How do the Social Policy Providers Evaluate the Social Policies on Green Card and Elderly Care in Tu

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How do the Social Policy Providers Evaluate the
Social Policies on Green Card and Elderly Care in
Turkey?

• Assoc. Prof. Sibel Kalaycioglu and Nurdan Atalay,
  Ph.D student
• METU
• April 2006

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Introduction

• The idea of the social welfare state as
  conceived and implemented by the policy planners
  and service providers in Turkey
• how the policy planners and service providers
  view the need and functions of the welfare
  mechanisms
• Levels of qualification of policy planners and
  providers and their professions determining their
  approaches towards the welfare provisions of the
  state.

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Introduction

• 'welfare state' refers to a " set of institutions
  and social arrangements designed to assist people
  when they are in need because of factors such as
  illness, unemployment and dependency through
  youth and old age.
• These institutions and arrangements social
  security, social services and social assistance
  mechanisms.

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Social security policies in Turkey

• The social security system in Turkey starts
  during the later stages of Ottoman Empire
• Civil servants and their families were given
  health insurance, pensions, yearly holiday leave,
  and job security. New policies in the late
  Ottoman period intended to bring some coverage
  and help for the orphans (Darülsafaka) and for
  the widows, the disabled,the elderly and for the
  victims of natural disasters (Darulaceze).

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Social security policies in Turkey

• In the Republican era,after 1923 welfare was only
  defined as provisions for the social security
  for those who are employed in the formal sector.
• In 1945 the Social Insurance Institution (SSK)
  was established for formal sector wage workers
• SSK based on the payment of premiums both by the
  employers and the employees during the employment
  period, which was paid back as retirement
  pensions and health coverage for the employee and
  his family all through their lives -

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Social security policies in Turkey

• The period can be named as a corporatist model
  (Esping-Andersen,1990).
• Özbek (2002) also discusses the corporatist
  tendencies and the idea of classless society,
  were quite influential on social policy approach
  in Turkey before the planned period started.
• 1960s start of five year development plans
• Two economic and social targets of the plans were
  
• - to increase the quality of life and
  welfare of the masses .
• -social security to every citizen and to
  distribute income fairly, in order to create
  equality of opportunity.

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Social security policies in Turkey

• Social security programs during planned period
  targeted
• - inclusion of self-employed people
• - unemployment security for permanent workers
• - provision of old age payments and health
  security to every one
• - The concept of poor included children
  without parents, elderly people, prisoners,
  disabled people, and children with learning
  difficulties the deserving poor were
  eligible for social assistance programs
  (Atalay,2002).

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Social security policies in Turkey

• In the period between 1980 and 2002 two
  significant policy implementations
• - Social Risk Mitigation Project (SRAP) and
  the Social Assistance and Solidarity
  Encouragement Fund (SASEF) was established in
  1986. It provided an assistance to those sections
  of the society who can be collected under the
  category of "deserving poor" (Himmelfarb 1984,
  Katz 1990).
• - Green Card Scheme was started in 1992,
  for provision of free health services for the
  poor, who can obtain necessary documents to prove
  their degree of poorness, a procedure somewhat
  similar to Means Testing.

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Welfare system in Turkey

• Despite these, the uncovered population totals to
  nearly half of the economically active population
  of Turkey.
• Limited coverage and fragmented structure of
  welfare regime of Turkey leaving out those
• -who are outside of the formal job market
• -working in agriculture
• -working in casual and seasonal jobs
• -employed in marginal or informal sector
  jobs
• -in homeworking and pieceworking (especially
  by
• women)

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The Role of Social Networks for Welfare policies
in Turkey

• In Turkey, family mutual help, intra-generational
  transfers and reciprocity in kinship networks are
  dominant (Kalaycioglu, Rittersberger-Tiliç,
  2000).
• The domination of social networks and reciprocity
  give us a different model of organisation of
  welfare state somewhat like in other Southern
  European models (Rhodes, 1997).
• In such an organisation of welfare, the role of
  family actually is very significant in
  encouraging the limited development of the
  welfare state (Bugra, 2001 Rittersberger-Tiliç,
  Kalaycioglu, 1998).

