Political Strategies for Health Reform in Turkey: Extending Veto Point Theory

This qualitative case study uses primary interview data to investigate the political processes of how Turkey established a unified and universal health coverage system. The goal of providing health coverage to all citizens through a unified system has been adopted by many low- and middle-income countries, but few have achieved it; Turkey is a notable exception. We use institutional veto point theory to identify four institutional obstacles to a unified and universal coverage system in Turkey between 2003 and 2008: (1) the Ministry of Finance and Treasury, (2) the Ministry of Labor and Social Security, (3) the Office of the President, and (4) the Constitutional Court. Our analysis shows how Minister of Health Recep Akdag and his team of advisors used political strategies to address and overcome opposition at each veto point. Where possible they avoided institutional veto points by using ministerial authority to adopt policies. When adoption required approval of others with veto power, they delayed putting forward legislation while working to facilitate institutional change to remove opposition; persuaded or made strategic compromises to gain support; or overpowered opposition by calling on the prime minister to intervene. Our findings propose an extension to institutional veto point theory by showing how the exercise of political strategies can overcome opposition at institutional veto points to facilitate policy adoption.