Spotlight on Turkey: Achieving radical healthcare reforms

When the Justice and Development Party (AK Party) became the ruling party in 2002, the Turkish healthcare system changed significantly. The key AK Party initiative, the Health Transformation Programme (HTP) was enacted in 2003 and some of its goals included:

Reducing inequality in healthcare access by establishing a universal health insurance fund
Improving maternal and child health
Narrowing the gap between the quality of healthcare service in Turkey as compared to other EU countries
Computerizing the healthcare information systems
Encouraging private sector investment in the healthcare arena

Progress is being made on these goals and the new Turkish healthcare system is a combination of a National Health Service and a Social Health Insurance system, with the primary level of care through family practitioners. In 2006, the Social Security and General Health Insurance Law and Social Security Institutional Laws were passed. The goal of these laws was to provide universal health coverage, even to those individuals not formally employed. The General Health Insurance Scheme (GHIS) was enacted by the Turkish Parliament in 2007 and this standardised the method by which social security institutions were paid.

Funding for Turkey’s growing healthcare system is a blend of public and private sectors. The main source of public pharmaceutical expenditure funding is from the SGK (Sosyal Guvenlik Kurumu/Social Security Institution) and the state. Public health spending as a proportion of total health spending, at 71%, in 2005 was just below the Organization for Economic Cooperation and Development (OECD) average of 73% However, it had increased significantly over the previous five years from 63% in 2000.

As part of the healthcare reforms, a new reimbursement system was introduced in February 2005, and reimbursement is now the remit of the Reimbursement Commission which consists of independent academics, bureaucrats from the Ministry of Labour, the Ministry of Health (MoH), the Ministry of Finance, the Treasury, the State Planning Organisation and industry representatives. Secretarial services for the Commission are provided by the SGK. A positive list, which grouped drugs by active substance, was introduced and a price banding system was introduced for 77 active substances and medicines. This has meant that budget impact and economic considerations play a major role in the process of assessing the positive reimbursement list and health technology assessment (HTA) is becoming an issue of growing focus in Turkey. Products that are to be reimbursed are listed and announced by the SGK.

Turkey is one of the lowest priced of all the OECD countries and price is seen as a separate process from reimbursement. There are no price negotiations and if the manufacturing company decides not to have their product reimbursed, there is in effect free pricing. Although the manufacturer’s price can be set at a higher rate than the reimbursed price it is the patient who must pay the difference between the manufacturer’s price and the reimbursed price.

Although the new Turkish pricing policy was widely seen as an improvement over the old system, it was heavily criticized by the pharmaceutical industry when it was introduced in 2004. The pharmaceutical industry would prefer a new price-setting mechanism based on the average of the lower priced markets rather than selected lowest prices. Currently the reference price countries are Portugal, Spain, France, Italy, Greece, with the price in Turkey not allowed to be more than the lowest price in any of those five countries.

Although the pharmaceutical market is still relatively small at around US$ 10 billion, Turkey has a large population. The 2009 estimate for the Turkish population is 76.8 million which is just behind the biggest country of the European Union, Germany, with an estimated 82.3 million. However a relatively young population profile and strong population growth is expected to take the Turkish population beyond Germany’s by 2010. Health spending accounted for 5.7% of the GDP in 2005 which is well below the OECD average of 8.9%, and lower than some recent entrants to the EU, such Poland.Turkey’s desire to become a fully fledged member of the EU has seen National legislation, including regulation of the healthcare sector, becoming increasingly aligned with EU guidelines.

Turkey’s large and growing population coupled with its increasing focus on European-style regulations make Turkey an attractive proposition for the pharmaceutical industry.

Seyfullah Dagistanli, MD, PhD, Associate
Emrah Aras, MD, MHA, Associate
Deborah Hooker, PhD, Senior Consultant

Bridgehead's Associates in Turkey

Seyfullah Dagistanli, MD, PhD
Dr Dagistanli served for several years as Head of the Pharmaceutical Registration and Quality Control Department at the Turkish Ministry of Health. As a Bridgehead Associate he maintains excellent access into the national Registration and Reimbursement departments, and he is also able to identify and carry out interview programmes with the KOLs that advise the reimbursement committees. He is an expert in government relations, pharmacovigilance, pharmacoeconomics, reimbursement, registration, as well as other areas and is well placed to advise on policy issues and to assist in development of drug reimbursement and pricing strategies.Dr Dagistanli is a medical doctor, with a PhD in Pharmaceutical Toxicology. He is Founder and President of the Pharmacovigilance Association of Turkey and Founder and Member of the Clinical Research Association of Turkey. He is editor of the GCP Journal and author of many articles on GCP, GMP, Pharmacovigilance, Pharmacoeconomics, Registration and Quality Control of Pharmaceuticalspatent and data exclusivity.

Emrah Aras, MD, MHA
Dr Aras is a specialist in Market Access, Business Development and Medical Management. His recent consultancy experience has included:

Providing solutions to various pharma companies from market access to life cycle management
Preparing reimbursement dossiers
Providing services of pharmacoeconomics, including arguments
Conducting face-to-face Reimbursement Committee meetings with, or on behalf of, clients
Organising related seminars and training programs.

Prior to becoming a consultant, Dr Aras was Health Economics Manager for sanofi-aventis in Turkey. During his time with sanofi-aventis, he initiated and managed pharmacoeconomics studies, prepared reimbursement dossiers, lobbied reimbursement agencies – including the Ministry of Finance, Ministry of Health, Ministry of Labor, Undersecretary of Treasury and related commissions – and managed lobbying activities to reimbursement bureaucrats and Health Commission Members. In addition, he was a member of the Product Development Team for Low Molecular Weight Heparin at corporate level and gained experience of medico-marketing. Dr Aras is a medical doctor and holds a Masters degree in Healthcare Administration. He lectures regularly on reimbursement and pharmacoeconomic topics.

Spotlight on Turkey: Achieving radical healthcare reforms

Bridgehead's Associates in Turkey

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