Health Policy Universal health coverage in Turkey: enhancement of equity

Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in fi nancing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003–13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its eff ects. Our fi ndings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifi able and benefi cial eff ects on all health system goals, with an improved level and distribution of health, greater fairness in fi nancing with better fi nancial protection, and notably increased user satisfaction. After the HTP, fi ve health insurance schemes were consolidated to create a unifi ed General Health Insurance scheme with harmonised and expanded benefi ts. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country—in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Severa