Selling Voluntary Health Insurance in a Publicly-Funded System: A Study With Insurance Agents in Turkey

Increasing voluntary private health insurance (PHI) uptake is a global trend. Turkey is not an exception to this trend despite it offers compulsory social health insurance for all. Two types of voluntary PHI are available in Turkey, namely, standard duplicate and supplementary PHI. This thesis explores the dynamics of increase in the PHI uptake through a descriptive analysis of official data and a qualitative study of insurance agent perspectives. Insurance agents are selected as key informants given their strategic position deriving from their closer relations with PHI buyers and holders and their possible role in increasing PHI sales. Seven semi-structured interviews were conducted with insurance agents based in Istanbul. Interview data were analyzed by using thematic analysis method relying on deductive coding approach. The thesis finds that increase in PHI uptake mostly occurs through individual purchases from insurance agents. It also shows insurance agents explain the increase in PHI uptakes in reference to two main factors: PHI buyers’ perceived problems in the publicly-provided healthcare services and PHI buyers’ and holders’ demand for private healthcare services that increased in capacity with the 2003 reform. In addition, this thesis also suggests that the trust relationship established by insurance agents with customers is a crucial factor for the growth of PHI's customer pool. Finally, the thesis provides evidence that the PHI product, which generally appeals to the high-income group in Turkey, has started to attract an economically diverse customer base with the introduction of supplementary PHI after the 2003 reform.