Turkey Health System. Health economics and politics.

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Turkey Health System is presented with various aspects and with last 10 years focus. Transformations, developments and amendments are the main topic. Graphs, data and charts are used to demonstrate the changes.

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  • Turkey area is near to area of Texas and Lousiana (302,000) Area of South Carolina is 1/10 of Turkey area (32,020.20 square miles)
  • GC will transfer to GHI with an income test. Some of members will become participants of GHI and some of them will be transferred to Social Policies Ministry
  • Turkey Health System. Health economics and politics.

    1. 1. TURKEY HEALTH SYSTEM Mustafa Said YILDIZ
    2. 2. Content Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    3. 3. Turkey at a glance Population 2013: 75,627,384 Population Growth Rate: %1,3 Area total: 302,535 sq mi  Density: 239.8/sq mi GDP(PPP) per capita: $15,001 HDI(2013): 0.722 (high) Government: Parliamentary Republic Growth Rate (2010): % 9,5 Inflation Rate: %7,4 Unemployment Rate: (2012) %9,2
    4. 4. Turkey at a glance (from USA) Population Population Growth Rate Area total (sq mi) Density (/sq mile) GDP(PPP) per capita(2011) Growth Rate (2010) Inflation Rate (2011) Unemployment Rate (2012) TURKEY 75,627,384 %1,3 302,535  239.8 $17,110 % 9,5 %7,4 %9,2 USA 313.900.000 %0,7 3,794,101  88.6 $49,922 %2,4 %3,0 %8,1
    5. 5. Population and area(from USA) (302,000 area 75 million Population) Populations Georgia South Carolina North Carolina Virginia Florida Tennessee Mississippi Alabama Kentucky TOTAL 9,919,945 4,723,723 9,752,073 8,185,867 19,317,568 6,456,243 2,984,926 4,822,023 4,380,415 70,542,783 Area Georgia South Carolina North Carolina Virginia Florida Mississippi TOTAL 59,424.77 32,020.20 53,818.51 42,774.20 65,754.59 48,430.19 302,222.46
    6. 6. BMJ, Healthcare in Turkey: from laggard to leader. 12 March 2011, vol. 342.
    7. 7. Life expectancy at birth and years gained since 1960 Not high. But increasing rapidly (especially for 10 years)
    8. 8. Health Status Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    9. 9. Improvement in short period Life expectancy at birth for Turkey was estimated to be 75 years by 2025 in the World Health Organisation report of 1998 (page 221). We have already achieved it: Female 72,4 Male 68,3 (2008) Female 76,8 Male 71,8 (2011) Although Turkey is an middle-upper income country, the life expectancy at birth is above the average of the countries in that group.
    10. 10. Improvement in short period (IMR: from 47 to 9.9 per 1000) INFANT MORTALITY RATE (p1000) 50 45 40 35 30 25 20 15 10 5 0 IMR(p1000) 1998 2003 2008 2009 2010
    11. 11. Ratio of Deliveries made at Hospital (from %73 to %90)
    12. 12. Improvement in short period: MMR: OECD in 25 years Turkey in 9 years Maternal Mortality Rate (per 100.000) of OECD countries (except Turkey) decreased from 60,1 (1960) to 14,5 (1984) in 25 years Maternal Mortality Rate (per 100.000) of Turkey decreased from 61 (2003) to 14,5 (2011) in only 9 years
    13. 13. Health Policy, Economics and Financing Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    14. 14. Health care coverage
    15. 15. Out of pocket health spending is decreasing
    16. 16. Percent of GDP allocated of to health
    17. 17. Total expenditure on health/capita (US$ PPP)
    18. 18. Total expenditure on health (% of) GDP
    19. 19. Annual average growth rate in health expenditure per capita 2000-09
    20. 20. Economic sustainibility Although health expenditure has risen, it has risen no faster than GDP Although there had been a serious increase in health expenditure, an unsustainable situation didn’t emerge because of constant growth in Real GDP Low expenditure on health as a percentage of GDP made increasing health expenses possible.
