Turkey: The ‘Full-Time Law’ in the Healthcare Sector

Private healthcare emerged in Turkey as a result of the long lines and poor medical services associated with state-run hospitals. Lately, private hospitals have been doing a better job of raising their quality of care through contracts with university professor-doctors – so-called "star doctors" – practicing in their areas of expertise. In 2003, responding to growing competition among private hospitals, the ruling Justice and Development Party (AKP) ushered in a sweeping health reform agenda to increase the market share of private healthcare providers, while at the same time making healthcare available to a larger share of the population by reforming state hospitals.

On 21 January 2010, the Turkish Parliament adopted the Law on Full-Time Employment of University and Healthcare Personnel (Full-Time Law). Prior to enactment of this legislation, doctors – under the leadership of the Turkish Doctors' Union (TTB) – had often protested against this proposed law's content. The Full-Time Law, prepared by the AKP, required doctors employed by public institutions (e.g. universities and state hospitals) to work a full day. Before that, doctors had been entitled to observe the half-time system, working in both public and private institutions (and opening their own offices) in line with the health reform program introduced in 2003. The Full-Time Law forces physicians to choose between working in a state hospital and working in private practice, and also includes a performance-based system in university hospitals, requiring physicians to work 13-16 hours a day to receive the same salary they now earn. A natural consequence of creating more widespread provision of healthcare services will be, apparently, a reduced incentive to train interns.

The Turkish Health Ministry, which owns and operates approximately 55 per cent of Turkey's 1,200-plus hospitals, has already announced its goal of extending healthcare to more patients. But the Ministry's view has attracted harsh reactions from experts and the TTB, which alleges that the Full-Time Law – due to its severe sanctions for non-compliance with the full-workday requirement – will form the basis for enslaving doctors in public institutions.

Following enactment of the Full-Time Law, the opposition Republican People's Party (CHP) filed a lawsuit before the Constitutional Court to annul it. The Constitutional Court partially repealed the law, rejecting some of major parts – including provisions preventing physicians from opening private practices or working in private clinics/hospitals as consultants or part-time doctors – and rejecting increases in the minimum working hours of university doctors. Subsequently, physicians in university hospitals were allowed to: (a) maintain their part-time positions and own offices, or their current positions in private clinics/hospitals as consultants or part-time doctors; or (b) switch from full-time to part-time status and work in private practice.

The decision, which only applies to physicians working in university hospitals, created ambiguity with regard to work hours and whether doctors would be able to work in private practice after completing eight-hour shifts in their university hospital positions. The working hours of physicians employed by university hospitals has also created a conflict between the Health Minister and the TTB, after the Minister's statement that he would report to Turkey's Board of Higher Education any physician who did not complete an eight-hour workday at a university hospital and left even five minutes early to go to his/her private practice.

The debate originated from the vagueness of the Constitutional Court decision, which did not annul the provision on doctors employed by university hospitals working full-time, but annulled the provision stipulating that a doctor working at a university hospital could not work at his or her own private practice. This, in turn, gave rise to debate over whether "full-time basis" referred to the official working time of eight hours, as different authorities put forth various interpretations. According to the Ministry of Health, the partial annulment decision and the phrase "permanent basis" meant that doctors could work at their own private practices only after finishing their full eight-hours at the university, and the annulment did not cover physicians employed by state hospitals. In other words, the court decision only pertained to university doctors, so state hospital doctors had to close their offices by July 30.

The TTB reacted to the court decision by applying to the Council of State (Turkey's highest administrative tribunal) for a stay of execution of the Health Ministry's decision. The TTB claimed that the decision contravened the principle of equality under the Turkish Constitution, and would create inequality between doctors working at university hospitals and those at state hospitals. The Council of State ordered a stay of execution of the ministry's decision ordering doctors in state hospitals to close their own offices by July 30. According to the Council of State, all doctors had the same legal status, and doctors working at state hospitals had the right to work at their own private practices just as those employed at university hospitals did.

Turkey has a highly multifaceted healthcare system because of the sector's rich mixture of plans and departments. Today, Turkish healthcare services are far better than in the past but still not of the expected and required quality, especially in most state hospitals. The government is thus very keen to make further changes to healthcare legislation to lift the standards of state-run hospitals vis-à-vis private hospitals, and foster greater competition between public and private healthcare. Nevertheless, one way it has chosen to achieve this objective – obligating doctors to either work in private practice or continue working in state-run hospitals without any attachment to private hospitals, clinics or personal offices – remains controversial.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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