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Research

• The findings of the research with the planners
  and providers related to their evaluations of
• - functions of social welfare state, the
  poor, Green Card beneficiaries, elderly and the
  aged people.
• - What are major responsibilities of the state
  towards its citizens?
• -The evaluations of the existing system of
  welfare provisions with a specific focus on the
  Green Card Scheme and the elderly care

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Evaluations of PolicyMakers and Providers-
welfare system

• Main strengths of Turkish welfare system are
• -that it exists as a constitutional right,
• -that as a social state, each citizen has
  social
• security rights.
• -that social welfare benefits are widely
  
• distributed

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Evaluations of PolicyMakers and
Providers-welfare system

• The main weaknesses of Turkish welfare system are
  
• - the role of clientelist relations and
  absence of both equity and reciprocity between
  the state and its citizens,
• - Reliance on family and social networks
• - It is partial and fragmented,
• - there is unequal distribution of resources
• because of problems of access to existing
• programs.

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Evaluations of PolicyMakers and Providers-Green
card scheme

• Main strength of Green Card Scheme is
• - inclusion of the poor and disadvantaged
  groups who are not covered by any system of
  security, into the health system despite all its
  drawbacks and limitations.
• - that it is the duty of the state to provide
  social security and health coverage of its
  citizens

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Evaluations of PolicyMakers and Providers Green
card scheme

• Main weaknesses of this scheme are
• -the difficulties during the process of
  application to the card
• -problems experienced by the beneficiaries
  during implementation like non-coverage of
  medicine expenses
• - Green card officers having insufficient
  sensitivity to poor and the vulnerable
• - bad treatment in the hospitals of Green
  Card patients

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Evaluations of PolicyMakers and Providers-About
beneficiaries

• Most of the Green Card beneficiaries are
  'lazy', 'uneducated', or 'tend to have many
  children.
• those people are very much inclined to abuse the
  system even if they do not have the need.
• the people in real need are not covered by
  any system.

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Evaluations of PolicyMakers and Providers-about
poverty and poor

• there are no poor people, but just 'lazy'
  people
• as a result of the personal choices of some
  individuals there is poverty.
• majority of the population do not like to work
  or reluctant to create some alternative survival
  strategies for themselves
• There must be distinction between deserving and
  undeserving poor (as mentioned in New Poor Law
  , Himmelfarb,1984)
• Culture of Poverty thesis by Oscar Lewis (1959)
  also comes close to this understanding.

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Evaluations of PolicyMakers and Providers-about
poverty alleviation

• the economic conditions of the country
  determined the level and size of provisions
• the amount of provisions are very low in most
  cases and very much insufficient to cover the
  needs of the poor
• The state doesnt afford anything, there are
  only some foundations that help the poor and
  there is the Green Card. Nobody is interested in
  what the poor eats and drinks or how well they
  are nourished.

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Evaluations of PolicyMakers and Providers-about
elderly

• there are not enough services for the elderly
  in Turkey.
• Th public life is not organized for them so
  they should stay at home.
• the elderly are selfish and very stubborn.
• They should not come out and take the advantage
  of their bus passes when the students are
  around.
• They are physically fragile,ill, disabled, can
  not think properly, so theyshoud be protected,
  can not be left alone.

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Evaluations of PolicyMakers and Providers-about
elderly

• the elderly can not behave, dress like the
  young.
• it is not correct to put the elderly into a
  nursing home.
• to be elderly in this society means to be
  isolated,it is the state of life where nobody
  wants you.
• we feel very sorry about the elderly.

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Evaluations of PolicyMakers and Providers-about
elderly

• The social services for the elderly are very
  insufficient
• State should strengten the care services.
• On the other hand
• Such assesments are also shared by the elderly
  and their relatives.
• Among the living arragements the demand for
  nursing home is least in the upper class and
  lower classes. Most demand is found among the
  middle class elderly who were civil servants,
  teachers, professionals.
• Lack of affection, emotional ties is most
  required by the elderly.Hence, still the care in
  the home is the most wanted living arrangement.

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Conclusion

• Three points are important as conclusion
• Effectiveness in the distribution of the
  available funds among the people and in easening
  the accessibility of the mechanisms by the poor
  and elderly to social services and health care is
  possible only if the providers can understand
  the significance of the concept of Inclusion.

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conclusion

• 2. It is not the enactment of new legislation
  but actual implementation that matters. The civil
  service is not, after all, a homogeneous body and
  battles both between and within departments can
  be easily exploited. Local officials
  ('street-level bureaucrats') who are heavily
  influenced by economic constraints, prevailing
  social prejudice and actions of competing
  agencies. Policy, in this perspective, is not
  what Cabinets and senior officials plan but what
  lower-paid officials do. (Lowe1999).

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conclusion

• 3. There are differences among the planners and
  actual implementers of the policies
• -Prejudices of the providers are more
  dominant than the planners
• -Planners perceive social state as a
  connected to national interests and citizenship
  duties
• -Providers perceive social state as
  interests and rights of the individuals.