Hostname: page-component-797576ffbb-cx6qr Total loading time: 0 Render date: 2023-12-06T20:01:40.677Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

The AKP between populism and neoliberalism: lessons from pharmaceutical policy

Published online by Cambridge University Press:  09 January 2017

Tim Dorlach*
Graduate School of Social Sciences and Humanities, Koç University, Rumelifeneri Yolu, 34450, Sarıyer, İstanbul, Turkey,


In September 2009, Turkey experienced a major reform of its pharmaceutical expenditure and price policy. By introducing a global budget, Turkey saved some 20 billion TL in public pharmaceutical expenditure in the 2010–2012 period. The lion’s share of this was achieved by introducing stricter price controls that reduced the profit margins of pharmaceutical producers and distributors (the populist policy solution), rather than by privatizing the cost of medicines through, for example, raising out-of-pocket payments (the neoliberal policy solution). This is a puzzle, given the Justice and Development Party (Adalet ve Kalkınma Partisi, AKP) government’s usual preference for lenient and business-friendly regulation. This article explains the policy reform with reference to (i) the pronounced electoral interests of the AKP’s political leadership in not substantially reducing access to public health services, (ii) the absence of powerful business interests in high medicine prices, and (iii) the absence of a developmentalist commitment to an industrial policy strategy for the pharmaceutical sector. This case study holds important lessons for scholars of Turkish politics. It suggests that externally the AKP’s economic and social policies are driven by the interests of its two major constituencies (namely, lower-class voters and “Anatolian capital”), while internally they are shaped by two camps of policy makers (namely, neoliberal-minded technocrats and election-focused party leaders).

© New Perspectives on Turkey and Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Author’s Note: I thank Ayşe Buğra, İpek Eren Vural, Bünyamin Esen, Çağlar Keyder, Tracy Lord, Ziya Öniş, Yalçın Özkan, Osman Savaşkan, Umut Türem, Alper Yağcı, conference participants at the London School of Economics, Middle East Technical University, and the University of Sheffield, as well as three anonymous referees and the editors of this journal for comments that helped improve this paper.


Acemoğlu, Daron, Egorov, Georgy, and Sonin, Konstantin. “A Political Theory of Populism.” The Quarterly Journal of Economics 128, no. 2 (2013): 771805.Google Scholar
Ağartan, Tuba I. “Marketization and Universalism: Crafting the Right Balance in the Turkish Healthcare System.” Current Sociology 60, no. 4 (2012): 456471.Google Scholar
Ağartan, Tuba I. “Explaining Large-Scale Policy Change in the Turkish Health Care System: Ideas, Institutions, and Political Actors.” Journal of Health Politics, Policy and Law 40, no. 5 (2015): 967995.Google Scholar
Ağartan, Tuba I. “Learn, Frame and Deploy? Cross-National Policy Ideas and Comparisons in Turkey’s Health Reform.” Journal of Comparative Policy Analysis: Research and Practice 18, no. 1 (2016): 5469.Google Scholar
Araştırmacı İlaç Firmaları Derneği (AİFD). “Letter to H.E. Prime Minister, Prof. Dr. Ahmet Davutoğlu, jointly signed by Turkish pharma industry representatives.” November 27, 2014. Scholar
Araştırmacı İlaç Firmaları Derneği (AİFD).Türkiye İlaç Sektörü Vizyon 2023 Raporu. 2012. Scholar
AİFD, İlaç Endüstrisi İşverenler Sendikası (İEİS), and Türkiye İlaç Sanayi Derneği (TİSD). Orta Vadeli Program ve Bütçe Disiplini Açısından AİFD-İEİS-TİSD Ortak Model Önerisi (01.12.2009). 2009. Scholar
Akıncı, Fevzi, Mollahaliloğlu, Salih, Gürsöz, Hakkı and Öğücü, Fatma. “Assessment of the Turkish Health Care System Reforms: A Stakeholder Analysis.” Health Policy 107, no. 1 (2012): 2130.Google Scholar
Alp, Aysel. “Grip olan hastaneye gidemeyecek!” Hürriyet. September 16, 2009.Google Scholar
Ateş, Hazal. “‘Kemer sıkma’ operasyonu başlıyor, ilk neşter sağlığa.” Sabah. September 3, 2009.Google Scholar
