The health field is characterised by high uncertainties which can lead to large expenditures. One way to manage these uncertainties is to develop collectively-financed health care systems. Some countries create this collective financing through general taxes, whereas others rely on premiums set up through compulsory social health insurance. Turkey, a middle-income country, has historically used several mechanisms to extend health care to its population. However, inadequate financing and poor service quality have plagued this health care system. Recently, a transition from a system of multiple insurance schemes that cover only about two-thirds of the population to a single-payer system aiming to achieve universal coverage has been under way to overcome problems in the fragmented health financing system and ensure universal coverage. With the enactment of the General Health Insurance Scheme Law in 2006, the Turkish health care system has embarked on one of its most radical and far-reaching reforms since the socialization attempt of the 1960s. This paper focuses on the health care financing reform in Turkey, concentrating on its salient features in terms of financing functions and policies and explores the main differences between the old and new systems. The care and coverage aspects are also dealt with. Our results suggest that if well implemented, the GHIS reform can be a powerful engine for achieving universal coverage and enhancing equity and solidarity in the Turkish health care system. However, to reach this end, a transition process is required, as the success of the GHIS will depend on its ability to manage challenges during the implementation process.
Dış kaynak kullanımı devlet hastanelerinde temel bir strateji haline gelmekte ve son zamanlarda tanınırlığı artmaktadır. Türkiye'de bu trendi oluşturan itici güç, özel sektördeki baskıların ve rekabetin kamu sektörünü daha verimli kılacağı gerçeğine dayanarak Sağlık Bakanlığı tarafından başlatılmıştır. Bu çalışmanın amacı, sistematik analiz yoluyla Türkiye'deki hastanelerde dış kaynak kullanımı konusunda elde edilen farklı araştırma bulgularını karşılaştırmak, bütünleştirmek ve gelecekteki araştırmalara yönelik öneride bulunmaktır. Analizde 2005 ve 2011 yılları arasında yayınlanmış toplam 15 çalışma (8 tez, 7 makale) kapsama alınmıştır. Bu çalışmaların sonuçlarına göre, dış kaynak kullanımının maliyetleri azalttığı, verimliliği ve hizmetlerin kalitesini artırdığı bulunmuştur. Sadece bir çalışmada dış kaynak kullanımının hastane maliyetlerine etkisi hastane kayıtlarına dayalı olarak incelenmiştir. Başka bir çalışmada ise hastane çalışanlarının memnuniyet düzeyi düşük bulunmuştur. Sonuç olarak, Türkiye'deki kamu ve özel hastanelerde dış kaynaklardan yararlanılarak verilen hizmetlerin etkilerini belirleyen objektif kalite, verimlilik ve maliyet indikatörlerine dayalı ampirik araştırmalara gereksinim duyulduğu söylenebilir.
In recent years, many healthcare organisations in the world have been changing in the direction of a professional management leaving behind a model of physician dominance. As one of the most essential functions in hospitals, professional management is vital in order to achieve performance effi ciently. The main point which must not be ignored is that the education, the knowledge and the skills are key elements for professional management in the healthcare sector. This issue is also currently one of the major topical issues in the Turkish healthcare system to overcome existing management problems. The study assesses the roles of physicians for the future environment by analysing the management roles of Turkish physicians based on available data.
This article discusses three faces of patient choice policy in a developing country, Turkey. As part of its wider health transformation programme (HTP), Turkey has created a purchaser/provider system in which a single public purchaser channels funding to a range of public and private hospitals, and patients--in theory at least--are given significant freedoms to choose their hospital and physician. At the same time, marketisation has been softened by an emphasis on the creation of 'human-centred' services, resulting in a variety of initiatives to enhance patient rights and using a similar rhetoric to that employed in modernising 'third-way' reforms in countries such as the United Kingdom. We argue that neither markets nor modernisation fully explain the specifics of Turkish choice policy, which is also driven by the strong political imperative arising from Turkey's proximity to the European Union and its accession ambitions. Europeanisation represents an approach to markets softened by social solidarity, and gives the Turkish reforms a very different profile from neo-liberal reforms implemented in other middle income countries. However, in practice, medical workforce shortages, the uneven distribution of resources across the nation, and the lack of systematic information on provider outcomes limit the scope of choice for much of the population. In this situation, a planned allocation of resources to support equity of provision has advantages over a system where resource flows to providers are determined by individual patient choices.
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