    21. 21. Turkish economy has been growing steadily for 10 years GDP per Capita - Current Prices (USD)
    22. 22. Turkey was the fastest-growing economy in Europe and one of the fastest-growing economies in the world in 2010 and 2011. Real GDP Growth (%)
    23. 23. Stabilization Coalitions, military cabinets after coups, temporary cabinet and rapid changes in ruler parties (swinging from left to right) were obstacle on stabilization and permanency. All of that changes reflected to health policies. Rulers parties couldn’t have a long term plan. Although the centralized and highly bureaucratic structure of administration, planning and reorganization opportunities could not be used for decades. Strong leadership and stewardship of health ministry enabled a planned and constant improving in health sector in that 10 years.
    24. 24. Terms of cabinets(months, after 1970) 26 cabinets in 30 years, 1 cabinet for 11 years
    25. 25. Terms of Ministers of Health (months, after 1970) 30 ministers in 30 years, 1 minister for 10 years
    26. 26. Health System Transition Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    27. 27. Eight themes of transation Transforming Ministry of Health and restricting its tasks to planning and supervising General Heath Insurance gathering all people under a single umbrella Widespread, easily accessible and friendly health service system (with strengthened primary health care services, effective chain of referral and administratively-financially autonomous health enterprises Knowledge and skills-equipped and highly-motivated health care human resources
    28. 28. Eight themes of transition System-supporting educational and scientific bodies Quality and accreditation for qualified and effective health care services Institutional structuring in rational drug use and material management Access to effective information in decision making: Health Information System
    29. 29. Dispersed and fragmented Social Security System Social Security Association - SSA(1946): operates both as an insurer and a health care provider(through its own hospitals) for its members (Blue-collar workers). Pension Fund for Civil Servants – PCS (1950) The members and their dependents are provided basic health care services at MoH (i.e. public) hospitals.  Social Insurance Agency of Self-employed (SISE) (1971). Purchases health delivery services from SSA. Green-Card (1992) For the needy citizens who has not any other health coverage
    30. 30. Dispersed and fragmented social security and hospital system SISE patient SISE Hospitals SSA patients MoH Hospitals PCS patients University Hospitals Military patients Military Hospitals Limited number of patient Private Hospitals
    31. 31. Unification of dispersed and fragmented social security system All social security institutions Soc. Ins. Agency of Self Employed (SISE), Pension fund of Civil Servants(PCS) and Social Security Institution (SSI) united under SSI(2005), and became infrastructure to Genaral Health Insurance, Green Card as an instrument of Social Policy covered needy and uninsured people from catastrophic health expenditures. (Some of members will be transferred to GHI with an income test)
    32. 32. Unification of Public Hospitals Ownership of all SSA’s hospitals are transferred to the MoH. Hence, with this final step unification process of the reform has been completed. (with law: 5502)
    33. 33. New system in healthcare Civil servants are allowed to benefit from private health institutions. (Protocol signed between MoH and the Ministry of Finance, (April 2003) A protocol signed that enables Members of SISE, PCS and GC to benefit from SSA hospitals, and members of SSA to benefit from MoH (public) hospitals. (July 2003) Currently all patients are covered by SSI(General Health Insurance) and all patients could benefit from either MoH, university or private hospitals, MoH Hospitals University Hospitals General Health Insurance Military Hospitals with c o-p aym ent Private Hospitals
    34. 34. With first step of transition;  Coordination, planning and organization of health services became more convenient. Ministry could implement standards and improved quality simultaneously in all facilities.  With easier allocation of resources to more uniform health care delivery system efficiency of hospitals increased,  Relatively smaller private and university hospitals adjusted their scales significantly as they have started to serve members of SSA and benefited from economy of scale.  Citizens reached to better insurance coverage and right to choose health facility,  General Health Insurance could assure financing the provision of a high quality health service for all population; fair, equal, protective and curative. People who are not included by insurance covered by “Green Card”.  Social benefits and services that were being carried out in a scattered manner is gathered and a system based on objective benefit criteria is established. That helped a under control, auditable and sustainable insurance system.  Administrative cost of insurance decreased by unification of insurance bodies,
    35. 35. Performance Based Payment System to Doctors High motivation of personnel Increased easiness to healthcare service and increase in healthcare service use Major decrease in dual practice in public and private sector and increase in full time service Opportunity to add quality measures to system (only for Lab services yet)
    36. 36. Doctor visit per capita
    37. 37. Decentralization new MoH structure  MoH hospitals became united under one union and Public Hospitals Union had mission of planning, budgeting, and implementation activities. In this way, the function of organization and coordination of hospital services was collected under union degree with enhanced financial and managerial autonomy. Higher service quality, effectiveness and lower administrative costs was targeted. Performance of hospitals and hospital unions was said to be assessed and monitored by Institution yearly for their effectiveness, quality, success in resource allocation and some other aspects.  MoH had a new organisational structure with stewardship, regulation and supervision tasks. Independent specialized agencies (Public Hospital Institution, Public Health Institution and Medicine and Drug and Medical Device Institution) are constructud.
