Equitable Access to Health (T urkey Experience) Snapshots from - - PowerPoint PPT Presentation

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Equitable Access to Health (T urkey Experience) Snapshots from - - PowerPoint PPT Presentation

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Equitable Access to Health (T urkey Experience) Snapshots from the Health Reform in T urkey Dr. Ali IRAVUL Dr. Ayhan ZZETNOLU Reasons that Render the Health Transformation Program Essential Cost st Increase ses s in the Delivery

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Equitable Access to Health (T urkey Experience)

Snapshots from the Health Reform in T urkey

  • Dr. Ali IRAVUL
  • Dr. Ayhan İZZETİNOĞLU
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Reasons that Render the Health Transformation Program Essential

Cost st Increase ses s in the Delivery y of Health th Care Services Inc ncreased ed Demand nds of the he Citizen ens Limited Payment t Capaci city ty of the Public Citi tize zens s Have Started to Questi stion the Underst standing of Management t in the Public c Secto tor

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Components of the Health Reform Program

  • Buildin a planner and supervisor Ministry of Health
  • for better health insurance, everyone should be under
  • ne roof, the roof of universal health insurance
  • For easily accessible, Widespreadand genial health

care system

  • Highly-motivated health worker’s, armed with

knowledge and skills.

  • High Quality and effective health care services

(certificate of quality and accreditation)

  • Management of Rational drug and medical material

use

  • Health İnformation System

Additional Topics (2007):

  • For a better future, healthy life and health

promotion programs

  • To bestir stakeholders for intersectoral

collaboration for versatile health responsibility

  • To increase the power of the country to cross-

border for international health services

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OLD

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NEW

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From rhetoric to reality…

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Turkey

Life expectancy for 2025: 75 years (WHO Estimation, 1998) Life expectancy for 2009: 75 years (World Health Statistics, 2011)

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Equitable Access in Turkey Health Transformation Program

I- Ethics and Politics II- Barriers to Access - Interventions for Improvement III- Key Success Factors IV- Lessons Learned V- Challenges VI- Fiscal Sustainability VII- Why Equitable Access to Health

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I- Ethics and Politics

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I- Ethics and Politics

Health Policy Cycle

Getting Health Reform Right, M. Robert et al, 2004

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I- Ethics and Politics

Health for all Human-centered

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II- Barriers to Access Interventions for Improvement

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II- Barriers - Interventions Physical Access Financial Access Quality Access

EQUITY

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II- Barriers – Interventions Physical Access

  • Insufficient workforce

and vehicles for emergency services

618 2.766 2002 2012

Number of Ambulances

Interventions Barriers

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II- Barriers – Interventions Physical Access

  • Insufficient workforce and

vehicles for emergency services

350.000 2.700.000

2002 2012

  • No. of Transferred Emergency Caces

Barriers Interventions

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II- Barriers – Interventions Physical Access

Barriers

  • Insufficient

workforce and vehicles for emergency services

Interventions

Rural is not “underserved” anymore

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Insufficient

workforce and vehicles for emergency services

  • Free service for all emergency cases
  • Percentace of attending emergency

call:

– In urban – In rural 0-10 min.: 94% 0-30 min.: 96%

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II- Barriers – Interventions Physical Access

Interventions

National Medical Rescue T eams

Barriers

  • Lack of

disaster preparedness

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II- Barriers – Interventions Physical Access

Barriers

  • Lack of

disaster preparedness

Interventions

Specially trained 4.909 health personnel

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II- Barriers – Interventions Physical Access

Barriers

  • Inadequate

preventive health services

Interventions

  • Comprehensive and widespread

immunization program

2002 2002 20 2011 Immunization Rate for Turkey (%) 78 97 Routine Vaccines of Childhood (7 antigens) (12 antigens)

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Inadequate

preventive health services

  • Improved mobile health services and

mobile pharmacy in rural areas

  • 20.000/day citizens receive their

medicines from mobile pharmacies

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Inadequate preventive

health services

  • “Guest mother”

project for pregnant women

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II- Barriers – Interventions Physical Access

  • Inadequate

preventive health services

Interventions Barriers

  • Home care services

“you are not alone at home…”

