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Reforms prove bitter pill for Turkey’s doctors – Financial Times

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By Daniel Dombey in Istanbul and Funja Guler in Ankara 

Turkey’s doctors are under siege. Over the past month a series of attacks on medical professionals has seen a 17-year-old boy stab the doctor who failed to save his grandfather and an opposition MP assault an emergency room medic treating his family. On one day in Istanbul there were two separate attacks on ambulances for allegedly arriving late.

Just what is causing the surge in violence remains the subject of debate. But for many doctors the blame lies with healthcare reforms that the government lists as among its proudest accomplishments even as it criticises medical professionals.

In the past, Turkey had a fragmented health system, with different facilities run by the ministry of health, university hospitals and several different social security schemes.

The reforms, which began in 2003, fundamentally changed that system, making health insurance much more portable and allowing people to go free of charge to emergency rooms at exclusive hospitals previously reserved for the rich.

The statistics are compelling. More than 90 per cent of the population now has coverage. Between 2003 and 2010, the number of mothers dying in childbirth fell more than 70 per cent, from 61 per 100,000 to 16.4. Infant mortality has fallen by almost two-thirds, and the proportion of families pushed into poverty by medical expenses has more than halved.

“Now we ordinary people can go to any state hospital or the emergency department of any private or state hospital free or for very little money,” said Zuleyha Telli, a 34-year old woman outside Ataturk hospital in Ankara. “The only problem is that hospitals are sometimes crowded … But what more could we ask for?”

Martin Raiser, the World Bank’s director for Turkey, hails the reforms as “one of the big success stories” of health reform internationally. But he adds a note of caution about cost: now at just under 7 per cent of gross domestic product, total health expenditure has outstripped GDP growth, at a time of economic boom.

“How do you go and say that there are some provisions that are not going to be covered by universal insurance?” he asks. “How do you manage expectations now that you have granted everyone access?”

Many doctors add that the reforms have been far less successful than portrayed.

They warn that the quality of treatment is falling because of reduced consultation time and fewer resources per patient, and that they are paid based on the number of consultations regardless of results.

“People with serious sicknesses don’t agree with the government,” says Ozden Sener, chairman of the Ankara medical association. “And now if doctors even go on their toilet break patients call the complaint line … High expectations and low quality of service result in violence.”

Many doctors blame Recep Tayyip Erdogan, Turkey’s prime minister, for going out of his way to cast them as the villains of the piece. Mr Erdogan relishes fights with Turkey’s old elites, and despite his party’s Islamist roots, many observers say its popularity over almost a decade in office is at least much the product of the prime minister’s identification with the underdog as of any religious affiliation.

The result, doctors say, is what sometimes can feel like open contempt for them from patients with unrealistic expectations.

“Doctors are portrayed as nasty, the health ministry creates an image of being on the people’s side against the doctors,” says a brain surgeon in Ankara. He and others say that patients are constantly invited to make formal complaints and then subjected to overcrowded hospitals that are the government’s, not doctors’, fault.

Ayse, a doctor in an Istanbul state hospital who like many others does not want to give her full name, recalls an incident last week where a patient headbutted a hospital worker, shouting: “This is how you beat a doctor,” because his appointment was rescheduled after he was late.

“People hear about these things, it makes them more angry. And then they say: ‘I can hit a doctor too’,” she says.

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