Overview of the social security system up to the 1980’s

Until the most recent reforms the social security system covering pensions and health insurance consisted of three institutions: the Social Insurance Institution (Sosyal Sigortalar Kurumu, SSK); the Retirement Chest (Emekli Sandigi, ES), and the Institution for the Self-Employed (Esnaf ve Sanatkarlar ve Diğer Bağımsız Çalışanlar Sosyal Sigortalar Kurumu, Bağ-Kur). ¹⁵⁰ This tripartite institutional structure established varying protection schemes, differentiated by eligibility and benefits in accordance with the beneficiary’s occupational situation (Buğra and Keyder, 2006: 213). The system covered five occupational groups:

workers, public servants, self-employed, agricultural workers¹⁵¹ and those self-employed in agriculture¹⁵² (Şahin, 2012: 146).

Turkey’s formal social security system, introduced for the most part after the Second World War, was built as a social insurance regime initially composed of two organizations providing old age and health benefits to employed workers (in the formal sector) and civil servants (Gümüş, 2010: 6). The Worker’s Insurance Institution, relabeled as the Social Insurance Institution (SSK)¹⁵³ in 1965, was established in 1945 to protect private-sector

150 The social security system, under this tri-partite institutional structure, provided six protection functions against social risks: job accidents and occupational disease; sickness; maternity; invalidity; old age; and survivors. It is important to note that the social security institutions assumed these functions over time with piecemeal and fragmented institutional developments via legislation, as the welfare state developed in Turkey.

For the SSK, the legislation for each function providing coverage against social risks was enacted from 1949 to 1964 (Özbek, 2006: 245). For the ES, the Law on the Retirement Fund in 1949 provided pension protection with insurance and income maintenance in the form of pensions for the retired, widow and orphans covering the occupational group of civil servants. The Law on Civil Servants (Law no. 657) regulated the health benefits of civil servants covering protection against the risks of illness, maternity, accident and disease. The Bağ-Kur provides coverage for old age, disability and death risks; with the Law no.3235 enacted in 1985, health insurance was established for the members of the Bağ-Kur (Özbek, 2006, 318-319).

151 The Law no. 2100 in 1977 included in the SSK those working in the agricultural sectors with an indefinite contract.

152 With the Law no. 2926 in 1983, those working in the agricultural sector independently were covered by Bağ-Kur.

153 The law no. 4792 on the Worker’s Insurance Institution enacted in 1945 constitutes the legal framework.

employees and blue-collar¹⁵⁴ public workers. It was financed by employer and employee contributions. The Retirement Chest (ES) was introduced in 1949 for civil servants, and therefore the state as employer makes contributions.¹⁵⁵ The third social security organization, Bağ-Kur was founded in 1971. It provides coverage of pensions and health insurance for the self-employed and agricultural workers and was extended to include independent farmers in the 1980’s.¹⁵⁶ Entitlements are provided for dependent family members as well, although arrangements differ in the three social security institutions (Aybars and Tsarouhas, 2010: 752).

These three institutions provide pensions according to a pay-as-you-go (PAYGO) system¹⁵⁷ (Elveren, 2008: 217). The state guaranteed to cover the deficit of all three institutions, but only made direct public contributions in the case of civil servants.

The healthcare system, in it its original form, was based as well on social insurance through a parallel and equally fragmented structure (Üstündağ and Yoltar, 2007). The state had the main responsibility for the provision of health care services,¹⁵⁸ supplied jointly by the Ministry of Health, SSK, universities, other state institutions such as the Ministry of Defense, municipalities and private hospitals. Health benefits were tied to membership in one of the three social security institutions and were therefore based on occupational status. Benefits also varied across different social insurance funds (Ağartan, 2012: 60-61). There were significant differences among the three social security institutions in terms of access to healthcare facilities, the quality of services and the benefit packages provided (Ağartan, 2008).

The social security system in Turkey in these years has been correctly characterized as

“corporatist” and “inegalitarian” (Buğra, 2012; Yakut-Çakar, 2007), although the

154 Workers employed by state owned enterprises.

155 The law no. 5434 on the Retirement Chest enacted in 1949 is the legal framework. The ES serves as the pension fund administration for white-collar workers employed by local and the central governments. The pension benefits and healthcare services of the Retirement Chest are financed in part through deductions from the salaries of state employees.

156 The law no. 1479 on Bağ-Kur was enacted in 1971. Law no. 2229 in 1979 allowed for the membership of housewives and others seeking voluntary membership. The Law no. 2926 in 1983 included those working in the agricultural sector.

