Health workers in Turkey’s primary health system have launched a five-day protest against new regulations that prioritize commercialization and profit over patient care. Beginning on January 6, the protests have included rallies across Turkey and culminated in a nationwide healthcare strike to emphasize the workers’ demands. The demonstrations are organized by a coalition of professional associations and trade unions, including the Turkish Medical Association (TTB), the Union of Health and Social Service Workers (SES), and the Federation of Associations of Family Health Workers, Midwives, and Nurses. This unified stand underscores the gravity of the issues faced by healthcare providers and the potential risks to patient care.
New Regulations and Their Impact
Financial Penalties and Performance Evaluation Systems
The primary issue at hand is the new regulation that imposes financial penalties on health workers and implements performance evaluation systems in primary care, similar to those already in place in hospitals. Dr. Emrah Kırımlı of TTB’s Family Physicians Branch criticized the government for treating healthcare as a sector focused on profitability rather than as a fundamental right. These changes include setting strict time limits for patient visits, which often results in appointments lasting only a few minutes. Such constraints compromise the quality of care, especially for patients with complex medical conditions that require more time and attention.
The new system pressures primary care physicians to see at least 64 patients daily to achieve a full salary, leading to patient overload and reduced time per patient. This approach incentivizes more patient visits, equating to higher payments but resulting in less focus on preventive care. The quality of patient care is further compromised by the impossible demands placed on healthcare workers, who must adhere to these stringent quotas to avoid financial penalties. Additionally, the Ministry of Health has claimed to expand healthcare coverage, but this expansion has been complicated by patients bypassing primary care and seeking consultations at other levels of the health system.
Private Sector Involvement and Its Consequences
Private sector involvement through outsourced services or standalone institutions has only exacerbated the issue. A devastating consequence of this trend was the transfer of infants from public to private hospitals for unnecessary procedures, leading to the deaths of at least ten children. These incidents highlight the inherent dangers of placing profit motives above patient care and moral responsibility. Health workers have long struggled against profit-driven healthcare policies to protect public health and well-being, extending their fight beyond immediate concerns to broader systemic issues plaguing the healthcare environment.
Reforms such as capitation-based payments have prioritized revenue generation over health needs, including the outsourcing of laboratory and imaging services to private firms and a focus on health tourism. Such practices place immense pressure on healthcare workers and divert resources from essential services. The cumulative effects of these changes corrode the foundational ethics of the healthcare system, undermining trust and efficacy while promoting a model of care that disproportionately benefits those with financial means.
The Impact on Healthcare Workers
Professional Independence and Administrative Burden
The threat of financial penalties for not meeting visit quotas is expected to drastically change the nature of general practitioners’ work. Strike organizers described the new system as reducing doctors to “video game characters collecting points,” which undermines their professional independence and dignity. Healthcare workers emphasized their role as doctors, not shopkeepers, and expressed concerns about the increased administrative burden and efficiency demands. Such demands not only detract from the quality of care provided to patients but also contribute to job dissatisfaction and burnout among healthcare professionals.
Administrative tasks and efficiency metrics imposed by the regulations overshadow the core values of medical practice. Doctors are forced to allocate considerable time to clerical duties and meeting arbitrary targets, which detracts from their clinical responsibilities. The frustration among healthcare professionals is palpable as their professional autonomy is increasingly compromised, leading many to question their future in such an environment. This erosion of autonomy has far-reaching consequences, potentially deterring new entrants from the profession and exacerbating existing staffing shortages.
Financial Pressures and Workforce Exodus
The new regulations will most severely impact those reliant on primary health services, such as migrants and populations facing barriers to healthcare access. Previously free services are now subject to fees, which disproportionately affects the most vulnerable groups. The ripple effects of these changes are expected to impact the entire health workforce. Out of Turkey’s 1.5 million health workers, fewer than 70,000 are employed in family health centers, and their earnings lag behind other parts of the healthcare sector. Nurses and midwives in primary care face salary cuts of 20-30%, exacerbating existing financial pressures.
Persisting with this model will drive healthcare workers away from primary care, further weakening an already fragile system. Financial pressures combined with increased workloads and diminishing job satisfaction continue to drive skilled professionals out of the field. This workforce exodus creates a vicious cycle, placing even more strain on those who remain and severely hampering the healthcare system’s ability to provide effective care. The long-term implications include exacerbated health disparities and reduced overall quality of care, ultimately impacting public health on a national scale.
Proposed Solutions and Demands
Reevaluation of Primary Health Care’s Role
Family physicians and other primary healthcare workers are calling for a reevaluation of primary health care’s role within the system. They seek more investment and a shift in focus toward prioritizing patient health. Key measures proposed include reducing the number of patients per physician from 3,500 to 2,000, improving the physical infrastructure of family health centers, and reallocating budgets to strengthen primary care instead of constructing new hospitals. These reforms would aim to create a more sustainable healthcare model that balances patient needs with the well-being of healthcare providers.
Efforts to reduce patient loads per physician could significantly improve the quality of care, as doctors would have more time to dedicate to each patient. Additionally, enhancing the infrastructure of family health centers would provide a more conducive environment for effective patient care. By reallocating budgets to strengthen primary care facilities, the healthcare system can ensure that resources are directed where they are most needed, benefiting both patients and healthcare workers. Such changes emphasize the need for a holistic approach to healthcare reform that prioritizes long-term well-being over short-term financial gains.
Enhancing Workforce and Infrastructure
Increased salaries for primary healthcare workers and expanding their overall numbers are also essential. Employing social workers, psychologists, dietitians, and physiotherapists to address local needs is crucial for a more robust primary healthcare system. If the workers’ demands are not met, Turkey’s health system faces further deterioration. This would likely lead to more healthcare workers emigrating and leave patients with limited options: either pay for private care or go without it entirely. This outcome would undermine the accessibility of healthcare and disproportionately affect the most vulnerable populations.
Enhancing workforce numbers and infrastructure is critical for sustaining a robust healthcare system. By boosting salaries and recruiting additional healthcare professionals, the burden on existing workers can be alleviated, improving job satisfaction and retention rates. The inclusion of multidisciplinary teams would enrich care delivery, addressing diverse and complex health needs within the community. Investing in the healthcare workforce and infrastructure represents a forward-thinking approach that can mitigate current disparities and prevent future crises, ensuring a resilient and responsive healthcare system.
Broader Implications
Conflict Between Profit-Driven Policies and Quality Care
Health workers in Turkey’s primary health system initiated a five-day protest against the new regulations, which they argue prioritize commercialization and profit over patient care. These protests began on January 6 and have included rallies across Turkey, culminating in a nationwide healthcare strike to reinforce the workers’ demands for a better focus on patient care. The demonstrations have been organized by a coalition of professional associations and trade unions, including the Turkish Medical Association (TTB), the Union of Health and Social Service Workers (SES), and the Federation of Associations of Family Health Workers, Midwives, and Nurses. This unified stance highlights the serious concerns of healthcare providers and the potential risks these new regulations pose to patient care. By coming together, these organizations hope to draw attention to the critical changes needed in the healthcare system to ensure that the well-being of patients remains a priority over financial gain.
