Türkiye'de Sağlıkta Dönüşüm Üzerine Tarihsel Bakış

Year 2022, , 188 - 193, 14.01.2022

Nurşen Aydın

https://doi.org/10.33631/sabd.1055675

Cited By: 2

Abstract

Türkiye, sağlık sistemini ve sağlık sonuçlarını dönüştürmek ve iyileştirmek için 2003 yılından bu yana büyük reformlar gerçekleştirmiştir. Bu tarihsel değerlendirme, Türkiye’nin Sağlıkta Dönüşüm Programı’ndan (SDP) elde edilen deneyimleri akademisyenler, politika yapıcılar ve halkla paylaşmayı amaçlamaktadır. Türkiye Cumhuriyeti'nin kuruluşundan bugüne kadar sağlık hizmetlerinin iyileştirilmesine yönelik yasal düzenlemeler ve uygulamalar anlatılmış ve tarihsel bir bakış açısıyla değerlendirilmiştir. İncelememiz, SDP'nin genel sağlık sigortası, aile hekimliği, sağlık hizmetlerine erişim ve hizmet kalitesi için hedeflere ulaşan bir model oluşturduğunu göstermektedir. SDP sağlık hizmetlerine erişimi artırdı ve hizmet kalitesini etkiledi. Ancak, ikinci ve üçüncü basamak sağlık hizmeti sunan kurumların adem-î merkeziyetçiliği tam olarak sağlanamamıştır. Kamu Hastane Birlikleri ve Halk Sağlığı Müdürlükleri, İl Sağlık Müdürlüğü bünyesinde yeniden birleştirilmiştir. Bunda, yönetimde üç farklı organın olması, atanan yöneticilerin yetkinliği ile ilgili sorunlar, kararsız organizasyon yapısı, birden fazla yöneticinin atanması ve sık sık görev değişikliği, sağlık çalışanlarının memnuniyetsizliği, koordinasyon sorunları gibi faktörlerin etkili olduğu belirtilmiştir. Reform yapmak isteyen ülkelerin, adem-î merkeziyetçiliği kendi koşullarına göre uygulamaları daha verimli olabilir.
Anahtar Kelimeler: Sağlık politikaları; sağlık reformu; kamu politikası.

Keywords

Sağlık politikaları, sağlık reformu, kamu politikası

Historical Perspective on the Health Transformation in Turkey

Abstract

Turkey has undertaken major reforms since 2003 to transform and improve its healthcare system and health outcomes. This historical evaluation aims to shares experiences gained from Turkey’s Health Transformation Program (HTP) with scholars, policymakers, and the public. Until today from the establishment of the Republic of Turkey, the legal regulations and practices for improving health services have been explained, and the results have been evaluated from a historical perspective. Our review shows that HTP has created a model that achieved goals for universal health insurance, family medicine, access to health services, and service quality. HTP increased access to health services and affected service quality. However, it has not achieved full decentralization of secondary and tertiary healthcare providers. Public hospital associations and public health directorates were reunited under the Provincial Health Directorate. It is stated that various factors such as having three different bodies in administration, problems with the competence of appointed managers, unsettled organizational structure, more than one managers being appointed and frequent changes in office, dissatisfaction of healthcare workers, and problems in communication and coordination. Countries wishing to reform may be more productive in implementing decentralization considering in their own circumstances.

