An analysis of the implementation of the PPP model in healthcare in Turkey

This study contains an analysis of the implementation of the Public Private Partnership (PPP) model used in the delivery of health services in Turkey. While making this analysis, first of all, the history of the model was discussed. In the history, the conditions that paved the way for the first emergence of the PPP model in the world and the country or countries where the model was first applied were traced. In the examination of the history of the model, answers were sought to the questions of whether the PPP is applied as a necessary and final outcome of the conditions and needs, or whether it is a voluntary preference of the governments. In which countries the model is used more widely, its change over time and the conditions leading to its use in Turkey are examined. In order to alleviate the burden of states on public finances as a result of expanding public finances and increasing debt burden with classical economics and welfare state practices until the 1970s, privatization practices were implemented throughout the world in the early 1980s, with the effect of neo-liberal policies. Due to the nature of the private sector, minimum cost and maximum profit targets have brought along many problems such as increasing unemployment and high cost of private sector services after a while. PPP emerged as a model based on the blending of scarce (inadequate) resources, increasing public finance debt burden, and tried-and-true policies that could not be yielded by privatization practices alone. As a model that started to be implemented from the early 1990s, which the literature references, and took the world by storm in a short time, PPP projects inevitably expanded its usage network in the world at the beginning of the 2000s. While it was first applied in the fields of energy and infrastructure, it has become a preferred model in many areas such as transportation, environment, educational buildings, culture, communication, health services, defense, public order and public security. With the widespread use of the model over time, the criticisms against the model have increased at the same rate. These criticisms are clustered on issues such as public loss, high costs, hindering competition, and lack of transparency and accountability principles. It is possible to say that these criticisms of the PPP model are not country-specific problems, but are problems arising from the implementation of the model. Because it has been observed that similar criticisms frequently take place both in the literature in Turkey and in the literature of the countries where the model is used. In this study, some suggestions have been developed under a separate heading in the light of literature findings in order to make the model more advantageous and usable within the scope of the criticisms directed at the PPP model applied in the delivery of health services in Turkey.