Publication: Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 2. Background Papers
Loading...
Published
2003-03
ISSN
Date
2013-08-01
Author(s)
Editor(s)
Abstract
Fundamental and systemic changes would have to be brought about in the ways that health care is financed, delivered, organized, and managed in Turkey in order to meet the ultimate objective of improving the health status of people, and not only meet but surpass the health-related Millennium Development Goals. This would require significant improvements in resource mobilization, allocation and utilization, enhanced efficiency in production and delivery of health services, including primary and hospital care, and greater emphasis on clinical quality and patient access to health services. Against this backdrop, the World Bank and the Government of Turkey agreed to undertake an intensive review of all aspects of the health sector, and the present report is produced from this effort. One objective of an evaluation at this juncture is to lay the foundation for developing a medium-term health sector strategy and a prioritized action plan aimed at improving access to health services, enhancing equity in utilization, increasing cost-effectiveness, enhancing quality of care and improving health outcomes overall. In particular, the emphasis of this study is to develop viable medium-term options for enhancing the health services coverage of poor and vulnerable groups and examine which priorities and approaches are likely to be most pro-poor. The study also examines the appropriate role of the government in providing health services, and the institutional, managerial, and administrative requirements for developing an efficient, sustainable, and patient-responsive health system. In doing so, the study examines ways in which public spending can be oriented so as to maximize its effects on access, equity, and efficiency in the health sector. An added objective of this study is to engage policy makers and major stakeholders in discussions and debates on health reforms and bring about a consensus among them not only on broad principles but also in terms of integrated and coordinated approach to implementing reform measures. This report is organized in two volumes. Volume 1 contains a discussion of health sector priorities and key recommendations for developing a medium-term reform strategy for Turkey's health sector. Volume 1 concludes with an implementation plan for the short and medium terms. Volume 2 contains the full background reports and data annexes that form the basis of the suggested health system reform.
Link to Data Set
Citation
“World Bank. 2003. Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 2. Background Papers. © World Bank. http://hdl.handle.net/10986/14766 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 1. Main Report(Washington, DC, 2003-03)Fundamental and systemic changes would have to be brought about in the ways that health care is financed, delivered, organized, and managed in Turkey in order to meet the ultimate objective of improving the health status of people, and not only meet but surpass the health-related Millennium Development Goals. This would require significant improvements in resource mobilization, allocation and utilization, enhanced efficiency in production and delivery of health services, including primary and hospital care, and greater emphasis on clinical quality and patient access to health services. Against this backdrop, the World Bank and the Government of Turkey agreed to undertake an intensive review of all aspects of the health sector, and the present report is produced from this effort. One objective of an evaluation at this juncture is to lay the foundation for developing a medium-term health sector strategy and a prioritized action plan aimed at improving access to health services, enhancing equity in utilization, increasing cost-effectiveness, enhancing quality of care and improving health outcomes overall. In particular, the emphasis of this study is to develop viable medium-term options for enhancing the health services coverage of poor and vulnerable groups and examine which priorities and approaches are likely to be most pro-poor. The study also examines the appropriate role of the government in providing health services, and the institutional, managerial, and administrative requirements for developing an efficient, sustainable, and patient-responsive health system. In doing so, the study examines ways in which public spending can be oriented so as to maximize its effects on access, equity, and efficiency in the health sector. An added objective of this study is to engage policy makers and major stakeholders in discussions and debates on health reforms and bring about a consensus among them not only on broad principles but also in terms of integrated and coordinated approach to implementing reform measures. This report is organized in two volumes. Volume 1 contains a discussion of health sector priorities and key recommendations for developing a medium-term reform strategy for Turkey's health sector. Volume 1 concludes with an implementation plan for the short and medium terms. Volume 2 contains the full background reports and data annexes that form the basis of the suggested health system reform.Publication Better Outcomes through Health Reforms in the Russian Federation : The Challenge in 2008 and Beyond(World Bank, Washington, DC, 2008-02)The purpose of this discussion paper is to discuss selected health challenges in the Russian Federation, focusing on outcomes, expenditures and options for policy and institutional reforms in the health care system. The areas covered in the paper draw on recent studies and reports, and take into account lessons derived from the implementation of the World Bank-funded Health Reform Implementation Project (HRIP) at the federal level and in the Chuvash Republic and the Voronezh Oblast-the pilot regions of the project, over the 2005-2007 period.Publication Croatia Program-for-Results : Improving Quality and Efficiency of Health Services(Washington, DC, 2014-01-04)This technical assessment has been carried out as part of the preparation of the Health Program-for-Results (PforR) operation