The aim of this study is to assess the 'Health Transformation Programme' (HTP) in Turkey announced in 2003. This assessment has been made according to the ultimate performance goals of a health care system, such as improvement in health status, financial risk protection and satisfaction with health care. This study provides a brief history of health policy since 1980, when the Turkish health care system began to transform with the introduction of both structural adjustment and market-oriented reform policy. The main aim of these reforms was increasing efficiency. Reform proposals of the 1990s focused on the introduction of a general health insurance (GHI) system, decentralization, introduction of a family medicine scheme, purchaser-provider split, contracting-out, quasi-markets and improvement of management information systems. Like the reform proposals of the 1990s, HTP has eight components, the major ones being a new role for the Ministry of Health (MoH), introduction of a GHI system, reorganization of health service delivery and human resources development. No component of HTP has yet been sufficiently realized. Therefore, despite some improvements, Turkish people continue to face low health status and a low level of financial risk protection. More research needs to be done for the determination of satisfaction with health services.
SUMMARYThis study aims to evaluate the General Health Insurance System (GHIS) in Turkey implemented since 1 October 2008, in order to assess whether the GHIS will be able to achieve its objective of universal coverage. Both the breadth and depth of coverage will be taken into account.The study notes out that some socio-economic problems, such as a significant informal economy, high unemployment rate, inefficiency in the creation of adequate employment opportunities, inequitable income distribution, and widespread poverty, are the main problems preventing the GHIS from reaching breadth of coverage in Turkey. Contribution conditions for entitlement to health services prevent the GHIS from providing breadth of coverage too. Outof-pocket payments, which are higher than in European and OECD countries, narrow the depth of coverage, but the GHIS brings additional user fees.Statistics show that despite its objective, the GHIS struggles to provide universal coverage. It seems the GHIS will not be able to provide universal coverage in the near future because of the socio-economic conditions and conditions for entitlement to health services.In this case the government will either introduce radical arrangements to cope with the socio-economic problems and issues with the funding system or should consider switching from an insurance-based system towards a tax-based system.
The Turkish Health Transformation Program, initiated in 2003, has identified achieving universal access to health care as 1 of its main tenets. To date, substantial progress has been made toward universal health coverage. Service utilization statistics display an upward trend. In this study, we use official and nationally representative microdata collected by the Turkish Health Research Surveys to examine young children's (ages 0-5) utilization of health services. Children in this age group deserve special attention because adverse health conditions in early childhood are known to have long-time consequences. Policy makers regularly monitor statistics such as infant mortality rate and under-5 mortality rate. We conduct logistic regression analyses to explain the probabilities of being taken to a health institution, to a dentist, and being included in the newborn screening program. We use a rich set of explanatory variables that represent the socioeconomic status (SES) of the child's household. Contrary to our expectations and to the goals of universal health coverage is SES indicators such as the insurance ownership of the parent matter for utilization. Decomposition analyses confirm these findings and reveal that the increase in utilization should have been higher than observed. Children from low SES households should be given special attention and that research efforts should focus on identifying the barriers that still hinder children's utilization of health-care services.
ÖZETSağlık kurumlarında hasta ve çalışan güvenliği, birçok faktörden etkilenmektedir. Bu faktörlerin en önemlilerinden biri çoğu zaman göz ardı edilen ergonomidir. Sistem, donanım, çevre, araç-gereçlerin insana uygun tasarlanması olarak tanımlanabilen ergonomi insan davranışları, sistem tasarımı ve güvenlik arasındaki etkileşimi anlamamızı sağlayan bir disiplin olarak ifade edilebilmektedir. Buradan hareketle çalışmanın amacı, ergonomik tasarımların hastane ortamında hasta ve çalışan güvenliğine olan olası etkilerini literatür ışığında incelemektir. Söz konusu incelemede önce ergonominin tarihsel ve kavramsal gelişimi ele alınarak ergonomik ilkelerin önemi üzerinde ayrıntılı durulmuştur. Daha sonra hastane ortamında ergonomik tasarımın ve kullanılan araç-gereçlerin hasta ve çalışan güvenliğine olan etkilerine değinilmiştir. Çalışmanın sonunda hastanelerde ergonomik müdahaleler ışığında yapılmış ulusal ve uluslararası çalışmalara yer verilerek araştırma amacının anlaşılması pekiştirilmiştir. ABSTRACTIn health organizations, safety of patients and employees are influenced by many factors. One of the most important of these factors is frequently ignored ergonomics. Ergonomics which can be defined as designing of system, hardware, environment, tools and equipment in accordance with human beings, Ergonomics, can be expressed as a discipline that allows us to understand the interaction between human behavior, system design and safety. Starting from this concept, the aim of the study is to examine the potential impact of the ergonomic design on healthcare professionals and patient safety in hospital setting in the light of the literature. Before examination, the historical and conceptual development of ergonomics has been dealt with, and then, the importance of ergonomic principles were emphasized in detail. Afterwards, the impact of ergonomic design in hospital environment and the tools used on the health professionals and patient safety was addressed. At the end of the study, national and international studies related to ergonomic interventions in hospitals were cites so as to consolidate the understanding of the research objectives.
Konsültasyon sürecinin etkin yönetimi acil serviste hekimi bekleyen bir hastanın gelecekteki yaşantısının sağlıklı bir şekilde devam etmesi açısından oldukça önemlidir. Bu çalışma, Ankara ilinde hizmet sunan 36 hastanenin acil servis hizmetlerinde gerçekleştirilen konsültasyon hizmetlerini, konsültan hekimlerin acil servise ortalama ulaşma süreleri ve bu süreyi etkileyen faktörler kapsamında incelemeyi amaçlamıştır. Araştırmanın evrenini, 2018 yılında Ankara ilinde hizmet sunan ve Türkiye Sağlıkta Kalite Göstergeleri Sistemi’ne veri girişi yapan 36 hastane (kamu, özel ve üniversite) oluşturmaktadır. Çalışma tanımlayıcı ve geriye dönük (retrospektif) bir araştırmadır. Çalışmada, kurum türü, yatak sayısı, yatan hasta sayısı, acil servis muayene sayısı, acil serviste gerçekleşen ölüm sayısı, acil serviste ortalama müşahede süresi, acil servis hasta memnuniyeti oranı, konsültan hekim istem sayısı değerlendirilmiş ve bu değişkenlerin konsültan hekimin acil servise ulaşma süreleri üzerindeki etkisi incelenmiştir. Değişkenlere yönelik tanımlayıcı bulgular raporlanmış, veriler üzerinde korelasyon analizi ve aşamalı (stepwise) regresyon analizi yapılmıştır. Analiz sonucunda konsültan hekimin acil servise ortalama ulaşma süresini etkileyen faktörlerin sırası ile acil servis muayene sayısı, kurum türü, konsültan hekim istem sayısı ve hastanenin yatak sayısı olduğu belirlenmiştir. Bu değişkenlerin konsültan hekimin acil servise ortalama ulaşma süresini etkileyen faktörlerin %77’sini açıkladığı tespit edilmiştir. Çalışmadan elde edilen sonuçlar doğrultusunda, acil servis hasta yoğunluğunun azaltılması, bunu gerçekleştirebilmek için ise birinci basamak sağlık hizmetlerinin güçlendirilmesi ile sağlık hizmetlerine erişimin önündeki arz ve talep yönlü engellerin kaldırılması yönünde politika değişiklikleri önerilmiştir. Ayrıca sağlıkta kalite değerlendirmelerinin etkin bir biçimde yürütülmesinin sürecin iyileştirilmesine katkı sağlayacağı da değerlendirilmiştir.
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