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

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

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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