    38. 38. Information Technologies  Hospital IT systems for medical records of the medical process  IT system between pharmacies, medical wholesalers and hospitals  IT System for hospital medicine stocks (that enables barter of medicines between hospitals and central controlling)  Central accounting IT system (to monitor hospital balances and financial reports)  IT system for medical records of Family Doctors.  IT system to assure communication between hospital emergency rooms and ambulances …
    39. 39. Health Prevention and Promotion Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    40. 40. Vaccination Vaccination Rate (%) Number of routine antigens implementing in Childhood 2002 78 2011 97 7 12
    41. 41. Home care 156.000 patient receives home care service currently -Service is given by public hospitals -Public funded
    42. 42. Monitoring and prevention Cancer monitoring centers(KETEM) are constructed in all of the provinces Breast cancer monitoring (Targeted population’s %29) Newborn monitor programs (Fenilketonüri, hipotiroidi, biyotinidaz…) Payless element and vitamin support to babies and mothers (%96 of population)
    43. 43. Increase in number and diversity of ambulances
    44. 44. Family Doctors  20.506 Family doctor is on duty  Geographic designation (per capita)  Publicly paid doctors (for visits and preventive med)
    45. 45. Health Promotion programs  Tobacco According to the WHO Report on the Global Tobacco Epidemic 2011, Turkey qualifies for the highest achieving category for the MPOWER tobacco control measurable indicators. There are only 4 countries (Turkey, England, Ireland and Iran) in the world that have reached this highest achievement in the Obesity Diabet Cardiovascular Mental Health
    46. 46. Health Human Resources Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    47. 47. The number of physicians per capita and change since 2000 Low. But increasing rapidly.
    48. 48. The number of medical specialists and general practitioners
    49. 49. Policies for scarce health capacity Obligatory service implementation to doctors after graduation Contracted doctor recruitment to areas that needs additional health services Central human resources planning for public and private hospitals Full time work for hospitals (doctors had to choose: to work for hospital or working independently) Increased admission to Medical schools
    50. 50. Full time work for hospitals Voluntary with Pay for Performance then Obligatory with regulation
    51. 51. Number of students admitted to Medical Schools (doctor nominees)
    52. 52. Physical Conditions Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    53. 53. MRI and CT exams per 1000 population
    54. 54. Number of Devices 1990 2000 2003 CT 82 121 375 MR 4 18 234 295 1320 Ultrasound 266
    55. 55. Better physical conditions From ward type patient rooms to patient rooms with 1 or 2 beds Room for all of policlinic doctors in public hospitals. Policlinic rooms increased from 6.643 in 2002 to 23.749 in 2012
    56. 56. Dental healthcare services Dentist Teeth repaired Number of dentures (thousand) 1994 2.636 209 2002 3.211 371 2011 7.225 8.334 97 349 5.576 Target received: at least one Public Dental Care Hospital for all of the provinces.
