Healthcare Sector Dynamics in Turkey (2002-2022): Trends, Breakpoints, and Policy Implications (Privatization in the Hospital Sector).

Abstract

Background/Objectives: This study examines the transformation of Turkey's hospital sector from 2002 to 2022, focusing on physical capacity, service utilization, and workforce distribution in the public and private sectors. Methods: Longitudinal data from the Ministry of Health were analyzed using trend and breakpoint methods to evaluate hospital beds, qualified beds, intensive care beds, service volumes (outpatient visits, inpatient admissions, surgeries, and hospitalization days), and staffing (physicians, nurses, and midwives). Results: Findings reveal a marked shift in the balance between public and private providers. Due to public regulations effectively controlling resource allocation, the private sector's share expanded to around one-fourth of the system. Private capacity in total beds rose from 7.53% to 21.00%, outpatient visits from 4.58% to 15.07%, and inpatient admissions from 10.10% to 30.63%. Breakpoint analyses indicate crucial turning points around 2005, 2008, and 2011, when policy changes restricted public capacity but facilitated private investment. Although the public sector's share in total beds declined, its proportion of qualified and intensive care beds, as well as dialysis machines, increased, suggesting a strategic shift toward complex, high-quality services. Conclusions: Over the past 20 years, Turkey's hospital sector exemplifies privatization without ownership transfer. Although delayed, private hospital expansion aligned with global neoliberal trends. Policy regulations played a key role in both promoting and limiting sector growth. A constant conflict exists between market-driven resource allocation and public health needs, which must be considered in restructuring efforts alongside private sector motivations.