Public hospital reform in Turkey: The "public hospital union" case (2012-2017).

The issue of public hospital reform in Turkey was raised in the mid-1980s due to the desire to restrict public expenditures for health care services. In the last 30 years, transformations of public hospitals into health enterprises with administrative and financial autonomy have been attempted in various ways. The process of subjecting public hospitals to reform evolved into the provincial "public hospital unions" model with the Decree Law No. 663 in November 2011. However, this model, which was created to use resources effectively and efficiently in the field of health, was terminated in 2017. The purpose of this study is to review and evaluate the "public hospital union" model of public hospital reform implemented between 2012 and 2017 as an integrated part of reforms in the Turkish health care system and to examine the factors and obstacles that led to the failure of this model. The level of autonomy, in terms of key management functions of unions and hospitals, was analyzed using the toolkit proposed by Chawla et al (1996), and Preker and Harding (2003). In the study, it is asserted that instead of autonomization and decentralization, such organizational reforms result in centralization and political control.