In 2003, Turkey’s total per capita expenditure on health care was Intl $294 (5 % of GDP).⁶² Among the six MECC countries of Middle East, this figure falls within a spending range of Intl $1839 in Israel (8.7 % of GDP) and Intl $153 in Egypt (3.9 % of GDP). At 3.9 % the smallest spending as a percentage of GDP is in Egypt (Tables 5 and 6). There are no available figures for the Palestinian Authority.

The WHO overall health system performance score places Turkey 70/191 countries. This composite measure of overall health system attainment⁶³ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

Tables 5 and 6 Total health expenditure (Intl $) per capita and as a percentage of GDP: Six MECC countries of the Middle East, 2003

Turkey has a complex, partly-nationalized health care system established in 1961, and a well-established private sector. As Savas et al. explain:

‘Turkey’s health care system is at once centralised and fragmented. Health care is provided by public, quasi-public, private and philanthropic organisations but relations among them are not well structured or regulated. Health care is financed by the government (through the Ministry of Finance), social security institutions (the Social Insurance Organisation (SSK), the Social Insurance Agency of Merchants, Artisans and the Self-employed (Bag-Kur) and the Government Employees’ Retirement Fund (GERF) and [private] out-of-pocket payments.’⁶⁴

The government public provision includes: Ministry of Health hospitals, health clinics and specific health centres (family, maternal and child health, tuberculosis dispensaries); Ministry of Defence military hospitals; and Higher Education Council funded university hospitals.⁶⁵ Philanthropic organisations include the Red Crescent which provides aid in natural and war-related disasters, as well as support in dispensaries. A variety of philanthropic non governmental organisations (NGOs) known as collectively as the ‘Foundations’ offer help to people with illnesses such as diabetes, cancer and AIDS, but as yet, not for palliative care.

People can access free services (including inpatient medication, but excluding outpatient prescriptions) in all Ministry of Health institutions and when referred in university hospitals if they have a ‘low income’ Green Card. The municipalities of the 3 largest cities run their own hospitals and offer free home care for the poor, which includes care at the end of life.⁶⁶

People without a Green Card cover their medical costs either through one of the three social security government schemes (SSK, Bag-Kur, GERF) or they have private health insurance. The State Planning Organisation estimates suggest around 83% population have health cover, with 87% of the population covered by some kind of insurance cover, either directly or as a dependent. The actual figures are thought to be lower. Over half the population contribute to one of the social security schemes: (34 million to the most flexible and comprehensive scheme at SSK). There are continuing concerns that a substantial proportion of the population are not covered by insurance, or that some schemes offer inadequate provision.⁶⁷ The lack of adequate provision is especially problematic for people at the end of life; some government insurance schemes do not cover outpatient medications, which mean many people have to go into hospital if they or their families cannot afford the costs of medication when at home. Conversely, private provision at the end of life is not always available. For example, many private nursing homes will not admit patients who are known to be in the terminal stage of their illness.⁶⁸