Keywords

Health policy, health care reform, public policy

References

• Küçük A. Public hospital reform in Turkey: the “public hospital union” case (2012-2017). Int J Health Plann Manage. 2018; 33(4): e971-84.
• OECD and World Bank. OECD reviews of health systems: Turkey. 2008. Available from: www.oecd.org/publishing/corrigenda
• Sulku SN. Türkiye’de sağlıkta dönüşüm programı öncesi ve sonrasında sağlık hizmetlerinin sunumu, finansmanı ve sağlık harcamaları. Ankara-Turkey: Maliye Bakanlığı-Strateji Geliştirme Başkanlığı; 2011. Yayın No: 2011/414.
• Ministry of Health. Health transformation program in Turkey and primary health care services november 2002-2008 (in celebration of the 30th year of the declaration of Alma-Ata). Akdag R, Aydin S, Buzgan T, Demirel H, Gunduz F, editors. Republic of Turkey, Ministry of Health; 2008. Health Publication No: 770.
• Ministry of Health. Progress report: health transformation program in Turkey. Akdag R, Aydin S, Demirel H, editors. Ankara-Turkey: Republic of Turkey, Ministry of Health; 2009.
• Akdur R. Temel kavramlar Türkiye ve Avrupa Birliği’nde durum ve Türkiye’nin birliğe uyumu. 2nd ed. Erhan Ç, editor. Ankara-Turkey; 2006.
• İleri H, Secer B, Ertas H. Sağlık politikası kavramı ve Türkiye’de sağlık politikalarının incelenmesi. Selcuk Univ J Soc Tech Res. 2016; 12: 176-86.
• Ministry of Health. Türkiye’de sağlıkta dönüşüm programı değerlendirme raporu (2003-2011). Akdag R, editor. Ankara-Turkey; 2012. Available from: http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/SDPturk.pdf
• TUSIAD. Charting the way forward: health care reform in Turkey. Istanbul-Turkey: TUSIAD-Turkish Industrialists’ and Businessmen’s Association; 2005. TUSIAD Publication No-T/2005-3/389.
• Erus B, Aktakke N. Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees. Vol. Working Pa. Cairo-Egypt; 2010.
• Hackler C. Health care reform in the United States. Heal Care Anal. 1993; 1: 5-13.
• Adinolfi P. Barriers to reforming healthcare: The Italian case. Heal Care Anal. 2014; 22(1): 36-58.
• Liaropoulos LL, Kaitelidou D. Surveys o f the distributio n o f freshwater crayfish (austropotamobius. Heal Care Anal. 1998; 6: 277-85.
• Tatar M, Mollahaliloglu S, Sahin B, Aydin S, Maresso A, Hernández-Quevedo C. Turkey: health system review 2011. Health Syst Transit. 2011; 13(6): 1-186.
• Ilgun G, Sahin B. Investigating the opinions of employees working in family medicine about family medicine practice. Hacettepe Saglik Idaresi Derg. 2016; 19(2): 115-30.
• Acar OK. Ministry of health organizations after health transformation program; quality analysis on Isparta river. MANAS J Soc Stud. 2018; 7(3): 703-22.
• Adar S. Turkey: reform in social security. J Eur Soc Policy. 2007; 17(2): 167-8.
• Istanbul Provincial Health Directorate. Organization chart. 2019. Available from: https://dosyaism.saglik.gov.tr/Resim/76569,teskilatsemasijpg.png?0
• Basol E, Isık A. Recent developments in health policy in Turkey: from health transformation program to present evaluation and some sugge*9stions. IAAOJ Soc Sci. 2015; 2(2): 1-26. Available from: http://iaaoj.com/index.php/sosyalbilimler/article/view/104
• Turan AM. Türkiye’nin yeni yönetim düzeni: Cumhurbaşkanlığı Hükümet Sistemi. Soc Sci Res Journa. 2018; 7(3): 42-91.
• OECD. OECD reviews of health care quality: Turkey 2014. OECD Publishing; 2014.
• WHO. Successful health system reforms: the case of Turkey. Copenhagen-Denmark; 2012.
• Sparkes SP, Bump JB, Reich MR. Political strategies for health reform in Turkey: extending veto point theory. Heal Syst Reform. 2015; 1(4): 263-75.
• OECD. Health at a glance 2017: OECD indicators. Paris: OECD Publishing; 2017. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2015_health_glance-2015-en
• Turkish Statistical Institute. Health expenditure statistics. Ankara-Turkey; 2019. Available from: http://tuik.gov.tr/PreTablo.do?alt_id=1084
• WHO. World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva-Switzerland; 2018.
• Sayim F. Health economics statistics and development of health expenditures in Turkey. Yalova Üniversitesi Sos Bilim Derg. 2017; 7(15): 13-30.
• Aydin N, Bakoglu R. Patient care costs in the state training and research hospitals in Istanbul in years 2000-2007. In: Procedia - Social and Behavioral Sciences. 2011. p. 1070-1089.
• Ali Jadoo SA, Aljunid SM, Sulku SN, Nur AM. Turkish health system reform from the people perspective. BMC Health Serv Res. 2014; 14: 1-9. Available from: http://www.biomedcentral.com/1472-6963/14/30%0ARESEA
• Bakan I, Buyukbese T, Ersahan B. The impact of total quality service (TQS) on healthcare and patient satisfaction: An empirical study of Turkish private and public hospitals. Int J Health Plann Manage. 2014; 29(3): 292-315.
• Cesur R, Gunes PM, Tekin E, Ulker A. The value of socialized medicine: the impact of universal primary healthcare provision on birth and mortality rates in Turkey. Cambridge, MA; 2015.
• Ministry of Health. Health statistics yearbook 2019. Ankara-Turkey: Ministry of Health; 2021. 182-184 p.
• UNICEF. Decline in the under-5 mortality rate (U5MR) in Turkey: a case study (December 2009). Jelamschi L, De Ver Dye T, editors. 2010. 44 p.
• World Bank. Health systems strengthening: lessons from the Turkish experience, 2009. Chakraborty S, editor. World Bank Knowl Br. 2009; 12. Available from: http://scholar.google.co.uk/scholar?start=60&q=allintitle:+Health+Systems+Strengthening&hl=en&as_sdt=0,5#9
• Hayran O. In terms of the success of health reforms, the decentralization-recentralization cycle and the situation in our country. J Biotechnol Strateg Heal Res. 2017; 1: 1-6.
• Agartan TI. Health workforce policy and Turkey’s health care reform. Health Policy (New York). 2015; 119: 1621-6.
• Memişoğlu D. Bir kamu politikası analizi örneği: Sağlıkta Dönüşüm Programı. Yasam Derg. 2018; 34: 62-93. Available from: https://dergipark.org.tr/tr/pub/yasamadergisi/issue/54465/741347
• Yilmaz E, Gedikli EK. 2nd International 12th National Congress on Health and Hospital Administration. In: Sağlıkta Dönüşüm Programı ile Sağlık Bakanlığının değişen teşkilat yapısı. Mugla-Turkey; 2018. p. 1715-28.
• Erdem F, Atalay M. The effect of health transformation policies on the resident physicians’ perception of the medical profession in Turkey. Int J Health Plann Manage. 2017; 32(2): 189-216.
• Keskin Hİ. Türkiye’de Sağlıkta Dönüşüm Programı ve kamu hastanelerinin etkinliği. Akdeniz Üniversitesi İktisadi ve İdari Bilim Fakültesi Derg. 2018; 38: 124-50.