157 PAYGO involves a transfer from the employed labor force to the retired.

158 The public system was based on the provision of primary care services through state-owned health centers and facilities by physicians that were state employees. The secondary and tertiary care was vertically organized through hospitals and health facilities owned by the Ministry of Health (MoH), the hospitals owned and operated by the SSK, university hospitals and health facilities owned and managed by public institutions and municipalities.

corporatist¹⁵⁹ feature was less apparent in the management of social security institutions. The main corporatist features derived from the fact that claims for benefits and coverage are highly dependent on membership of occupationally defined corporatist groups. As a Bismarckian corporatist¹⁶⁰ regime the aim was to preserve status, based on the normative assumptions of the male breadwinner model and combined with strong familialism (Kılıç, 2009).¹⁶¹ The social security institutions assume that the “father” or “husband” provides coverage to the dependent members of the family.¹⁶²

The inegalitarian character of the social security system reflected in its corporatism and its limited coverage of only those working in the formal sector.¹⁶³ Everything from pension entitlements to healthcare services varied according to occupational groups. Civil servants covered by the ES had generous pensions and quality healthcare services with access to the university hospitals (Sayan, 2006; Aybars and Tsarouhas, 2010: 752; Ağartan, 2012).¹⁶⁴ The workers’ pension benefits under the SSK fluctuated in time while their members and dependents received healthcare services in SSK owned hospitals (Kılıçdaroglu, 1998). The pension benefits for the self-employed including agricultural workers under Bağ-Kur were

159 SSK and Bağ-Kur were designed as autonomous social security institutions where the board of directors was composed of the representatives of union confederations, employer associations, representatives of retirees and professional associations and state representatives appointed by the Ministry of Labor (later in the 1970’s by Ministry of Social Security; and after 1980’s following their merger by the Ministry of Labor and Social Security). The balance in the composition of the Board of Directors between the corporatist actors and state representatives has varied in time but state actors dominated in the post-1980 period. The ES, however, was institutionally under the authority the Ministry of Finance. Despite the autonomous status of SSK and Bağ-Kur, ministries and state agencies set the rules for insurance funds, decided the criteria for entitlement, the premium rates and co-payments. Özbek (2006) emphasizes that this interference into the management of insurance funds dates back to the early formation phase of the SSK in the 1950’s, where the Ministers of Labor commanded certain decisions and interfered into the affairs SSK Directors and Board.

160 Although the term “Bismarckian” is used in different ways by scholars (Bonoli, 1997), it refers to the conservative corporatist regime type described by Esping-Andersen (1990). Palier (2010: 24) characterizes the four main characteristics of Bismarckian tradition of social insurance: “Entitlements are associated with employment status…primarily aimed at insuring salaried workers who paid contributions…; Social benefits are earnings-related…; Financing mechanisms are based principally on social contributions…; Administrative structures are para-public, involving the social partners in the management of the social insurance funds….”

161 Familialism is defined by the extent to which families can be held responsible for their members’ welfare (Esping-Andersen, 1999).

162 Male breadwinner was also reflected in the survivor pension, which favors female over male survivors (Kılıç, 2009). Accordingly, women left without a male breadwinner were protected by the state, until they (re)married.

163 The informal and formal segmentation of the labor market also constitutes an important dimension that demonstrates the inegalitarian structure of the social security system. Aydin, Hisarciklilar and Ilkkaracan (2010:

26) calculate the share of the informal employment in total non-agricultural sectors as 34% in 1988.

164 ES members also could access public hospitals and private healthcare facilities with which the fund had established a contractual agreement.

comparatively less generous, healthcare coverage was fragmented and quality lower (Sayan, 2006). The formal system and social insurance schemes reinforced the inequalities over time among different groups of beneficiaries.

With a Bismarckian regime of this type, Turkey’s non-contributory social assistance mechanisms were limited (Buğra, 2012: 24).¹⁶⁵ Introduced in 1976, a means-tested social assistance program, in the form of a minimum pension targeting the disabled and elderly, was conditional upon the absence of close relatives (Özbek, 2006: 360). The establishment of the Social Solidarity and Assistance Fund (Sosyal Yardimlaşma ve Dayanışmayı Teşvik Fonu, SYDTF) in 1986 provided emergency relief for citizens in severe deprivation and poverty.

Benefits were mostly in-kind, as a last-resort mechanism. The Fund was an umbrella organization for a network of local Social Cooperation and Solidarity Foundations which cooperated closely with the local authorities on the district or provincial level in the provision of social services (Eder, 2010: 174). In addition, informal mechanisms of social protection based on family and kinship relationships were an important pillar of the welfare regime in Turkey.

This overview of the social security system up through the 1980s illustrates the institutional characteristics and provides a description for the subsequent analysis of the reforms. However the above overview informs little about the politics that generated this inegalitarian and corporatist system grounded on the structural economic and societal changes at the time. The analysis of these historical dynamics is key in order to characterize empirically the policy legacies of the social security system. Of course, an exhaustive historical analysis of the Turkish social security system is beyond the scope of this chapter.

