Equitable Access to Health (T urkey Experience) Snapshots from the Health Reform in T urkey Dr. Ali IRAVUL Dr. Ayhan İZZETİNOĞLU
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
Components of the Health Reform Program Additional Topics (2007): Buildin a planner and supervisor Ministry of Health for better health insurance, everyone should be under For a better future, healthy life and health one roof, the roof of universal health insurance promotion programs For easily accessible, Widespreadand genial health To bestir stakeholders for intersectoral collaboration for versatile health responsibility care system To increase the power of the country to cross- Highly-motivated health worker’s, armed with border for international health services 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
OLD
NEW
From rhetoric to reality…
Turkey Life expectancy for 2025: 75 years (WHO Estimation, 1998) Life expectancy for 2009: 75 years (World Health Statistics, 2011)
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
I- Ethics and Politics
I- Ethics and Politics Health Policy Cycle Getting Health Reform Right, M. Robert et al, 2004
I- Ethics and Politics Health for all Human-centered
II- Barriers to Access Interventions for Improvement
II- Barriers - Interventions Physical Access Financial Access Quality Access EQUITY
II- Barriers – Interventions Physical Access Interventions Barriers 2.766 Number of Ambulances • Insufficient workforce and vehicles for emergency services 618 2002 2012
II- Barriers – Interventions Physical Access Interventions Barriers 2.700.000 No. of Transferred Emergency Caces • Insufficient workforce and vehicles for emergency services 350.000 2002 2012
II- Barriers – Interventions Physical Access Barriers Interventions • Insufficient Rural is not “underserved” anymore workforce and vehicles for emergency services
II- Barriers – Interventions Physical Access Barriers Interventions • Free service for all emergency cases • Insufficient workforce and vehicles • Percentace of attending emergency for call: emergency services – In urban 0-10 min.: 94% – In rural 0-30 min.: 96%
II- Barriers – Interventions Physical Access Interventions Barriers National Medical • Lack of Rescue T eams disaster preparedness
II- Barriers – Interventions Physical Access Barriers Interventions • Lack of Specially trained 4.909 health personnel disaster preparedness
II- Barriers – Interventions Physical Access Barriers Interventions • Inadequate • Comprehensive and widespread preventive immunization program health services 2002 2002 20 2011 Immunization Rate for Turkey (%) 78 97 Routine Vaccines of Childhood (7 antigens) (12 antigens)
II- Barriers – Interventions Physical Access Barriers Interventions • Inadequate • Improved mobile health services and preventive mobile pharmacy in rural areas health services - 20.000/day citizens receive their medicines from mobile pharmacies
II- Barriers – Interventions Physical Access Interventions Barriers • “Guest mother” • Inadequate preventive project for pregnant health services women
II- Barriers – Interventions Physical Access Barriers Interventions • Inadequate • Home care services preventive “you are not alone at home…” health services
II- Barriers – Interventions Physical Access Barriers Interventions • Cancer screening centers (KETEM) • Inadequate preventive health services
II- Barriers – Interventions Physical Access Barriers Interventions • Neonatal screenings • Inadequate preventive Phenylketonuria, Hypothyroidism, health services Biotinidase, Hearing • Free micronutrients support – Fe, Vit-D (for 1.3 million children/year)
II- Barriers – Interventions Physical Access Barriers Interventions • Inadequate • Family medicine preventive established in 2005 as health pilot project and fully services implemented in 2010
II- Barriers – Interventions Physical Access Barriers Interventions • Inadequate health • Health promotion promotion – tobacco • the fourth of the 31 countries in “Europe 2010 T obacco Control Grading”
II- Barriers – Interventions Physical Access
II- Barriers – Interventions Physical Access Barriers Interventions • All public hospitals managed by MoH • Inefficient hospital with increased autonomy of hospitals services • Separate consultation room for each physician
II- Barriers – Interventions Physical Access Barriers Interventions • Oro-Dental Health Centers • Inefficient hospital services
II- Barriers – Interventions Physical Access Barriers Interventions • Inefficient • Common Hospital Appointment System hospital services
II- Barriers – Interventions Physical Access Barriers Interventions • Uneven • Obligatory service distribution of health • Contract-based recruitment for workforce underserved regions • Central human resources planning both for public and private sector
II- Barriers – Interventions Physical Access Barriers Interventions • More seats in medical and • Insufficient numbers of nursing schools health workforce 2002 2011
II- Barriers – Interventions Physical Access Barriers Interventions • Low productivity of • Increased health workforce productivity by Performance Number of visits to physician Based Payment / person / year System
II- Barriers – Interventions Physical Access Barriers Interventions • Increased • Less consultation time with consultation the patients (from 4,5 time for patients min. to 9,5 min).
II- Barriers - Interventions Financial Access Barriers Interventions • Social security schemes integrated • Fragmented social security schemes under Social Security Institution (SSI) with different benefits and low • Universal Health Insurance (UHI) coverage introduced (98% coverage)
II- Barriers - Interventions Financial Access Barriers Interventions • Inadequate • Poor people covered under UHI health benefits with same benefits for poor people
II- Barriers - Interventions Financial Access Barriers Interventions • Free emergency and intensive care in all • High catastrophic hospitals including private health expenditures • 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
II- Barriers - Interventions Financial Access Barriers Interventions • High catastrophic health expenditures
II- Barriers - Interventions Financial Access Barriers Interventions • Full-time employment of physicians • High catastrophic health expenditures
II- Barriers - Interventions Quality Access Barriers Interventions • Healthcare service quality • Weak service quality standards developed
II- Barriers - Interventions Quality Access Barriers Interventions • Increasing full service • Weak rooms in hospitals infrastructure
II- Barriers - Interventions Quality Access Barriers Interventions • Weak • Investment in infrastructure medical equipment and technology • Service procurement • Outsourcing
II- Barriers - Interventions Quality Access Barriers Interventions • Weak • Public Investments infrastructure
II- Barriers - Interventions Quality Access Barriers Interventions • Lack of effective • Regulations for patient rights mechanisms for patient rights • Patient Rights Units in all public hospitals – 720.000 application in 8 years, 83% resolved on site
II- Barriers - Interventions Quality Access Barriers Interventions • Supply-driven • Change to demand-driven healthcare healthcare delivery through delivery performance-based supplementary payment system
II- Barriers - Interventions Quality Access Barriers Interventions • Appropriate incentive systems • Low motivation among healthcare (performance- based payment, staff in public contract- based recruitment) sector
III- Key Success Factors
III- Key Success Factors • Political Commitment and Government Support • Resource Allocation/Mobilization • Dedicated Reform T eam • Feedback • Partnerships
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