Turkey - Health and Welfare

Health and welfare

Health care and related social welfare activities in the 1990s remain the responsibility of the Ministry of Health. Legislation has directed and authorized the ministry to provide medical care and preventive health services, train health personnel, make preservice and in-service training available, establish and operate hospitals and other health care centers, supervise private health facilities, regulate the price of medical drugs, and control drug production and all pharmacies. In addition, the ministry supervises all medical and health care personnel in the public sector.

The overall ratio of inhabitants to physicians has continued to improve significantly. Whereas there was one physician for every 2,860 individuals in 1965, that ratio improved to one to 1,755 in 1976, one to 1,391 in 1985, and an estimated one to 1,200 in 1995. From 1977 to 1995, the number of all health care facilities--hospitals, health centers, clinics, and dispensaries--rose from 7,944 to 12,500. Simultaneously, the number of available hospital beds increased even more rapidly than the rate of population growth; the ratio was one bed per 400 citizens in 1995.

Turkey had reported sixteen cases of acquired immune deficiency syndrome (AIDS) to the World Health Organization in the first nine months of 1994. The rate of AIDS cases per 100,000 population was 0.1 for both 1992 and 1993, with twenty-nine cases reported in 1992 and thirty in 1993.

In the early 1990s, the most important underwriters of social security plans were the Government Employees' Retirement Fund, the Social Insurance Institution, and the Social Insurance Institution for the Self-Employed. In 1995 at least 15 percent of the working population participated in the social welfare system. If the agricultural sector is excluded, this percentage rises to 40 percent. Less than 1 percent of agricultural workers were part of the social security system in 1995, but the government has made efforts for at least a decade to increase their participation. Employers pay insurance premiums to cover work-related injuries, occupational diseases, and maternity leave. Both employers and employees contribute specified proportions to cover premiums for illness, disability, retirement, and death benefits. Thus, in these and other instances, Turkey is moving toward a more Westernized approach to socioeconomic, educational, and health matters, and is seeking to lay a firmer basis for participation in the EU.

Turkey has achieved progress in controlling various debilitating and crippling diseases and in treating major infectious diseases. The incidence of measles, pertussis, typhoid fever, and diphtheria all declined dramatically between 1969 and 1994. The greater availability of potable water in both urban and rural areas has contributed to a general fall in the former prevalence of water-borne illnesses, especially of diarrhea among children and infants. Infant mortality, which at 120 per 1,000 live births in 1980 was among the highest rates worldwide, had declined to fifty-five per 1,000 live births by 1992. Nevertheless, this rate was still very high by European standards, being six times the rate of neighboring Greece, which had an infant mortality rate of nine per 1,000 live births.

Availability of health care in the mid-1990s is significantly better than it was twenty years earlier, but its quality remains uneven. Medical facilities are concentrated in the cities and larger towns, leaving most rural areas without adequate access to medical care. This situation is especially acute in eastern Anatolia, where medical care is generally available only in the provincial capitals. The salaries paid to state-employed physicians are low compared with what doctors in private practice earn. Consequently, most Turkish physicians prefer to work in the more highly developed urban centers or even to emigrate.

THE TURKISH WELFARE REGIME: AN EXAMPLE OF THE SOUTHERN
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