The characterization of the policy legacies is based on the findings of the scholarly research already undertaken into the historical development of social policies in Turkey such as Özbek (2008; 2006); Buğra (2008; 2007a; 2006) and Boratav and Özuğurlu (2006).

165 Social assistance and social services were underdeveloped and not institutionalized until the reforms in 2000’s. The policies were strongly means-tested and designed as a last-resort safety net for the poor.

I.a. The historical development of social security in Turkey: From the early Republican period to the 1980’s

The aim in this section is to analyze the genesis and evolution of social policies in various sequences. In what follows, the scope of analysis will concentrate on the overview of institutional and legislative measures in the social security system, analyzing the relation between the state, political elites and corporatist actors while considering the realignments of domestic actor coalitions.

In a first period from 1923 to 1946, and as already sketched in Chapter IV, modernization and economic development were the two main projects of the political cadres who, under the leadership of Mustafa Kemal Ataturk, embarked on the societal project of reforming the ancien régime (Pamuk, 2008; Eralp, 1994). In the early years of the Republic, and despite its étatism, there were few legislative and institutional developments in the realm of social security. The Law no. 151 in 1921 (amended in 1923) established an insurance fund for the mineworkers of the Ereğli region that provided workmen’s compensation, sickness and old-age pension coverage. In 1930, the Military and Civil Retirement Fund (Askeri ve Mülki Tekaüd Kanunu) was established as a fund for military personnel and civil servants (and their widows and orphans) against the risks of old-age, sickness and job accident. This was done by uniting the old Ottoman retirement funds.

In the period 1923 to 1946, state ideology was characterized by a nationalist civic republicanism that framed an organic relationship between state and society and rejected class-based or interest-class-based representation (Baban, 2005: 54). Buğra (2008) and Boratav and Özuğurlu (2006) indicate that the state elite considered child poverty as the main social problem.¹⁶⁶ Thus the Public Health Law (Law no. 1593) introduced in 1930 aimed to tackle major illnesses and emphasized building and growing a healthy nation. It prioritized pro-natalist policies on the grounds that rising birth rates were needed for modern state-building (Ağartan 2008: 139; Özbek, 2006: 90-91).¹⁶⁷ However the development of healthcare services

166 The Red Crescent Society (Kızılay) inherited form the Ottoman Empire and the Society for the Protection of Children, established in 1921 (Himaye-i Etfal Cemiyeti, later Cocuk Esirgeme Kurumu) exemplify the quasi-public charity associations that used limited state funds to address the poverty and health problems of children.

167 The Ministry of Health was established in 1921.

was also shaped by the limited state capacity to finance centralized health services and by shortages of health personnel particularly in rural areas. The Law no. 1593 recognized the need to provide insurance-based health benefits for the working population but never fully implemented this regime. In reflecting the main concerns of this period, this legislation has prioritized the protection of children and women by regulations on the minimum age of employment, working time and health conditions (Özbek, 2006: 132). Another important innovation was the Labor Law no. 3008, targeting workers in manufacturing industry. It regulated working conditions and provided limited protective measures for enterprises with more than ten employees (İŞKUR, 2011a: 6).¹⁶⁸ This period was characterized by social policy initiatives constrained by a scarcity of resources and shaped by the political and economic goals of the Turkish elite before the Second World War.

In a second period from 1946 to 1980 major institutional and policy developments concerning the social security system occurred, as Turkish elites sought to respond to the needs of an industrialized and then import-substitution economy, which was the strategy behind developmentalism in these years. The main institutions were built in a top-down manner by the state. The transition towards multiparty democracy in 1946 and the election of the Democrat Party (DP) under the leadership of Adnan Menderes in 1950 represented new dynamics in the social policy environment in Turkey (Aydın, 2005).

In 1945 the Worker’s Insurance Institution (later the SSK) was established for private-sector employees (more than 10 employees) and blue-collar public-private-sector workers (Özbek, 2006: 162).¹⁶⁹ The fund provided coverage first against the risk of industrial accidents and occupational diseases. Then pensions were added in 1949¹⁷⁰ and health insurance¹⁷¹ in 1950.

With the introduction of the Retirement Chest (ES) in 1949 for civil servants, two of the major institutions of the social security system had been established. Buğra (2007a) indicates that the Turkish context of transition to multi-party democracy in 1945 was conducive towards the

168 Turkey joined the International Labor Organisation (ILO) in 1932, with the result that ILO experts became involved in the preparation of draft legislation (Sur, 2009: 191).

169 Ayse Buğra (2007a) and Adem Y. Elveren (2008) indicate that German experts who escaped from Nazi Germany, such as Ernst H. Hirsch who was the First General Director of the Worker’s Insurance Institution (Özbek, 2006: 170), were instrumental in the establishment of the modern social security institutions.

