The Phenomenon of subcontracted work in Turkish health care sector: a state ethnography

Abstract

This thesis examines the recently emerged phenomenon of subcontracting work in the Turkish public health system. The main focus is on the health care workers, who are employed via subcontracting practices at Istanbul Faculty of Medicine Çapa University Hospital. It is argued that the emergence of these practices leads to the commodification of health care work, since the supportive health care workers are deprived of being public servants in a public health institution. This development is part of a bigger transformation in the health care field. Thanks to the rise of neoliberalism, the health care system goes through a deep restructuring, in which health care is ceasing to be a public good –though it was not a social right of citizenship with equal access for everyone- and transforms into a commodity to be marketed. On this point, a detailed analysis is provided regarding the health care “reform” and it is argued that Turkish health care sector is in process of marketization via autonomization by disengaging the public health care institutions from the central state budget. The state deserts from the area of health care provision by leaving it to the market forces by producing a discourse, which brings an unprecedented change in the conceptualization of health care with reliance on neoliberal principles of efficiency and cost-containment in health care. This thesis illuminates the reflections of this macro reform project on a particular hospital environment and the situation of its workers, who are primarily affected from this. Regarding the fact that introduction of subcontracted work in health care sector is a highly contested issue, blurring the boundaries and the relationship between the state and this particular public service, the subcontracted workers’ perceptions about themselves and their work lead to new subject positions.