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II- Barriers – Interventions Physical Access

  • Inadequate

preventive health services

  • Cancer screening centers (KETEM)

Interventions Barriers

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Inadequate preventive

health services

  • Neonatal screenings

Phenylketonuria, Hypothyroidism, Biotinidase, Hearing

  • Free micronutrients support

– Fe, Vit-D (for 1.3 million children/year)

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II- Barriers – Interventions Physical Access

Interventions

  • Family medicine

established in 2005 as pilot project and fully implemented in 2010

Barriers

  • Inadequate

preventive health services

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II- Barriers – Interventions Physical Access

Interventions

  • Health promotion

– tobacco

  • the fourth of the 31 countries

in “Europe 2010 T

  • bacco

Control Grading” Barriers

  • Inadequate health

promotion

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II- Barriers – Interventions Physical Access

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Inefficient

hospital services

  • All public hospitals managed by MoH

with increased autonomy of hospitals

  • Separate consultation room for each

physician

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Inefficient

hospital services

  • Oro-Dental Health Centers
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II- Barriers – Interventions Physical Access

  • Inefficient

hospital services

  • Common Hospital Appointment System

Interventions Barriers

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Uneven

distribution of health workforce

  • Obligatory service
  • Contract-based recruitment for

underserved regions

  • Central human resources planning both

for public and private sector

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II- Barriers – Interventions Physical Access

  • Insufficient numbers of

health workforce

Interventions

  • More seats in medical and

nursing schools

Barriers

2002 2011

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II- Barriers – Interventions Physical Access

Barriers

  • Low productivity of

health workforce

Number of visits to physician / person / year

Interventions

  • Increased

productivity by Performance Based Payment System

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II- Barriers – Interventions Physical Access

Interventions Barriers

  • Less

consultation time for patients

  • Increased

consultation time with the patients (from 4,5

  • min. to 9,5 min).
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II- Barriers - Interventions Financial Access

Interventions Barriers

  • Fragmented social

security schemes with different benefits and low coverage

  • Social security schemes integrated

under Social Security Institution (SSI)

  • Universal Health Insurance (UHI)

introduced (98% coverage)

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II- Barriers - Interventions Financial Access

Interventions Barriers

  • Inadequate

health benefits for poor people

  • Poor people covered under UHI

with same benefits

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II- Barriers - Interventions Financial Access

Interventions Barriers

  • High

catastrophic health expenditures

  • Free emergency and intensive care in all

hospitals including private

  • Care for burn injuries, congenital anomalies,

newborn care, cancer care, organ transplantations, dialyses and CVS procedures in private hospitals are fully covered by Social Security Insurance

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II- Barriers - Interventions Financial Access

  • High catastrophic health

expenditures

Interventions Barriers

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II- Barriers - Interventions Financial Access

  • High

catastrophic health expenditures

Interventions

  • Full-time employment of physicians

Barriers

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II- Barriers - Interventions Quality Access

Interventions Barriers

  • Weak service

quality

  • Healthcare service quality

standards developed

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II- Barriers - Interventions Quality Access

Barriers

  • Weak

infrastructure Interventions

  • Increasing full service

rooms in hospitals

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II- Barriers - Interventions Quality Access

  • Weak

infrastructure

  • Investment in

medical equipment and technology Interventions Barriers

  • Service

procurement

  • Outsourcing
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II- Barriers - Interventions Quality Access

Interventions Barriers

  • Weak

infrastructure

  • Public Investments
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II- Barriers - Interventions Quality Access

Interventions Barriers

  • Lack of effective

mechanisms for patient rights

  • Regulations for patient rights
  • Patient Rights Units in all public

hospitals

– 720.000 application in 8 years, 83% resolved on site

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II- Barriers - Interventions Quality Access

Interventions Barriers

  • Supply-driven

healthcare delivery

  • Change to demand-driven

healthcare delivery through performance-based supplementary payment system

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II- Barriers - Interventions Quality Access

Interventions Barriers

  • Low motivation

among healthcare staff in public sector

  • Appropriate incentive systems

(performance- based payment, contract- based recruitment)

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III- Key Success Factors

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III- Key Success Factors

  • Political Commitment and Government Support
  • Resource Allocation/Mobilization
  • Dedicated Reform T

eam

  • Feedback
  • Partnerships
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III- Key Success Factors

Political Commitment and Government Support

Political decisions can only be implemented with the full support of the Prime Minister and the Government.

