Taking the right, selling it in the market: commodification and commercialization of health care in Turkey since the 1980s

Abstract

This thesis examines the processes that caused the commodification of health care through commercialization and privatization of the services in Turkey since the 1980s. The time scope covered approximately three decades in which the status of health care transformed from a right to a commodity to be bought and sold in the market. In order to clarify this transformation and provide a comparative analysis, the pre 1980 period, especially the understanding of health care in the 1960s is also scrutinized, as it was the decade when the state has embraced the characteristic of being a “social state” and declared its responsibility for the provision of health care to its citizens as a right. In the 1960s, the citizenship based health care understanding that was aimed to be established both by the 1961 constitution and the socialization law, could not develop properly due to the simultaneous presence of the employment based social security schemes that covers health insurance and universalization of health care failed due to several other reasons, which are mentioned in the thesis. In the 1980s with the transformation of public healthcare institutions into business enterprises, rights based approach was left and health care began to be transformed into a commodity being sold in a market where public and private sector competed with each other. The means based policies enacted in the 1990, which aimed to cover a certain part of the population excluded by the commercialized healthcare sector, displayed crucial contrast with the rights based understanding and failed to provide the whole population the guarantee to health care. In the 2000s, the general health insurance that was claimed to cover the whole population, managed to universalize the access to healthcare services to the people who were able to pay the monthly premiums and contribution payments. Apart from general health insurance, the laws on foreign direct investment and privatization of public healthcare facilities forestall even the imagination of health care as a right while strengthening the idea that those services are commodities sold in order to gain profits. In the thesis, this period of commodification of health care is analyzed with a critical perspective and the exclusion and inequality created among the society through the transformation of right to health care to a commodity is underlined.