in Croatia. The primary focus of the assessment is on the Government's Program, and the National Health Care Strategy 2012-2020, and serves as the policy framework for this operation. The needs that Croatia's health system must address have changed as a consequence of the demographic and epidemiological transition in the country. The disease burden in Croatia has shifted from being dominated by maternal and child health and communicable diseases to being dominated by chronic and non-communicable conditions. The Government of Croatia's National Health Care Strategy sets out development directions for the health sector and is the framework for making policy and operational decisions, including the distribution of budgetary resources. The development of emergency medical services and investment planning project supported technical assistance to develop a hospital rationalization master plan, and this will enable the Ministry of Health to develop specific proposals for funding that can be submitted to European Union (EU) structural funds. The hospital rationalization plan will be completed only in December 2013. In the interim, however, the Ministry of Finance has expressed its commitment to support the Ministry of Health to meet interim funding needs.Publication Romania - Functional Review : Health Sector(Washington, DC, 2011-05-11)This Functional Review was carried by a Bank team upon request by the Government of Romania. As a starting point, it shows that: (i) health outcomes in Romania lag behind those of the EU; (ii) users are not satisfied with its lack of responsiveness - long lines, informal payments, discourteous handling of patients, poor cleanliness, lack of maintenance, and breach of safety measures; (iii) the poor and other vulnerable groups (for example Roma communities) suffer from a significant lack of access to services; and (iv) the fiscal contraction of 2008-2010 exposed the weakness of financial controls in the health sector. The Review examines four health functions in depth: service delivery, financing, stewardship and resources (including pharmaceuticals). Based on our findings, we present recommendations categorized by the three set of challenges that the sector is facing: (i) improving governance and management; (ii) streamlining the health service network and re-launching quality control systems; and (iii) increasing preventive services and equity. For any expansion of the sector to be sustainable, a number of pre-requisites will need to be in place, including a private sector development strategy, stronger fiscal controls, a system of health technology assessment, and stronger management in key agencies.Publication Kyrgyz Republic Public Expenditure Review Policy Notes : Health(Washington, DC, 2014-05)Over the past two decades the Kyrgyz Republic implemented important health financing and organization reforms. Compared to other former Soviet republics and other low-income countries, the Kyrgyz Republic shows good results in term of health outcomes, access to health services, and financial protection. Life expectancy exceeds that of several of the most prosperous former Soviet republics, including Russia. Infant and under-5 mortality rates were halved between 1990 and 2010. More than 98 percent of births are attended by skilled health staff and children immunization rates exceed 90 percent. Utilization of both hospital and outpatient health services are quite equal across income groups. Overall distribution of public health spending is slightly pro-poor. The Kyrgyz health system shows low incidence of catastrophic and impoverishing out-of pocket spending for health care.
Users also downloaded
Showing related downloaded files
Publication Mongolia Country Climate and Development Report(Washington, DC: World Bank, 2024-10-22)Mongolia’s development prospects are uniquely challenged by both the impacts of climate change and the global shift toward a low-carbon economy. The country’s efforts toward decarbonization pose significant challenges given the structurally high-emission intensity of its economy. While challenging, climate action also presents Mongolia with opportunities to achieve important development benefits. The effects of climate risks and the shift away from coal will have diverse impacts across different regions, communities, and socioeconomic levels. The report assesses the critical interconnections between Mongolia’s development ambitions and climate change action and identifies ways to transition to a more economically diversified, inclusive, and resilient development path. It highlights key climate and transition risks affecting Mongolia’s future development and presents a pathway to enhance climate mitigation and adaptation. The report also makes a case for strengthening policies to enhance resilience to climate change and ensure a just transition, particularly for the most vulnerable. The report is structured as follows: section 1 gives introduction. Section 2 delves into the linkages between development and climate in Mongolia and presents model-based findings on the economic and poverty impacts of climate change under different scenarios. Section 3 covers four in-depth sectoral analyses. The first two mainly focus on adaptation to climate change in the agriculture and water sectors. The third considers prospects for the extraction sector, while the fourth sectoral analysis focuses on decarbonizing power and heat generation. Section 4 shifts the focus to how the government can boost resilience for climate-vulnerable populations. Section 5 outlines options for mobilizing private and public financing and private investments to support the green transition. Section 6 examines the existing institutional and governance structure for climate action and presents recommendations to improve its effectiveness, and section 7 concludes with a framework for prioritizing the policy actions outlined in this report.Publication Comoros Country Climate and Development Report(Washington, DC: World Bank, 2025-06-18)The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Guinea-Bissau Country Climate and Development Report(Washington, DC: World Bank, 2024-10-23)Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.