Abstract
In the last decade Turkey has undergone a process of reform in the field of social policy. This reform reached its most decisive and controversial phase with recent legislation regarding the Turkish social insurance and healthcare system. Until recently Turkey’s welfare policies have relied largely on the model of the male-breadwinner family both as a source and a normative framework of welfare provision.
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Notes
- 1.
The author gratefully acknowledges the support of the Boğaziçi University Social Policy Forum for the preparation of this article.
- 2.
Major social security institutions include: the Social Insurance Institution (SSK) for workers founded in 1945, the Retirement Chest (ES) for civil servants founded in 1949 and Bağ-Kur for the self-employed founded in 1971.
- 3.
In addition to social insurance and healthcare, the reform package originally included a draft proposal for Social Assistances and Non-Contributory Payments. This proposal has not been brought to the parliament or sufficiently debated. In fact, it is not certain if the full draft proposal will ever be taken to parliament. The proposal included policies like the introduction of child and disability allowances, improving work prospects for assistance recipients, and minimum income support. It also planned to bring social assistance and social security arrangements within the same administrative framework.
- 4.
The dependents of the insured person – an uninsured spouse, children under 18 (or 25, depending on educational and marital status), and parents who are cared for by the insured – will benefit from the services as a part of his/her insurance. According to this system, retirees and survivor pensioners would be exempt from paying premiums. However, all persons would be obliged to pay user fees for healthcare services and some medicine costs.
- 5.
The provision and financing of the existing healthcare system is quite fragmented, with both public and private providers and financiers. However, the public sector predominates both in provision and financing. Eighty-nine percent of the population (including repeated registers) are insured by the three main insurance schemes while the Green Card program covers about 15.3% of the population (TÜSİAD, 2004). Yet, in practice there is a significant discrepancy between the percentage of the population insured and access to healthcare in practice. The main factors preventing access to healthcare are informal and irregular forms of employment, ineligibility for the Green Card program and premium debts to Bağ-Kur (there is no obligation for those insured under Bağ-Kur to register for healthcare insurance). For instance, many of the insured who are self-employed cannot regularly pay the monthly premium to Bağ-Kur. As of 2006, 60% of these insured persons were not eligible for healthcare insurance due to premium debts. This fact illustrates the risks of a healthcare reform based on required premium payments (Üstündağ & Yoltar, 2007, p.74).
- 6.
For a more detailed discussion of the gender dimension of Turkey’s social security system from both historical and contemporary perspectives, see Kılıç (2008a, 2008b). I should note that women and men are of course not homogenous groups; however, here I aim to outline such abstract categories as embodied in the social policy legislation and discourse and discuss their gendered implications for the majority of women, who are economically more vulnerable to social risks. On the other hand, one can notice that such a gendered social policy environment does not necessarily mean favoring men, either.
- 7.
The 2006 reform granted survivor sons, as well as daughters, marriage allowances. However, during the amendment process the government declared that this was a technical fault due to the fact that survivor sons’ pensions are not terminated before they formally end as a result of marriage.
- 8.
Orphans are treated differently according to gender in all cases except for a 2003 reform which extended the disability pension to survivor females.
- 9.
Changes to Turkish civil law follow a parallel trend. The Civil Law of 1926, which was in force until the Law of 2001, relied on the male breadwinner family model, explicitly considering the husband the head of the family responsible for maintenance of the household, while regarding the wife as the housekeeper and subject to permission from her husband in order to work. In 1990 the provision regarding permission for work was annulled by the Constitutional Court and the rest was changed by the Civil Law of 2001, which ended the attributed roles of family head, maintenance and care and refers to the shared contributions of spouses reflected by their capability.
- 10.
The amount of cash transfers varies according to the number, gender, age, and the educational level of children. In 2008, the amount given for primary school children was 20 YTL for boys and 25 YTL for girls and approximately 80% higher for the secondary school children (note that the minimum net wage was 435 YTL, which was about 228€). The allowances are granted for 9 months a year. See SYDGM (2008).
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- 12.
- 13.
Through home-visits, midwives monitor the health of pregnant women and their babies in the area they cover. During these visits, they can offer information on mother and child health, nutrition, first aid, prevention of diseases as well as providing primary-level care, vaccination, and family planning services.
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- 15.
The term refers to the entire body of European laws, which must be adopted and implemented by the candidate countries to be allowed to join the EU. For the accession negotiations with Turkey, the acquis has been divided into 35 chapters, with a special chapter on social policy and employment as well. For an evaluation of the Turkish accession to the EU from a social policy perspective, see Manning (2007).
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Kılıç, A. (2010). Gender, Family and Children at the Crossroads of Social Policy Reform in Turkey: Alternating Between Familialism and Individualism. In: Ajzenstadt, M., Gal, J. (eds) Children, Gender and Families in Mediterranean Welfare States. Children¿s Well-Being: Indicators and Research, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8842-0_8
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