The irresponsible actions of the administration that put healthcare professionals in front of patients cost Dr. Ersin Aslan his life.

Any practice of populism leads to a disaster. This is the case for the health sector as for any other. I believe that the uncontrolled widening of the spectrum of services in the Turkish health sector is a sort of populism. The assault that led to the death of doctor Ersin Aslan in Gaziantep is evidence that the populism in the health sector has overstepped the limit. Let me tell you why.

The first concrete sign that the decade-long populism in the health sector is reaching its end was the recent decision to raise the limit of the additional charge private hospitals can demand from patients to 90 percent. Before widening the services spectrum, they did not warn us that “only God can give without compromise.” From now on, we will have to bear increases in additional charges and fees. The out-of-pocket healthcare period has started. Either the scope of services will be limited and the quality of services and equipment will be lowered or we will get used to paying health expenses out of our pockets.

Financing matters has been neglected

In the last decade, Turkey made substantial progress in terms of access to health services. Customer satisfaction improved rapidly along with the rise in access. Unfortunately, the system did not pay enough attention to the sustainability of the improvement in satisfaction. Given the upcoming elections, the system concentrated on expanding the service spectrum and making sure that patients did not pay for services out of pocket. How the new wide spectrum of health services that satisfied everyone would be financed, however, was neglected. Likewise, the question of how the rise in the number of private service providers would affect the size of the pool of doctors in the public sector was ignored.

Such is populism. You distribute what you have today without thinking much about the future. Then you realize that there is nothing more to distribute. Politicians are exactly like what is depicted in the following anecdote: A sultan, bored with his vizier, tells him to teach his donkey how to read and write. The vizier, who is a masterful populist politician says, “Yes, my sultan. But it cannot be done overnight. I need some money, a couple of palaces and one year's time.” “All right,” the Sultan responds, sure that the vizier will be decapitated in the end. Having heard the conversation and after the sultan left, the people say to the vizier, “Have you gone mad? You can never teach a donkey how to read and write, not even in ten years.” “Wait and see,” the vizier responds. “Who knows what will happen in a year’s time? The donkey might die. So might the sultan, or I.” Such is life for a populist politician.

Statism has risen from the grave

So, the spectrum of health services was expanded. When the budget constraint led to problems, pharmaceutical companies were asked to cut prices. Not once or twice, but three times. Then, health institutions were asked to cut prices, several times. The same path was tried every time budget constraints were encountered. When the pool of medical doctors in the public sector started to shrink, the full-time law was introduced. The Minister of Health accused doctors of being greedy. The freedom to contract in the health sector was suspended. In short, the statism of the 1930s rose again.

If a populist does not calculate outcomes correctly at the beginning, he ends up being a statist, limiting freedoms. Such was the case in Turkey. But public resources in the health sector are evaporating. First, it is impossible for the state to bear the burden of the services spectrum unless the share of health expenditures in the GDP is increased. It is necessary to seek solutions. I think it is a must for Turkey to make private health insurance obligatory as a complementary mechanism.

Second, the quality erosion in the current system has been becoming increasingly visible due to the government’s populism. The irresponsive actions of the administration that have pushed healthcare professionals in front of the patients cost Dr. Ersin Aslan his life. The Ministry of Health is as pure as the driven snow, isn’t it?

Populism always leads to disaster. And if you spend everything you have recklessly, you will end up giving the shirt off your back.

This commentary was published in Radikal daily on 20.04.2012