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The health field is characterised by high uncertainties which can lead to large expenditures. One way to manage these uncertainties is to develop collectively-financed health care systems. Some countries create this collective financing through general taxes, whereas others rely on premiums set up through compulsory social health insurance. Turkey, a middle-income country, has historically used several mechanisms to extend health care to its population. However, inadequate financing and poor service quality have plagued this health care system.Recently, a transition from a system of multiple insurance schemes that cover only about two-thirds of the population to a single-payer system aiming to achieve universal coverage has been under way to overcome problems in the fragmented health financing system and ensure universal coverage. With the enactment of the General Health Insurance Scheme Law in 2006, the Turkish health care system has embarked on one of its most radical and far-reaching reforms since the socialization attempt of the 1960s.This paper focuses on the health care financing reform in Turkey, concentrating on its salient features in terms of financing functions and policies and explores the main differences between the old and new systems. The care and coverage aspects are also dealt with. Our results suggest that if well implemented, the GHIS reform can be a powerful engine for achieving universal coverage and enhancing equity and solidarity in the Turkish health care system. However, to reach this end, a transition process is required, as the success of the GHIS will depend on its ability to manage challenges during the implementation process. [ABSTRACT FROM PUBLISHER]

European Union (EU) healthcare services policy has been largely driven by the European Court of Justice (ECJ) applying the law of the internal market to the previously separate area of healthcare systems. We argue that it opened up two major risks: that health service planning would be disrupted by cross-border flows of patients and professionals, including ostensibly interchangeable professionals or procedures that actually vary in quality; and that health systems would be disrupted by the application of liberalizing EU regulatory frameworks. The threats have largely been managed by four developments. Cross-border flows have largely appeared as spot markets rather than broad competition. States, meanwhile, have managed both regulatory and planning risks by debating and then legislating, which increases legal certainty, and the ECJ has taken the hint and become more cautious in its rulings. Meanwhile, states and health systems alike have implemented a strategy of ‘bureaucratic resistance’ upon discovering how easy it is to comply in only the narrowest ways, thereby limiting affects on systems and regulations alike. The experience testifies to the difficulty of creating and sustaining health markets, but also to the risks of international trade in health services and the amount of effort it takes to manage such risks. [ABSTRACT FROM PUBLISHER]

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]