The influence of a market-oriented primary care reform on family physicians’ working conditions: A qualitative study in Turkey

Abstract

Background: Turkey has undergone a 'Health transformation programme' putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system. Objectives: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions. Methods: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews. Results: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician-patient relationship in PC (into a provider-customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion. Conclusion:By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Change from health center to family physician period in the Turkish health system: A qualitative study

“…The patients are therefore contacted by phone or when they present to the health care facility. According to participants, there were no differences between FP and HC periods in preventive and therapeutic health care services and follow‐ups, while services not included in the performance analysis were lower in FP period in the studies . The services in the HC period were mostly based on individual efforts.…”

“…Lack of regional planning and workload are basic factors for the provision of heath care services only to those presenting to the facility. In the study by Baysal and Nur in the study by Ciceklioglu and Aktan, regional planning was more beneficial in the HC period . In the study by Ocek and Freeman, registered patient lists did not work properly in places with migratory movements in and out of the region in FP period, during which regional planning was superior .…”

“…The administrators and service users showed willingness to use a referral chain, while physicians and nurses rejected the use of a referral chain because of concerns about increasing work load. Similarly, in the study by Ocek et al, Ciceklioglu et al, and Aktan et al, all participants agreed that the system would collapse if a referral chain came into effect, and a referral chain was not implemented in the study by Ocek et al The studies by Nur et al, Baysal et al, Nesanir et al, Eskiocak et al, and Ocek et al indicated excessive population and work load . In the FP period, the Family Physician's Information System and computer facilities provide convenience in rendering these services.…”

“…In the studies conducted by Tanır in Adana, Aycan et al in Ankara, and Ocek et al in İzmir, Yama, and Gunes, in cities in Turkey, family physicians were mostly preferred because of preventive health care services and represcription of regular drugs . According to participants, HC were mostly preferred for preventive health care services, represcription of regular drugs, examination, and moderate health problems; in the study by Ciceklioglu and Aktan et al, community clinics are mostly preferred for preventive health care services . The waiting times were longer in the HC period because of lower number of outpatient clinics compared to FP period.…”

China’s National Health Guiding Principles: a perspective worthy of healthcare reform

“…Nonspecific immunity is essential for human immunology, and similarly, nonspecific social approaches may also be essential for healthcare. Existing studies about healthcare reform always emphasize the power of the government and markets (Bamford and Porter-O'Grady, 2000;Schlesinger, 2002;Burström, 2009;Tang, 2013;Çiçeklioğlu et al, 2015;Maarse et al, 2015). However, given the social determinants of health, the power of nonspecific social approaches, such as community involvement, as well as science and education have perhaps not been sufficiently emphasized.…”