Public-Private Partnership in Turkish Healthcare Provision: The City Hospital Model

The city hospital program has been the latest example of the public-private partnership (PPP) paradigm in the Turkish healthcare system, which has transformed the role the public sector plays in the provision of public services. This thesis examines the city hospital model as a case study of PPP that has emerged out of a process of policy transfer and an interplay of public and private actors within policy transfer networks. In this regard, this thesis explores the policy networks, motivations of actors to be involved in these networks, political dynamics behind the introduction of PPP in healthcare provision in Turkey, and the perceptions, contributions and resistances of different actors about this introduction. This thesis relies on participant observation and a comprehensive review of legal and policy documents. The analysis has unveiled four key findings. First, the city hospital model emerged out of the government’s relationing to epistemic communities and is an example of policy transfer in which the state was voluntarily involved and appreciated the contributions of private actors. Second, the city hospital model was implemented in a top-down, undemocratic manner, with critical details of projects not disclosed to the public. Third, the lack of expertise of the public sector created information and power asymmetries, which resulted in pushing the public sector into a passive role and the empowerment of private actors. Fourth, rapid implementation of the PPP model in healthcare without ample planning is in line with the appreciation of health care as a short-termist economic growth strategy that is capable of yielding popular support and legitimacy.