Ateş, Leyla. “Domestic Political Legitimacy of Tax Reform in Developing Countries: A Case Study of Turkey.” Wisconsin International Law Journal 30, no. 3 (2012): 706760.Google Scholar
Ateş, M. Rauf. “Sadece ilaç sektörü değil, eczacılar da isyanları oynuyor.” Hürriyet. October 1, 2009.Google Scholar
Aytaç, S. Erdem and Öniş, Ziya. “Varieties of Populism in a Changing Global Context: The Divergent Paths of Erdoğan and Kirchnerismo.” Comparative Politics 47, no. 1 (2014): 4159.Google Scholar
Barr, Robert R. “Populists, Outsiders and Anti-establishment Politics.” Party Politics 15, no. 1 (2009): 2948.Google Scholar
Bozkurt, Umut. “Neoliberalism with a Human Face: Making Sense of the Justice and Development Party’s Neoliberal Populism in Turkey.” Science & Society 77, no. 3 (2013): 372396.Google Scholar
Buğra, Ayşe and Savaşkan, Osman. “Politics and Class: The Turkish Business Environment in the Neoliberal Age.” New Perspectives on Turkey 46 (2012): 2763.Google Scholar
Buğra, Ayşe and Savaşkan, Osman.New Capitalism in Turkey: The Relationship between Politics, Religion and Business. Cheltenham: Edward Elgar, 2014.Google Scholar
Buğra, Ayşe and Keyder, Çağlar. “The Turkish Welfare Regime in Transformation.” Journal of European Social Policy 16, no. 3 (2006): 211228.Google Scholar
Brown, Sarah. Hole, Arne Risa and Kılıç, Dilek. “Out-of-pocket Health Care Expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys.” Economic Modelling 41 (2014): 211218.Google Scholar
Çakkal, Ömer. “Adil Gür: Türk Halkı, Hükümetin en Başarılı İcraatı Olarak Sağlığı. Görüyor.” Sağlık Düşüncesi ve Tıp Kültürü Dergisi 18 (2011): 2631.Google Scholar
Çekirge, Fatih. “Yeni önlem paketi geliyor.” Hürriyet. August 31, 2009.Google Scholar
Çelik, Aziz. “Turkey’s New Labour Regime under the Justice and Development Party in the First Decade of the Twenty-first Century: Authoritarian Flexibilization.” Middle Eastern Studies 51, no. 4 (2015): 618635.Google Scholar
Dalan, Necla. “200 milyon $ yatıracak ‘jenerik’te ilk 5’e girecek.” Vatan. August 23, 2014.Google Scholar
Demiralp, Seda. “The Rise of Islamic Capital and the Decline of Islamic Radicalism in Turkey.” Comparative Politics 41, no. 3 (2009): 315335.Google Scholar
Demirkan, Özge. “Bakana baskı.” Vatan. January 27, 2003.Google Scholar
Dorlach, Tim. “The Prospects of Egalitarian Capitalism in the Global South: Turkish Social Neoliberalism in Comparative Perspective.” Economy and Society 44, no. 4 (2015): 519544.Google Scholar
Düzel, Neşe. “İlaççılar IMF’yi bile devreye soktu.” Radikal. August 16, 2004.Google Scholar
Eder, Mine. “Deepening Neoliberalization and a Changing Welfare Regime in Turkey.” Turkey’s Democratization Process. Edited by Carmen Rodriguez, Antonio Ávalos, Hakan Yılmaz, and Ana I. Planet. Abingdon and New York: Routledge, 2013. 195220.Google Scholar
Edwards, Sebastian. Left Behind: Latin America and the False Promise of Populism. Chicago: University of Chicago Press, 2010.Google Scholar
Eren Vural, İpek. “Domestic Contours of Global Regulation: Understanding the Policy Changes on Pharmaceutical Patents in India and Turkey.” Review of International Political Economy 14, no. 1 (2007): 105142.Google Scholar
Eren Vural, İpekNeoliberalism, Intellectual Property Rights and the Turkish Pharmaceutical Industry in the 2000s.” In The New Political Economy of Pharmaceuticals Production, Innovation and TRIPs in the Global South. Edited by Hans Löfgren and Owain David Williams. Basingstoke: Palgrave Macmillan, 2013. 221245.Google Scholar
Eren Vural, İpek. “Politics, Reforms, and Regulation of Pharma Prices and Expenditures in Turkey over the 2000s.” In Pharmaceutical Prices in the 21st Century. Edited by Zaheer-Ud-Din Babar. Cham: Springer International, 2015. 267296.Google Scholar
Erus, Burçay and Aktakke, Nazlı. “Impact of Healthcare Reforms on Out-of-pocket Health Expenditures in Turkey for Public Insurees.” The European Journal of Health Economics 13, no. 3 (2012): 337346.Google Scholar
