Turkey reforms and hospital sector

Turkey has a constantly improving trend in many indicators like life expectancy, infant mortality and density of physicians and nurses in last decade, although it still ranks last or among the worst compared with other OECD countries.[1] Reforms within the context of the Health Transformation Program that is implemented after 2003 like integration of security schemes under the Social Security Institution(SSK), transfer of  SSK health facilities to the MoH, performance-based supplementary payment system (P4P), implementation of family medicine are being counted effective on that trend.[2]

Health Transformation Program that is implemented after 2003 aimed to increase access to healthcare services and to improve efficiency of providers.

Program aimed to achieve a transformation in the framework of eight themes:

(1) Transforming Ministry of Health and restricting its tasks to planning and supervising

(2) General Heath Insurance gathering all people under a single umbrella

(3) Widespread, easily accessible and friendly health service system (with strengthened primary health care services, effective chain of referral and administratively-financially autonomous health enterprises

(4) Knowledge and skills-equipped and highly-motivated health care human resources

(5) System-supporting educational and scientific bodies

(6) Quality and accreditation for qualified and effective health care services

(7) Institutional structuring in rational drug use and material management

 (8) Access to effective information in decision making: Health Information System[3]

(MoH, 2007).

After integration of security schemes under the Social Security Institution (SSI) and the implementation of Universal Health Insurance, Health Transformation Program focused transforming Ministry of Health and restricting its tasks to planning and supervising. For this purpose on 02.11.2011, Decree in Force on Law no. 663 on the Organization and Duties of the MoH and its Affiliates came into force.[4] 

Proper to this Decree on Law, Public Hospitals Institution(PHI) that is related to MoH and 87 Public Hospital Unions (PHU) was generated until the end of 2012. With this new organisation , 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.[5] 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.[6] 

The hospital sector in Turkey can be broadly classified publicly owned hospitals(843 of whom owned by Ministry of Health, 62 by universities) and 489 privately owned hospitals by private. The public sector inpatient and outpatient health care delivery in Turkey is provided mainly through the MoH, university, and the MoD military health facilities. So, 77 percent of hospital beds were administrated publicly  Therefore, the public sector accounted for approximately 77% of total bed capacity and the hospital care is predominantly provided by publicly funded MoH hospitals. (119.891 of MoH, 35.000 of universities, of 199.950 hospitals)

Bed Occupancy Ratio that differentiates by sectors and regions gives us the clue of inefficiency…? (an article says similar)

Turkey Hospitals can be grouped into various categories; general hospitals (integrated and secondary) hospitals, tertiary hospitals (public training and research hospitals, public university hospitals, foundation university hospitals and public-university affiliated hospitals) and specialty hospitals, each with different service functions. Speciality hospitals has different focus areas either public or private like emergency and traumatology, physical treatment and rehabilitation, chest and cardiovascular diseases, ophthalmology, obstetric and child, cardiology, bone diseases, lepra, oncology, psychiatry, and veneral diseases.

Health resources is not distributed in equity to geography and population. When number of hospital beds, doctors, surgical operations, surgical operation groups and hospital visits per 10.000 population, number of surgical operations per 1.000 population by NUTS-1 (Nomenclature of Territorial Units for Statistics) is observed that can be seen clearly.[7]

Public Hospitals Institution(PHI) makes financial and administrative regulations for public hospitals and carries out monitoring and assessment of public hospital and public unions. Ministry of Health is responsible for preparing and implementing standards to hospital healthcare services (public hospitals, university hospitals and private hospitals). Private hospitals comes into business after MoH permission and approval. MoH plans and determines number of doctors and their branches that will work in private hospitals.[8] So it can be said that, Ministry of Health and Public Hospitals Institution (which is related to MoH) is a powerful central authority, with responsibility of determining the principles and goals for health policies about hospitals, planning health resources for public and private hospitals and determination and implementation of healthcare service standarts.  

Share of Public and Private Health Expenditure in GDP increased from 4,76% (by 1999; 2,91% of public) to 6,08% (by 2008; 4,44 public).[9] Per Capita Health Expenditure by Years, PPP, in US $ from 395(1999) to 846(2008)Although figures for distribution of health expenditure more recent years are not available[10] when we look to the components of health expenditure we can say that hospitals remains utilizing biggest part of total health expenditures like other countries[11] In that period, new infrastructure investments for providing better health services(like new hospital campuses), and serious improvement in medical technologies (number of computerized tomography and magnetic resonance devices of MoH 139 in 2002 to 609 in 2009), number of  beds and intensive care unit beds, (total number of intensive care unit beds in MoH hospitals 869 in 2002 to 7351 in 2009)[12] doctors (Total number of Specialist Physicians 52.868 in 2006 63.563 in 2010) and medical staff (82.626 in 2006 and 114.772 in 2010) can be monitored.[13]

 [1] Tatar M, Mollahaliloglu S, Sahin B, Aydin S, Maresso A, Quevedo C, Turkey Health System Review, European Observatory on Health System and Policies, Vol 13 No:6 2011

[3] The MoH of Turkey. 2007. Health at a Glance in Turkey. Refik Saydam Hygiene Center, School of Public Health: Ankara.

[4] Decree Law No. 663 On Structure and Duties of The Ministry of Health and Affiliated Institutions Official Gazette No. 28103 dated 02.11.2011

[5] Regulatory Statute about Turkey Public Hospital Institution Provincial Organisation Operation Procedure (http://www.tkhk.gov.tr/TR,964/turkiye-kamu-hastaneleri-kurumu-tasra-teskilati-calisma-.html)

[6] Regulatory Statute about Public Hospital Unions Assessment Procedure (http://www.tkhk.gov.tr/Eklenti/310,kamu-hastane-birlikleri-verimlilik-degerlendirmesi-hakk-.pdf?0)

[7] The Ministry of  Health of  Turkey Health Statistics Yearbook 2010, Refik Saydam Hygiene Center Presidency School Of Public Health, 2011

[8] Decree Law No. 663 On Structure and Duties of The Ministry of Health and Affiliated Institutions Official Gazette No. 28103 dated 02.11.2011

[9] The Ministry of  Health of  Turkey Health Statistics Yearbook 2010, Refik Saydam Hygiene Center Presidency School Of Public Health, 2011

[10] Tatar M, Mollahaliloglu S, Sahin B, Aydin S, Maresso A, Quevedo C, Turkey Health System Review, European Observatory on Health System and Policies, Vol 13 No:6 2011

[11] Sahin I, Ozcan Y, Ozgen H, Assessment of hospital efficiency under health transformation program in Turkey, CEJOR (2011) 19:19–37

[12] Health Transformation Program In Turkey, Progress Report, Akdag,R, September 2010,

[13] The Ministry of  Health of  Turkey Health Statistics Yearbook 2010, Refik Saydam Hygiene Center Presidency School Of Public Health, 2011

 

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