170 The first legislation set the minimum age for retirement at 60 years old, and required contributions for 25 years (200 working days per year).

171 The Social Insurance Institution added health insurance in 1950 and coverage extended from urban city centers to all regions over ten years.

establishment of the two main pieces of the institutional structure. An important issue that emerged in these years was the problems of the rural areas, in terms of both adequate income and health services. Agricultural price support policies and subsidies were introduced to address the first and primary care was developed at the district level to deal with the second (Ağartan 2008: 150).

After the coup of May 1960, as already noted, the military regime imposed a shift in economic policies towards the protection of the domestic market from international competition and an import-substitution industrialization (ISI) (Aydın, 2005).¹⁷² With the adaptation of a nationalist developmentalist strategy, a series of legal and institutional changes were introduced, oriented towards state-led planning and industrialization including the establishment of the State Planning Organization (Devlet Planlama Teşkilatı, DPT)as already described in Chapter IV (Ünay, 2006: 104). This period brought crucial changes to social security legislation, and as we have already described in Chapter IV, to labor law.

The 1961 Constitution specified the social aspect of the state, institutionalizing the access to education, health and employment as constitutional rights for citizens (Boratav and Özuğurlu, 2006: 174; Buğra, 2007:178). The Constitution also provided a legal framework for industrial relations. In this framework, employees had a right to social security as well as to form trade unions and engage in collective bargaining and strike. Tripartite representation was institutionalized as well (Boratav and Özuğurlu, 2006).¹⁷³

With respect to the social security system, the First Five Year Development Plan (1963-1967) (DTP, 1963: 109) prepared in 1963 indicated the policy direction chosen for this period:

“One of the main issues regarding income inequality involves expanding the coverage of social security. In the next 15 years, the fragmented and limited social security system will be expanded and unified incrementally to provide adequate coverage.”

37 The transition towards import-substitution industrialization (ISI) was influenced by internal and external factors. On the one hand, a coalition of Turkish actors (industrialists, small and medium size business owners, workers and civil servants) supported the idea of national developmentalism with protected markets (Pamuk, 2008: 284; Aydın, 2005: 35). The international institutions such as the World Bank and OECD also supported protectionism as well as the idea of planned development as a way of supporting rapid industrialization and development (Ünay, 2006: 103; Pamuk, 2008: 283).

173 These rights were granted in a top-down manner by the military regime and they were not the result of labor struggle (Boratav and Özuğurlu, 2006). Ünay (2006) argues that the developmentist economic policy necessitated the support of the working classes for planned industrialization and wage arrangements.

One of the main goals expressed in the first Five Year Development Plan (DTP, 1963:

111) was to expand the coverage of health insurance following passage of a Law on the Socialization of Health Services”¹⁷⁴ in 1961 by the National Unity Council after the 1960 coup. It represented major changes in terms of financing and provision of services (Ağartan, 2008).¹⁷⁵

In 1964 the Social Insurance Law (no. 506) unified several different social insurance regimes for workers under a single legislative framework and at the same time adopted the name Social Insurance Institution (SSK) (Özbek, 2006: 245). This law expanded the regime by obliging all employers and workers to pay into social insurance even in companies with less than 10 employees (which had been the previous limit) and coverage was extended to new occupational groups and new retirement ages were set. The institutional capacity of the SSK was also reinforced. The Bağ-Kur,¹⁷⁶ founded in 1971, provided coverage of pensions for the self-employed, and agricultural workers as well as local administrators, allowing participation of these groups in the social security system, even though it was less generous than the pillars for civil servants and industrial workers (Buğra and Keyder, 2006; Sayan, 2006; Aybars and Tsarouhas, 2010).

In 1974, the Ministry of Social Security was established and SSK and Bağ-Kur were put under its jurisdiction, while the ES was kept under the jurisdiction of the Ministry of Finance (Ministry of Labor and Social Security, 2012). With amendments in 1979¹⁷⁷, voluntary participation in Bağ-Kur was opened to all, including housewives. However the Bağ-Kur did not provide healthcare benefits until the mid-1980’s. The retirement age was also adjusted, and the contribution period was reduced to 20 years for women (Özbek, 2006: 295).

In 1974, the Ministry of Social Security was established and SSK and Bağ-Kur were put under its jurisdiction, while the ES was kept under the jurisdiction of the Ministry of Finance (Ministry of Labor and Social Security, 2012). With amendments in 1979¹⁷⁷, voluntary participation in Bağ-Kur was opened to all, including housewives. However the Bağ-Kur did not provide healthcare benefits until the mid-1980’s. The retirement age was also adjusted, and the contribution period was reduced to 20 years for women (Özbek, 2006: 295).