Erus, Burçay, Yakut-Çakar, Burcu, Cali, Sanda and Adaman, Fikret. “Health Policy for the Poor: An Exploration on the Take-Up of Means-Tested Health Benefits in Turkey.” Social Science & Medicine 130 (2015): 99106.Google Scholar
Espin, Jaim, Rovira, Joan and de Labry, Antonio Olry. “External Reference Pricing.” WHO/HAI Project on Medicine Prices and Availability, 2011.Google Scholar
Fearon, James D.Counterfactuals and Hypothesis Testing in Political Science.” World Politics 43, no. 2 (1991): 169195.Google Scholar
Fisher Ellison, Sara and Wolfram, Catherine. “Coordinating on Lower Prices: Pharmaceutical Pricing under Political Pressure.” The Rand Journal of Economics 37, no. 2 (2006): 324340.Google Scholar
Gereffi, Gary. The Pharmaceutical Industry and Dependency in the Third World. Princeton, NJ: Princeton University Press, 1983.Google Scholar
Gidron, Noam and Bonikowski, Bart. “Varieties of Populism: Literature Review and Research Agenda”. Weatherhead Center Working Paper Series. Cambridge, MA: Weatherhead Center for International Affairs, 2013.Google Scholar
Göçmen, Ipek. “Religion, Politics and Social Assistance in Turkey: The Rise of Religiously Motivated Associations.” Journal of European Social Policy 24, no. 1 (2014): 92103.Google Scholar
Gürcanlı, Zeynep. “Başbakan ‘milli ilaç’ istedi.” Hürriyet. January 19, 2013.Google Scholar
Güven, Ali Burak. “Rethinking Development Space in Emerging Countries: Turkey’s Conservative Countermovement.” Development and Change 47, no. 5 (2016): 9951024.Google Scholar
Hale, William and Özbudun, Ergun. Islamism, Democracy and Liberalism in Turkey: The Rise of the AKP. London: Routledge, 2010.Google Scholar
Hay, Colin. “Ideas and the Construction of Interests.” In Ideas and Politics in Social Science Research. Edited by Daniel Béland and Robert H. Cox. New York: Oxford University Press, 2011. 90114.Google Scholar
Hill, Raymond and Chui, Mandy. “The Pharmerging Future.” Pharmaceutical Executive 29, no. 7 (2009).Google Scholar
Hürriyet . “Dolar düştüithal ilaç ucuzlamadı.” January 11, 2004.Google Scholar
Hürriyet . “Kanser ilacı ucuzlayacak.” January 18, 2004.Google Scholar
Hürriyet . “İthal ilaçlar ucuzluyor.” January 29, 2004.Google Scholar
Hürriyet . “45 milyon kişin ilaççilesine son veren imza.” December 15, 2004.Google Scholar
Hürriyet . “İlaç sektörünün önü açık.” February 3, 2009.Google Scholar
Hürriyet . “IMF’den orta vadeli programa ‘cesaret verici’ mesajı geldi.” September 18, 2009.Google Scholar
Hürriyet . “İlaç krizi çözüldü.” December 19, 2011.Google Scholar
İlaç Endüstrisi İşverenler Sendikası (İEİS). Partnering with the Government to Globalize the Turkish Pharmaceutical Industry. İstanbul: Pharmaceutical Manufacturers Association of Turkey, 2011.Google Scholar
İlaç Endüstrisi İşverenler Sendikası (İEİS). “Türkiye İlaç Endüstrisi’nin Küreselleşmesi için Devlet ile Ortak Yol Haritası.” 2011.Google Scholar
Karataşlı, Şahan Savaş. “The Origins of Turkey’s ‘Heterodox’ Transition to Neoliberalism: The Özal Decade and Beyond.” Journal of World-Systems Research 21, no. 2 (2015): 387416.Google Scholar
Keyder, Çağlar, Üstündağ, Nazan, Ağartan, Tuba and Yoltar, Çağrı, eds. Avrupa’da ve Türkiye’de Sağlık Politikaları. İstanbul: İletişim, 2007.Google Scholar
Medimagazin . “Sağlık harcaması son 9 yılda yüzde 40 arttı.” September 14, 2009.Google Scholar
Milliyet . “Bütçe açık verirse versin.” September 3, 2009.Google Scholar
Milliyet . “Çember daralıyor, varlık barışından yararlanın.” September 7, 2009.Google Scholar
ntvmsnbc. “Ekonomi yönetimi sosyal güvenliği görüşüyor.” September 4, 2009.Google Scholar
Organisation for Economic Co-operation and Development (OECD). Pharmaceutical Pricing Policies in a Global Market. 2008. Scholar
Ökem, Zeynep Güldem and Çakar, Mehmet. “What Have Health Care Reforms Achieved in Turkey? An Appraisal of the ‘Health Transformation Programme.’Health Policy 119 (2015): 11531163.Google Scholar
Öniş, Ziya. “The Political Economy of Turkey in the 1980s: The Anatomy of Unorthodox Liberalism.” In Strong State and Economic Interest Groups: The Post-1980 Turkish Experience. Edited by Metin Heper. New York and London: Walter de Gruyter, 1991. 2740.Google Scholar
