Primary Health Care in Turkey A Brief History and Current Situation - PowerPoint PPT Presentation

Loading...

PPT – Primary Health Care in Turkey A Brief History and Current Situation PowerPoint presentation | free to view - id: 297837-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Primary Health Care in Turkey A Brief History and Current Situation

Description:

35,000 practitioners (w/o vocational training after completion of medical school) ... 'family doctors' for every individual rather than territory based primary care ... – PowerPoint PPT presentation

Number of Views:95
Avg rating:3.0/5.0
Slides: 37
Provided by: zlem
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Primary Health Care in Turkey A Brief History and Current Situation


1
Primary Health Care in TurkeyA Brief History and
Current Situation
Türkiye Aile Hekimleri Uzmanlik DernegiTurkish
Association of Family Physicians
  • Dr. Rusen TopalliKocaeli University Medical
    SchoolDepartment of Family Medicine

2
Content
  • 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

3
Late 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

4
Independence War Period
  • May 1920 Ministry of Health (Minister Dr.
    Adnan Adivar)
  • October 1923 Republic of Turkey

5
Republic of Turkey (1923)
  • 12,000,000 population
  • And 554 physicians...

6
Early 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

7
Government 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...

8
Vertical Organizations
  • Specific institutions for specific diseases. Such
    as
  • Trachoma
  • Malaria
  • Syphilis
  • Tuberculosis

9
1937 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)

10
Specialization 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...

11
1950 1960 Period
  • Priority given to hospital medicine...
  • Local hospitals became units of the Ministry of
    Health (MoH).
  • New hospitals opened by MoH.

12
After 1960Socialization of Health Services
  • Act 224 (May 1961)Prof. Dr. Nusret Fisek
  • Primary care based health services
  • 17 years before Alma-Ata

13
Socialization 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...

14
However...
  • All the tasks of the old government doctor
    transferred to Saglik Ocagi doctor...
  • Including environmental health issues, forensic
    duties...

15
From 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)...

16
Socialization 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

17
Why 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)

18
Vertical Organizations
  • Still alive... Overlapping tasks with Saglik
    Ocagi
  • Maternal Child Health Family Planning Centres
    (AÇSAP)
  • Ambulatory Tuberculosis Units (VSD)
  • Disease State Management (Hypertension, Diabetes,
    ...)

19
From 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

20
From 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...

21
The 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...

22
What about the specialty of FM?
  • Is it a success story or not?

23
Specialization 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)

24
TAHUD
  • Turkish Association of Family Physiciansestablish
    ed in 1990

25
Some milestones...
  • Departments in Universities (1993)
  • 1st National Congress of Family Medicine
    (Istanbul, 1993)
  • Branches of TAHUD (Istanbul 1993, Izmir 1995,
    Ankara 1998, Bursa 2000)

26
Some milestones...
  • 1st attendance to WONCA-Europe Meeting (1995)
  • Turkish Journal of Family Practice (1997)
  • Decision to join WONCA (1998)

27
Today...
  • 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

28
While 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...

29
Institute 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)

30
Turkey 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...)

31
Current status of primary care...
Hospital
Saglik Ocagi
Patient
Is that so simple?
32
Certainly not...
  • To understand the (complexity of) health care
    services, one should first try to understand
    social security system of Turkey...

33
Who 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

34
SSK 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)
35
What 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

36
Thanks for joining...
About PowerShow.com