Erdogan Seeks Re-Election as Turkish Health-Care Plan Trumps Headscarves

By Steve Bryant - Nov 8, 2010

Prime Minister Recep Tayyip Erdogan is pushing out a nationwide system of personal healthcare that may win him more votes in next year’s election than all his rows with Turkey’s secular-minded generals.

Next month Erdogan’s government says it will complete a network of family doctors -- one for every 3,500 Turks. That’s a first for the European Union membership candidate where infant mortality is 17 in a thousand, the highest in the 33-nation Organization for Economic Cooperation and Development.

The overhaul is the latest step in a drive toward universal healthcare that has won record approval ratings. It’s key to Erdogan’s bid to win a third term, explaining his willingness to stretch the budget as medical spending is set to rise five times faster than overall costs next year. The World Bank says outlays are manageable, and pollsters say the benefits they buy matter more to most Turks than Erdogan’s bid to rein in the military and ease curbs on religious symbols such as the headscarf.

“Voters aren’t particularly moved by the ideological debates, it’s not what they talk about on the street,” said Adil Gur, head of Istanbul-based polling company A&G Arastirma, which correctly predicted the outcome of the last three elections. “There are very few developing countries that have done what Turkey has in terms of healthcare and it has a direct relationship to voting.”

Erdogan, 56, was re-elected in 2007 with the biggest majority in 40 years, after a series of clashes with the army and courts, which say measures such as the easing of a ban on Islamic-style headscarves undermine Turkey’s secular system.

Unequal Benefits

Health reforms have been central to Erdogan’s second term. He unified three systems of hospitals and insurance for different professions that were criticized for offering unequal benefits and reserving the best hospitals for civil servants while others waited in long queues.

Approval of the system rose to 65 percent in 2009 from 56 percent in 2005, according to the state statistics agency’s annual Life Satisfaction Survey. Turks consistently cite health as the government’s most important achievement, and health chief Recep Akdag as one of the Cabinet’s most successful ministers, studies by pollsters A&G and Ankara-based MetroPOLL show.

Erdogan’s government ended restrictions on the pharmaceuticals market and let Turks use their state benefits at private hospitals. The measures have drawn investment from funds, including Carlyle Group, the world’s No. 2 private equity firm, which bought 40 percent of hospital operator Medical Park Saglik Grubu AS for an undisclosed price last year.

Dubai-based Abraaj Capital Ltd., a private-equity firm that manages $6.6 billion, bought 54 percent of hospital chain Acibadem Saglik Hizmetleri & Ticaret AS for $606 million in 2007 and 2008. Acibadem shares have surged 4,500 percent since 2002 and the benchmark ISE-100 Index increased about sixfold.

Green Cards

Erdogan has given Green Cards guaranteeing free treatment to more than 9 million poorer Turks. The Health Ministry says infant and maternal mortality have fallen, and measles and malaria have been all but eradicated.

“The health status of the Turkish population today is hugely better than it was,” Ulrich Zachau, director of the World Bank’s Turkey unit, said in an interview.

The measures aren’t cheap. The Health Ministry budget is due to increase 24 percent next year to 17.2 billion liras ($12.2 billion), while overall spending climbs 5 percent.

The social security fund, which pays pensions and medical benefits, is owed contributions of 47 billion liras, its head Emin Zararsiz said on Oct. 16. Transfers to the fund will rise 11 percent to 62.4 billion liras next year, one-fifth of the budget. Spending on Green Cards has risen eightfold since 2002.

Fiscal Risks

Now Erdogan is adding a new layer: the family doctors who are charged with holding down costs by treating locally, catching conditions like diabetes and obesity early, and only referring serious cases to hospitals that previously were the only recourse for many patients with minor ailments.

The Ankara-based institute Tepav, which monitors Turkey’s budget, cites rising spending on pharmaceuticals and poor collection of social security premiums as fiscal risks. “The financial structure can only be set on a sustainable path by policies to strengthen the revenue side” and ensure patients are treated more cheaply by family doctors instead of at hospitals, it said in a November 2009 report.

Erdogan scrapped proposed legislation in September that mandates the government reduce a fiscal deficit that was 5.5 percent of gross domestic product last year, raising concern that he may loosen budget discipline as elections approach.

Turkey’s health spending at 6 percent of GDP is lower than all OECD members bar Mexico, and compares with 16 percent in the U.S., the OECD said last month.

Spending is “affordable and manageable,” Zachau said. “The challenge is to keep it that way.”

‘Incredibly Bad’

Reha Denemec, a deputy leader of Erdogan’s Justice and Development Party, said the government has rebuilt a system that was “incredibly bad eight or 10 years ago.” He said Erdogan was personally motivated to make the changes after he was shunted from hospital to hospital following a car accident in the late 1980s. The premier is also an outspoken anti-smoker and has banned cigarettes from restaurants and bars.

The Turkish Medical Association considers the market-based changes “wrong for Turkey in terms of delivery and in terms of financing,” said Eris Bilaloglu, president of the group that represents about 90,000 doctors. The new system requires patients to supplement the government contributions with top-up fees for treatment that some of them can’t afford, and thus isn’t fair on the poor, he said.

Family Clinic

Erdogan’s party “depends on the votes of relatively poor people and it takes some skill to act against their interests,” Bilaloglu said. “But that’s what they’ve done.”

There’s satisfaction with the system, though, at a new family clinic in the Mamak suburb of Ankara, where patients leave after examination and cross the road to the pharmacist opposite, bearing a prescription.

“We don’t need to go to the hospital now, for basic things we can just come here,” says Elveda Abatay, 29, guiding her two-year-old daughter, Busra. “It’s much better. Doctor Omer knows who Busra is and says hello when we arrive. That didn’t happen before.”

Source: Bloomberg.
Link: http://www.bloomberg.com/news/2010-11-07/turkey-s-erdogan-seeks-re-election-as-health-care-plan-trumps-headscarves.html.