Öniş, Ziya. “Power, Interests and Coalitions: The Political Economy of Mass Privatisation in Turkey.” Third World Quarterly 32, no. 4 (2011): 707724.Google Scholar
Öniş, Ziya. “The Triumph of Conservative Globalism: The Political Economy of the AKP Era.” Turkish Studies 13, no. 2 (2012): 135152.Google Scholar
Öniş, Ziya and Burak Güven, Ali. “Global Crisis, National Responses: The Political Economy of Turkish Exceptionalism.” New Political Economy 16, no. 5 (2011): 585608.Google Scholar
Öniş, Ziya and Şenses, Fikret, eds. Turkey and the Global Economy: Neo-Liberal Restructuring and Integration in the Post-Crisis Era. London: Routledge, 2009.Google Scholar
Özcan, Gül Berna and Gündüz, Umut. “Political Connectedness and Business Performance: Evidence from Turkish Industry Rankings.” Business and Politics 17, no. 1 (2015): 4173.Google Scholar
Özcan, Gül Berna and Gündüz, Umut.“Energy Privatisations, Business-Politics Connections and Governance under Political Islam.” Environment and Planning C: Government and Policy 33, no. 6 (2015): 17141737.Google Scholar
Özpeynirci, Emre. “Pfizer, 80 milyon dolarlık rest çekti.” Hürriyet. May 11, 2002.Google Scholar
Pierson, Paul. “Big, Slow-Moving, and … Invisible: Macrosocial Processes in the Study of Comparative Politics.” In Comparative Historical Analysis in the Social Sciences. Edited by James Mahoney and Dietrich Rueschemeyer. New York: Cambridge University Press, 2003. 177207.Google Scholar
PricewaterhouseCoopers. “Pharmaceutical Deals: Mergers and Acquisitions Activity within the Turkish Pharmaceutical Market, 2006–2009 Review.” 2009. Scholar
Roberts, Kenneth. “Neoliberalism and the Transformation of Populism in Latin America: The Peruvian Case.” World Politics 48, no. 1 (1995): 82116.Google Scholar
Rovira Kaltwasser, Cristóbal. “Latin American Populism: Some Conceptual and Normative Lessons.” Constellations 21, no. 4 (2014): 494504.Google Scholar
Sabah. “Erdoğan düğmeye bastı Uludere olayı araştırılıyor.” January 5, 2012.Google Scholar
Sanyer, Ruhi, “İlaççılar orta yol peşine düştü.” Radikal. May 6, 2002.Google Scholar
Sanyer, Ruhi, “Pfizer’den Ankara turu.” Radikal. May 10, 2002.Google Scholar
Shadlen, Kenneth and da Fonseca, Elize Massard. “Health Policy as Industrial Policy Brazil in Comparative Perspective.” Politics & Society 41, no. 4 (2013): 561587.Google Scholar
T.C., Sağlık Bakanlığı. Sağlıkta Dönüşüm. Ankara: Ministry of Health, 2003.Google Scholar
T.C., Sosyal Güvenlik Kurumu (SGK). Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliği. Adopted June 15, 2007. Resmi Gazete 26532 (Mükerrer). May 25, 2007.Google Scholar
T.C., Sosyal Güvenlik Kurumu (SGK), Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliği. Adopted February 29, 2012.Google Scholar
Top, Mehmet and Tarcan, Menderes. “Türkiye İlaç Ekonomisi ve İlaç Harcamaları: 1998–2003 Dönemi Değerlendirmesi.” Liberal Düşünce 35 (2004): 177200.Google Scholar
Tuğal, Cihan. Passive Revolution: Absorbing the Islamic Challenge to Capitalism. Stanford, CA: Stanford University Press, 2009.Google Scholar
Weyland, Kurt. “Neoliberal Populism in Latin America and Eastern Europe.” Comparative Politics 31, no. 4 (1999): 379401.Google Scholar
Wikileaks. “Turkey: Compromise Deal Reached on Pharma, but Industry, Pharmacists Still Angry.” Cable no. 09ANKARA1740_a. December 7, 2009.Google Scholar
World Health Organization (WHO). Turkey: Country Cooperation Strategy at a Glance. Geneva: World Health Organization, 2013.Google Scholar
Yenimahalleli Yaşar, Gülbiye. “‘Health Transformation Programme’ in Turkey: An Assessment.” International Journal of Health Planning and Management 26, no. 2 (2011): 110133.Google Scholar
Yıldırım, Deniz. “AKP ve Neoliberal Popülizm.” In AKP Kitabı: Bir Dönüşümün Bilançosu. Edited by Bülent Duru, and İlhan Uzel. Ankara: Phoenix, 2009. 66107.Google Scholar
Yılmaz, Volkan. “Changing Origins of Inequalities in Access to Health Care Services in Turkey: From Occupational Status to Income.” New Perspectives on Turkey 48 (2013): 5577.Google Scholar