Medicalization in Turkey in the Context of the "Health Transformation Programme"

There has recently been a growing interest on the effects of health care systems on medicalization in particular national contexts. This paper contributes to this literature by focusing on the case of Turkey, where medicalization in the form of increasing consumption of medications, use of health care services and diagnosis of a number of diseases goes in parallel with the health reform process that started a decade ago aiming to radically transform the provision and financing of healthcare services. Special emphasis is given on how policy measures such as separating purchasers from providers, encouraging competition among public providers, implementing performance-based payments, and combining public and private health care services affect medicalization by creating financial and professional incentives for physicians to alter their diagnostic and treatment behaviors. Additionally, the arguably positive and negative impacts of medicalization are discussed with reference to recent statistical data including population health indicators, patient satisfaction, outpatient/inpatient ratio, consumption of pharmaceuticals, the number of screening tests performed and the number of doctor visits with a particular focus on indications of overdiagnosis/overtreatment.