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III- Key Success Factors

Resource Allocation / Mobilization

Source: TURKSTAT, OECD Health Data 2010, Note: TURKSTAT has last published data of 2008. *2011 figures for Turkey are based on MoH estimation; OECD figures cover 2009 or last available year. /

2002 2002 PPP PPP$ $ (%GD GDP) P) 2008 2008 PPP PPP$ $ (%GD GDP) P) 20 2011* 1* PPP PPP$ (%GD GDP) P)

Public

Turkey 335 (3.8%) 659 (4.4%) 734 (4,4%) OECD 1,565 (5.9%) 2,224 (6.1%) 2,320 (6,9%)

Private

Turkey 138 (1.6%) 243 (1.6%) 246 (1,5%) OECD 612 (2.4%) 846 (2.5%) 902 (2,7%)

Total

Turkey 473 (5.4%) 902 (6.1%) 981 (5,9%) OECD 2,178 (8.3%) 3,101 (8.6%) 3,223 (9,6%)

Public and Private Health Expenditure (Per Capita by Year and Ratio to GDP)

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III- Key Success Factors

Devoted Reform T eam Political commitment and a devoted reform team are key to a successful reform coupled with professionalism.

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III- Key Success Factors

Feedback

Citizen Satisfaction Rate in

  • Citizen

Satisfaction Health Services (%) Surveys

75,9 39,5

2003 2004 2005 2006 2007 2008 2009 2010 2011

Source: TURKSTAT

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III- Key Success Factors Feedback

  • Field Coordinators
  • Site visits for Monitoring & Evaluation – 345 visits for 81 provinces (2002-2011)
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III- Key Success Factors Feedback

  • T

ele and web-based assistance

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III- Key Success Factors Feedback

  • T

ele and web-based assistance – 6 million calls in 8 years

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III- Key Success Factors Feedback

  • Online “Meeting-Point for Health Staff”
  • Media
  • Politicians
  • Impact assessment (field surveys)
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III- Key Success Factors Partnerships

Cooperation with

  • International organizations (WHO, UNICEF

, OECD…)

  • Other ministries and public institutions
  • NGO’s (Unions of Professionals)
  • Universities
  • Trade unions

…

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V- Challenges

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V- Challenges

Need for:

  • Increasing human resources
  • Institutionalization of reforms
  • Improving clinical quality
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V- Challenges

  • To Reduce obesity and physical inactivity

Obesity in Turkey (2012)

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V- Challenges

Need for:

  • Improving health information system
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VI-Fiscal Sustainability?

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Yes...

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VI-Fiscal Sustainability

  • Health service needs mostly met
  • Economic growth continuing
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VI-Fiscal Sustainability

  • Pharmaceutical prices under control
  • Flat budget in place
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VI-Fiscal Sustainability

  • Preventive health strenghtened
  • Health promotion started
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VI-Fiscal Sustainability

  • Outsourcing in procurement
  • New hospital investments by PPP
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VII-Why equitable access to health?

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VII-Why equitable access to health?

  • Human rights
  • Social justice
  • Social cohesion
  • Citizen satisfaction
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VII-Why equitable access to health?

  • Productivity
  • Social welfare
  • Political stability

…

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British Medical Journal, 12 March 2011, vol. 342

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II- Barriers – Interventions Physical Access

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II- Barriers – Interventions Physical Access

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Sati tisfaction wi n with H th Health th Ca Care S e Ser ervi vices According to the life satisfaction research conducted by the TURKSTAT, satisfaction rate for health care services was 39.5% in

  • 2003. This rate increased

by 33.6 points and reached to 73.1% in 2010.

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314 According to a research conducted by TURKSTAT in 2003, satisfaction rate from public hospitals increased by 33.8 points and reached to 74.8% in

  • 2010. In same time

period satisfaction from private practices reduced to 39% from 46.7%.

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T.C. İzmir Governor Provincial Health Directorate