employers pay insurance premiums to cover work-related injuries, professional job diseases, or maternity leave. Both employers and employees contribute specified proportions to cover premiums for illness, disability, retirement, and death benefits. A new law provides health care also to unemployed people if they match certain criteria.
SGK (formerly known as SSK) is a social security organization for private sector and blue-collar public sector workers. The law entitles all persons who are employed by a contract of service to benefit from social insurance and health care. Agricultural workers, Self-employed, and Persons contributing to one of the pension funds established by law are excluded from the coverage of the SGK. Ministry of Health can do special contracts with University and Private hospitals in order for their members to use such hospitals besides the SGK hospitals. There are co-payments on medical drugs for outpatients; retired pay 10% and employed pay 20%.
SGK members are insured for work injuries and professional job diseases, medical care, illness, disability, and maternity. When the insured person paid all his/her contributions for a specified period and have reached a specified age, they're entitled for Old Age Pension. If the insured person dies, widow, children, or close parents of the deceased are paid for funeral expenses and get his/her Pension payments.
SSK-SGK coverage is now known as 4-A plan.
This institution covers the self-employed outside the coverage of the Social Insurance (SGK) Law. These would be craftsmen, artisans and small businessmen, technical and professional people who are registered to a chamber or professional association, shareholders of companies other than co-operatives and joint stock companies, and self-employed in agriculture.
Members of Bag-Kur can choose the step at which they make their contributions between scales of 1 to 24, being 1 the lowest premium payment level with certain medical care limits. They are covered for all outpatient and inpatient diagnosis and treatment. Bag-Kur does not operate its own health facilities, but contracts with other public providers, including the SGK hospitals. Therefore the patient pays for the medical expenses and than get reimbursed by Bag-Kur. Pensioned members have to pay 10%, and active members and their dependants pay 20% of drug costs.
Bag-Kur coverage is now known as 4-B plan.
This is a Government Employees Retirement Fund for retired civil servants, it also includes health insurance. Retired Government employees pay only a 10% co-payment for medical drugs and all the rest for their health care is paid by this Fund. There is no specific health insurance premium collected from active civil servants therefore this Fund has huge expenditures with very little control on it, it's completely financed by Government allocations only, causing a big gap in the Ministry's budget.
Besides retirements pension after completing a specific period of state service, the Fund offers other benefits such as a retirement bonus and a death grant payable to the survivors of a pensioner, and many other privileges.
Emekli Sandigi coverage is now known as 4-C plan.
Green Card System
The Green Card system was established in 1992 and is directly funded by the Government. Poor people earning less than a minimum level of income which is defined by the law, are provided a special card giving free access to outpatient and inpatient care at the state and some university hospitals, and covering their inpatient medical drug expenses but excluding the cost of outpatient drugs. The expenditure for the almost 9 million Green Card holders has exceeded Government allocations thus causing big gaps in the budget. Only the Ministry of Health is authorized to issue Green Cards.
Other Health Services
Private health insurance is well developed in Turkey. Many people pay their premium to private companies besides their regular contribution to state insurance systems, in order to get a better quality health service if they're ill. Also private pension funds (known as BES) have been started in 2003 and growing fast. These private funds are usually private banks or big insurance companies that offer this service. Depending on the pension plan you choose, after 10 - 15 - 20 years you can get an accumulated bonus when you retire from these private funds or get your monthly pension until death.
There are many pharmacies all over Turkey (Eczane in Turkish) which are concentrated especially near hospitals but also in every neighborhood. Certain drugs are sold with Green or Red prescriptions permitting the Ministry to control sale of some medicines, and there are also many sold over the counter (OTC) without the need of a prescription.
The Red Crescent (Kizilay), equivalent of the Red Cross, is a humanitarian aid organization and covers the widest range of welfare services in Turkey, especially in times of war or natural disasters such as earthquakes or floodings.