    57. 57. Turkey Private Hospitals  Turkey has the highest number of JCI accredited hospitals in the world. (28 hospitals, 3 Genetics Diagnostic Centers, independent laboratories, over 4.000 inpatient beds and 957 ICU beds, 179 operating theaters and 2.000 physicians employed)  Affiliations and collaborations with prestigious medical centers like; Harvard Medical International, Johns Hopkins Medicine International, Mayo Clinic, Houston Memorial, Sloan-Kettering Cancer Centre…  Turkey has capabilities & Expertise in high level medicine including Liver, Kidney and Pancreas Transplantations, Robotic Surgery, Bone Marrow Transplantations, Cardiology and Cardiovascular Surgery…
    58. 58. New policies, new horizon Turkey at a glance from USA Health Status Health Policy, Economics and Financing Health System Transition Health Prevention and Promotion Health Human Resources Physical Conditions New policies, new horizon Patient Satisfaction
    59. 59. Central Appointment System Patients can have a doctor appointment from Hospitals and Family Doctors from telephone or web site. http://hastanerandevu.gov.tr/Vatandas/
    60. 60. Improvement of infrastructure; Building Health Campuses with PPP model  Public private partnership(PPP) model is being utilized to have healthcare services with  much higher quality and much more modern conditions. With that way, resources and experiences of private sector can be used for reconstruction.  There is 3 hospital campus project on construction phase (Ankara Bilkent and Etlik, Kayseri) 9 on contract phase, 8 in bid and qualification phase  Research Centers, Congress Centers, Patient Hotels will accompany hospitals
    61. 61. One of Health Campuses: Bilkent  Work is in progress at the Bilkent Integrated Health Campus in Turkey, poised to be Europe’s largest medical campus upon completion. The project is a public-private partnership that is part of a larger healthcare program within Turkey.  When completed, the 3,662-bed health campus located 4.35 miles south of Ankara, will be the largest in the world and will occupy a plot of more than 1 square kilometer (247 acres).  The integrated medical campus will provide access to a full range of specialist facilities, including a 562-bed general hospital, a women’s hospital (574 beds), a children’s hospital (514 beds), a cardiovascular surgery hospital (425 beds), an oncology hospital (557 beds), a neurological science and orthopedics hospital (412 beds), a physical therapy and rehabilitation hospital (300 beds), a psychiatric hospital (198 beds), a high-security forensic psychiatric hospital (100 beds), a burn unit (20 beds), and a diagnosis and treatment center.
    62. 62. Health Free Zones for Medical Tourism and Medical Device Industry To accelerate the entrance of foreign capital and high medical technology To make the country an attractive center in the region, With that policy, direct investment of international hospital chains and international medical device or research companies will be encouraged by tax incentives. Turkey will be more competitive in medical tourism and health technology.  Non-Turkish foreign health personnel could be assigned to foreign patients at private hospitals that are to be established in the zones.  It is estimated that 85 percent of the zones’ patients will be foreigners.
    63. 63. Drug regulations Referenced Price system: Determining the drug prices based on an average of some other country prices (decrease in prices) Information technologies that connects pharmacist, hospital and social security agency Square code system for drug counterfeiting and fraud (that makes enable to trace drugs in process (from wholesaler to pharmacist and patient
    64. 64. Satisfaction of people from healthcare services
    65. 65. Conclusion with quotes “good practice” in the development and implementation of major health system reforms and preliminary indications are that it has been successful. (OECD report, 2010)  Health Transformation Program seems to represent  “Based on the overall information available from the latest national health , it appears that the Turkish health system performs quite well in terms of equity and financial protection, both in absolute terms and relative to other countries.” accounts and Household Budget Surveys (OECD Review of Health Systems Report)
    66. 66. Conclusion with quotes The lessons from Turkey are that with political commitment and a flexible, results oriented approach, Health Systems Strengthening interventions can be successfully implemented to have an important impact on the performance of the health sector. (World Bank Report, Sarbani Chakraborty Lessons from the Turkish Experience, Dec 2009, Volum 12)
    67. 67. Thanks…

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