Title: Primary Health Care in Turkey A Brief History and Current Situation
1Primary Health Care in TurkeyA Brief History and
Current Situation
TĂĽrkiye Aile Hekimleri Uzmanlik DernegiTurkish
Association of Family Physicians
- Dr. Rusen TopalliKocaeli University Medical
SchoolDepartment of Family Medicine
2Content
- Brief history of health care services in Turkey
- Brief history of family medicine in Turkey
- Current health care system (in theory in
practice) - Ongoing changes in health care
3Late Ottoman Period
- 1827 First modern medical school
- 1871 Memleket Tabibi (Country physicians) First
primary care tasks... - 1914 General Health Directorate under Ministry of
Internal Affairs
4Independence War Period
- May 1920 Ministry of Health (Minister Dr.
Adnan Adivar) - October 1923 Republic of Turkey
5Republic of Turkey (1923)
- 12,000,000 population
- And 554 physicians...
6Early Republic Period
- Dr. Refik Saydam (1st Minister of Health 1923 -
1937) - Priority given to preventive services...
- Country doctors of Ottoman Empire became
government doctors of the new republic... - Hospital services were seen as a duty of local
authorities
7Government Doctors
- Many tasks (104 articles) ...
- Environmental health
- Forensic tasks
- Infectious diseases surveillance
- Occupational and school health
- Administrative tasks
- Free health care of the poor... etc...
8Vertical Organizations
- Specific institutions for specific diseases. Such
as - Trachoma
- Malaria
- Syphilis
- Tuberculosis
91937 1949 Period
- Plan for broadening of health care services to
small towns and villages... - Health centres for every 20,000 population...
- Integration of preventive and curative health
services... - Separate health service organization for workers
(SSK)
10Specialization in General Medicine
- 1947, general health specialists for health
centres - Probably the first recognition of a primary care
specialty in the world - Abandoned in 1955 and general health specialists
were given the right to continue in another
specialty...
111950 1960 Period
- Priority given to hospital medicine...
- Local hospitals became units of the Ministry of
Health (MoH). - New hospitals opened by MoH.
12After 1960Socialization of Health Services
- Act 224 (May 1961)Prof. Dr. Nusret Fisek
- Primary care based health services
- 17 years before Alma-Ata
13Socialization of Health Services
- 1 Saglik Ocagi (the main primary care unit) for
each 5-10,000 population - Teamwork Physician, nurse, midwife,
environmental health technician etc. - Integrated preventive and curative health care
services...
14However...
- All the tasks of the old government doctor
transferred to Saglik Ocagi doctor... - Including environmental health issues, forensic
duties...
15From 1960 to present...
- Socialization broadened to all country...
- Number of Saglik Ocagis approached to 6000 (1 SO
for 11,500 citizens). - 15,000 physicians work at Saglik Ocagis (1 SO
physician for 4,500 citizens) - Every citizen is registered to a Saglik Ocagi
(whether he/she knows or not)...
16Socialization of Health Services(A success story
or not?)
- Socialization, that is succesfully practiced
from 1963 to 1965, became unsuccesful after
1966. - Prof.Dr. Nusret Fisek
17Why not?
- Lack of financial support
- Abundance of tasks
- Lack of personnel motivation
- Lack of lab./imaging facilities
- Loss of trustworthiness
- Inadequately educated personnel (esp. physicians)
18Vertical Organizations
- Still alive... Overlapping tasks with Saglik
Ocagi - Maternal Child Health Family Planning Centres
(AÇSAP) - Ambulatory Tuberculosis Units (VSD)
- Disease State Management (Hypertension, Diabetes,
...)
19From 1990s to present day...
- An initiative from the government...
- Called HEALTH REFORM
- A new primary care system promoted called
family medicine system - Caused confusion about family medicinea
discipline or a system
20From 1990s to present day...
- Family medicine system is percepted as
privatization in health care... - Most parties at the left wing of political
spectrum are against this system, on the other
end, central and right wing parties all include
family medicine in their programmes...
21The specialty of family medicine
- And family physicians tried to explain
- Family medicine is not a system, it is a medical
specialty and discipline... - And family physicians are the main primary care
physician workforce of any health system...
22What about the specialty of FM?
- Is it a success story or not?
23Specialization in Family Medicine
- 1983 Regulation basis completed...
- 1985 Training began in 9 teaching hospitals
- A 3-year-all-hospital-rotation programme(9
months internal disease, 9 months paediatrics, 8
months obstetrics gynaecology, 6 months general
surgery and 4 months psychiatry)
24TAHUD
- Turkish Association of Family Physiciansestablish
ed in 1990
25Some milestones...
- Departments in Universities (1993)
- 1st National Congress of Family Medicine
(Istanbul, 1993) - Branches of TAHUD (Istanbul 1993, Izmir 1995,
Ankara 1998, Bursa 2000)
26Some milestones...
- 1st attendance to WONCA-Europe Meeting (1995)
- Turkish Journal of Family Practice (1997)
- Decision to join WONCA (1998)
27Today...
- 1200 family physicians distributed to 90 of the
country - 32 academic departments out of 48 medical schools
- 29 residency training programmes
- 5 national congresses (6th Bursa 2004)
- Member of WONCA
28While these are happening...
- Turkish Medical Association (one of those who
equalize family medicine and privatization of
health services) made repeated attempts to end
family medicine, to close departments at the
universities, etc...
29Institute of General Practice
- Turkish Medical Association established an
Intitute with a small number of practitioners in
1998. - Their aim is to make General Practice
recognized as a separate discipline and to
educate GPs... - They sometimes define GP different from FP (GP is
community oriented while FP focuses on the
individual)
30Turkey today (physician workforce)
- 68,000,000 population
- 95,000 physicians
- 45,000 specialists (including 1200 FPs)
- 15,000 trainees in various specialties
- 35,000 practitioners (w/o vocational training
after completion of medical school) - (25,000 medical students...)
31Current status of primary care...
Hospital
Saglik Ocagi
Patient
Is that so simple?
32Certainly not...
- To understand the (complexity of) health care
services, one should first try to understand
social security system of Turkey...
33Who pays for health services?
- SSK (workers) 45
- Bag-kur (self-employed) 15
- State employees 10
- Emekli Sandigi (retired state employees) 4
- Yesilkart (no-insurance poor) 15
- Private insurance 1
- Self paying or none 10
34SSK Hospital
SSK Teaching Hospital
SSK
SSK ACC
University Hospital
Bag-Kur
Saglik Ocagi
Private Hospital
State Employee
MoH Hospital
Ins. HC
MoH Teaching Hospital
Retired
Yesilkart
Turkish health care sytem (simplified version)
35What changes ahead? (Plans of the Current
Ministry of Health)
- (not so much different from previous plans)
- All social security plans will be united in a
single general health insurance - Personal family doctors for every individual
rather than territory based primary care - Family physicians and practitioners will be
recruited as family doctors
36Thanks for joining...