An Ethical Analysis of Performance-Based Supplementary Payment in Turkey’s Healthcare System
In 2003 Turkey introduced the Health Transition Program to develop easily accessible,
high-quality, and effective healthcare services for the population. This program, like
other health reforms, has three primary goals: to improve health status, to enhance fi nancial protection, and to ensure patients’ satisfaction. Although there is considerable literature on the anticipated positive results of such health reforms, little evidence exists on their current effectiveness. One of the main initiatives of this health reform is a performance-based supplementary payment system, an additional payment healthcare professionals receive each month in addition to their regular salaries. This system may cause some ethical problems.Physicians have an ethical duty to provide high-quality care to each patient; however, payfor-performance and other programs that create strong incentives for high-quality care set up a potential confl ict between this duty and the competing interest of complying with a performance measure.