Turkey

Turkey

International-based evidence and experience indicate that health system based on an effective primary healthcare in which well-trained family physicians work is much more successful than the others. For that reason, a lot of work has been done to implementFamily Medicine Model in our country recently.

Primary health care in Turkey has essentially been organized after 1960s. Previously, preventive medicine services could be provided only by the government with inadequate number of physicians. Also some organizations were established to struggle with epidemic diseases in those days.

After the World War II, family and society-based health service was adopted in principle in Turkey like the other countries all over the world. With the aim of ‘Health for Everybody’, primary health care units became widespread throughout our country. Not all the planned applications could be put into practice but a lot has been done successfully.

Family Medicine has an effective and important role in European countries. After Turkey’s nomination to European Union in 1999, the Family Medicine was finally launched through the ‘Health Transformation Programme’, a project of the Ministry of Health. In 2005, Family Medicine pilot implementation was launched in one of the provinces of Turkey. At the end of 2010, Family Medicine Model was implemented in the primary care all over the country. Family practice was accepted as a field of specialization in Turkey like the other European countries. Three-year residency trainingprogrammebegan in 1985. As the number of family physicians was inadequate, general practitioners (medical doctors who complete 6 years basic medical education and have no specialization training in primary health care) took place in Family Medicine implementation. However the training programme has not been launched yet. In the current situation, short term adaptation training is mandatory for all primary care physicians before starting to work in the provinces where family medicine is implemented and long term in-service training programs are under development(there are variety of suggestions).At the moment there is an ongoing online second adaptation training programme of which at the end of the year you must pass the exam.

Currently, no convenient referral system has been utilized. Ministry of health points to the inadequate number of physicians for not being able to initiate referral chain obligation. Though the transition to Family Medicine system is fast and has some inadequacy, there has been very important and hopeful development in such a short time. For example; Turkey has almost become the most successful country with ℅ 97 vaccination rate. There has been positive development in mother-child mortality rates, control of epidemic diseases and follow up of chronic diseases.

FINANCING OF HEALTH CARE AND SOCIAL HEALTH INSURANCE IN TURKEY

Public health expanditure in Turkey is financed by the social security institution (SSI) under the Ministry of Labor.SSI provides payment for this service from insurance premiums and the state treasury support.It is compulsory to pay SSI premiums according to the law of SSI . Up to 20% of the declared income is to be paid as health insurance premiums.Global budget model is adopted in the public health expenditure .SSI stated that excess payment won’t be paid in case of exceeded budget.Each year SSI announces targeted budgets in accordance with the targets of pharmaceutical and hospital expenses ,and accordingly a budgetary discipline is tried to be provided. Health expences are increasing wherefore the increasing of policlinic numbers; as a result of expanding social umbrella of patients.Intervention of the government in this process is often, because most of the budget is provided by the state treasury.

General practice: All citizens of the state under the age of 18 are covered by insurance. Over the age of 18 must pay the premium.In accordance with the Turkısh family structure; spouses and parents are covered by the insurance.In addition, every citizen has the right to have additional private health insurance.All applicants treated in public hospitals must pay the fee for physical examination.It costs 5 TL in secondary and tertiary health care services.İn case of making an agreement with the SSI in our country ,after the treatment of patients ,private hospitals can charge the costs to the SSI.Fee for examination of patients in private health care institutions is 12TL. Contracted with the institution, private universities and private health institutions and organizations can request for additional payment for the treatment costs. This ratio should not exceed 90% of the price specified for that service which is explained in the (Health Application Notification).For the primary health care service,3TL. is charged as fee for prescription;and if the number of pillboxes exceeds 3,additional 1TL. is charged for each box for examination fee.Examination fees are charged from persons at the first application to the pharmacy(İt’s cut from their superannuation for retirees) 

These inspection fees are delivered to the Social Security Institution.

As an example: In 2010 ,%60 of treatment costs were realised in public hospitals ,25 percent in private hospitals and university hospitals were expressed 18 percent.

On the other hand we provide the most comprehensive system in EU.In Europe there is no other insurance system in which all the diseases are covered Especially when compared to the premium and the service provided.

The Future Objectives of AHEF (Federation of Family Physicians Associations)

In order to find solutions for the troubles the doctors had in Family Medicine Practice, Federation of Family Physicians Associations(AHEF) was established in 2008. AHEF serves as a professional organization for family physicians and tries to improve both the discipline of family practice and the rights of the family physicians. More Provincial Associations have been getting into AHEF as the time goes by. Currently, 58 provinces out of 81 are members of AHEF. In other words, AHEF represents 10127 family physicians.Future projections of AHEF are as follows:

*to gather all the family physicians in Turkey under the same roof and represent them in the national and international area.

*to protect the rights of family physicians and provide them to work in the best conditions socially, scientifically, economically and legally.

*Increase the number of professionals working in the name of AHEF and to penetrate to various organizations

*To improve EU projects, AHEF based intelligence technologies also for all UEMO countries.

* to find solutions for the problems that arise in the field of general practice, by taking public health into account.

* to prepare action plans and put them into practice.

*To maintain intimate congress organizations

*To try to provide the correct ratio between current salaries and superannuation of family physicians .

* to arrange its activities according to international norms, ethic principles and law and carry them out independently from individuals and political corporations.

*To show our scientific case in international platforms and improve the prestige of family physicians.

*to make the Family Medicine Practice in Turkey respectable and desired one in the field of primary health care throughout the world.

*Being the first organization to organise training programmes at appropriate working conditions after determining the training needs of family physicians .

*to gather all family physicians legally under the same umbrella to get legal support

*to provide source of income-generating projects for provincial associations.

*To provide source to AHEF and provincial associations by EU projects,and to use these sources to obtain scientific datas.

*To share projects and targets with the policy makers and to put forward solution proposals in order to reach the best implementation of family medicine.

Dr. MEHMET TANSU DERE

Dr. MUZAFFER GÜLEÇ

Related articles