Transformation of health system and new forms of employment: A sociological study on subcontract healthcare workers

This study tries to analyze the effects of subcontracting, which is one of the flexible employment policies in public health services and looks at the views of the health workers who are engaged in core work tasks in the field of health. In the study, based on the periodization of the French Regulation School on the historical development of the capitalist production process, attempts were made to understand the transformation of public health services in the postfordist period through personnel employment policies. Both of quantitative and qualitative research methods were used so as to comprehend conditions of subcontract workers in the public health sector. For this purpose, a questionnaire was conducted to 120 healthcare workers employed in Elazığ Fırat University, Fırat Medical Hospital through service procurement. On the other hand, an in-depth interview was also carried out with 17 healthcare workers to understand the process from a comprehensive perspective. It was observed that the majority of the health care workers in the research sample group were from the lower and middle-class families and got access to the health profession through social networks. It was seen that health care workers in the sample initially tried but failed to have a permanent job in the public sector. Hence, working on subcontract base is their secondary option and that it is better than being unemployed. Transformation in health sector in Turkey has paved way for a more flexible work arrangements and this then has resulted in an increase in work load, pressure at work and working on long hours. In addition to this, a new performance system has also been introduced to enhance the efficiency of the health services by the state, but this has also deteriorated the working conditions in the health sector. As to the personal rights and benefits, subcontract health care workers are mostly excluded from basic employment rights such as occupational security, permanent contract and union membership which is always seen a threat by the employers. Although most subcontract health care workers perform the same work duties as the permeant workers they don't get the same pay and other work-related rights such as annual paid leave, pension scheme and statutory sick pay. It was found that the employees see the transformation process in health as a process which is mostly positive in terms of the actors benefiting from health services and mostly negative for health workers. Key Words: Fordism, Post-fordism, Public Health Services, Regulation School, Subcontractor