Expropriation is a must!

The first regulation regarding city hospitals was made on July 3, 2005, with a small article added to the Health Services Fundamental Law. That day, the General Assembly convened with only AKP members of parliament. It was then scheduled to recess until October 1. Neither political party groups nor members of parliament spoke on the article.

In any case, there weren't even any talk of "Public-Private Partnerships" or " City Hospitals ." In other words, no one knew that this issue would eventually become a national issue .

The rest came step by step. The relevant regulation was published in July 2006, the Law on the Establishment of the Public-Private Partnership Department was passed in June 2007, the first tender announcement for Kayseri City Hospital was published in 2009, and the Etlik City Hospital tender was held in 2011. Others followed.

Finally, the “Law on Construction, Renovation and Procurement of Services through the Public-Private Partnership Model” was passed by the Parliament on February 21, 2013.

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Let me give him credit, the first politician to realize the danger was MHP’s former Minister of Health, Osman Durmuş . He spoke in Parliament on December 3, 2010, and said regarding the city hospitals, “This is a robbery .”

The first person to grasp the significance and importance of the incident from our perspective was then-Turkish Medical Association (TTB) President Dr. Eriş Bilaloğlu . He told Özgür Erbaş, a lawyer who joined the TTB Law Firm in 2011 to specifically pursue the matter: “It's not on anyone's agenda today. Five years later, it will gradually become a topic of discussion, and ten years later, it will be on everyone's agenda. On that day, I want the TTB to be the source of information for those who will discuss these hospitals.”

Indeed, that's what happened. Özgür Erbaş collected information, wrote, and drew like a needle digging a well; the TTB informed the public with brochures, books, symposiums, and panels, keeping the issue constantly on the agenda.

When the cost of the project, which was said to be "without a single penny from the state's coffers, we will have a free hospital," began to emerge, the issue sparked debate within the AKP. Indeed, former Prime Minister Ahmet Davutoğlu would later say, "I tried to include Public-Private Partnership projects in the budget, and very shortly thereafter, I was dismissed in an internal party coup ."

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Over time, the topic of City Hospitals attracted the attention of journalists and social scientists. This has led to the creation of a fairly comprehensive collection of City Hospitals. I can't list the titles of each book, but for those interested, I'd like to remind you of the works of Kayıhan Pala, Bayazıt İlhan, Çiğdem Toker, Özgür Erbaş, Merve Kayaduvar, and Uğur Emek.

A significant contribution to this body of work has recently arrived. I'm referring to the book "Turkey's Public Expenditures from City Hospitals to Earthquake Expenditures (2006-2023)," edited by Nurhan Yentürk .

In the book, a range of topics from taxes to earthquake and disaster expenditures, from social protection to social assistance, from social security to military expenditures are analyzed based on data.

Naturally, the article that caught my attention the most was "The Historical Course of Public Health Expenditures," co-authored by Prof. Nurhan Yentürk and Assoc. Prof. Volkan Yılmaz .

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The article first highlights that public health spending in Turkey is at the bottom of the OECD average, below even half that of EU countries. However, total public health spending exceeded inflation at constant prices between 2003 and 2023, with the exception of 2022.

The authors say that this increase may be due to a number of reasons, such as the increase in the use and provision of health services, the recruitment of personnel and medical equipment, the construction of hospitals, and the inclusion of private hospitals in the system.

Interestingly, the increase in public health spending occurred primarily not in individual but in collective health spending, including preventive and basic health expenditures, personnel and other current health expenditures, and investment expenditures. The exception was family medicine in the 2020s.

Yentürk and Yılmaz then examined the Ministry of Health's expenditures, which consist of five items: personnel expenses, goods and services purchases, current transfers, capital expenses , and capital transfers. They found that capital expenses saw the fastest increase, increasing almost sevenfold from 2006 to 2023. The primary reason for this increase was that the rents of city hospitals were covered by capital expenses.

The Ministry of Health's expenditures on city hospitals increased almost fourfold from 2019 to 2023, with more than forty-five percent of the Ministry's total investment expenditures in 2023 going to city hospitals as rent.

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Tayyip Erdoğan described city hospitals as " a 14-year dream " in 2016. The Ministry of Health also turned a deaf ear to criticisms of the project for a long time. However, two years later, in 2018, it was forced to halt the project.

Last year, when handing over his duties to his successor, former Minister of Health Fahrettin Koca made a remarkable statement: "The maximum cost of our 18 City Hospitals, built through Public-Private Partnerships, over 25 years was € 322 billion . We have limited this cost to a maximum of € 27.5 billion . This way, we have prevented the City Hospitals from becoming a burden on the budget."

Fahrettin Koca said so, but as Yentürk and Yılmaz also noted, it seems that city hospitals will be a burden on the Ministry of Health budget for many years to come.

Expropriation is a must!