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Öğe Conclusions(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaTurkey has achieved considerable health status improvements since the 1980s in major health status indicators. However, although infant mortality, child mortality and maternal mortality rates have decreased, and life expectancy at birth has increased over time, the indicators are still not compatible with the current development level of the country. In addition, regional inequalities constitute a challenge for the years ahead. Improved access to health care services in recent years has contributed positively to the improvements in health status; however, for further improvements, developments in the country’s socioeconomic level are also required.Öğe Executive summary(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaTurkey is located in the northern hemisphere and bridges Europe and Asia. The bordering countries are Greece, Bulgaria, Georgia, Armenia, the Islamic Republic of Iran, the Syrian Arab Republic and Iraq. The country has a population of 73 million, 26% being under 14 years of age in 2010. Turkey is a parliamentary democracy with a clear separation of executive, legislative and judicial powers. The 1982 Constitution describes Turkey as a democratic, secular and social state governed by the rule of law. The Turkish Grand National Assembly (Türkiye Büyük Millet Meclisi), or parliament, is the legislative body acting on behalf of the nation. The President, elected by the people, and the Council of Ministers (Cabinet) headed by the Prime Minister, exercise executive power. Independent courts handle judicial power. Administratively, Turkey is divided into 81 provinces headed by provincial governors appointed by the central government. Provincial governors are the representatives of all ministers at the provincial level. All ministries, including the Ministry of Health, have their own local organizations in the provinces and the heads of these organizations are responsible to the provincial governor.Öğe Financing(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaSources of health expenditure and its share of GDP have always been contentious topics in Turkey. As will be outlined in detail in this chapter, because of the different approaches taken to calculate GDP in different time periods, the share of health expenditure as a proportion of GDP can range from 7.5% to 5.4% for the same year (TURKSTAT, 2009e; Yardım et al., 2007). According to the most recent official statistics, 81.9% of the population was covered by one of the (then) available social security schemes in 2007 (SSI, 2008). This figure does not include Green Card holders, who only have health care coverage (17.9% of the population in 2007) (SSI, 2008). The benefit package is quite comprehensive in Turkey, covering both inpatient and outpatient care. There are co-payments for pharmaceuticals (20% of the prescription for active workers and 10% for retirees) and medical devices such as prostheses.Öğe Introduction(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaTurkey is located in the northern hemisphere and bridges Europe and Asia. The bordering countries are Greece and Bulgaria to the north-west, Georgia and Armenia to the north-east, the Islamic Republic of Iran in the east and the Syrian Arab Republic and Iraq in the south-east (Fig. 1.1). The country is surrounded by the Aegean Sea to the west, the Black Sea to the north and the Mediterranean Sea to the south. The Marmara Sea, with its passages in Çanakkale Straits (Dardanelles) and Bosphorus, connects the Aegean Sea to the Black Sea.Öğe Physical and human resources(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaThe Ministry of Health’s General Directorate of Curative Services is responsible for licensing health care institutions and major medical technologies in Turkey. The Directorate also is in charge of establishing health care institutions of the Ministry of Health and increasing their capacity; licensing private and public sector facilities (except those affiliated with the Ministry of National Defence); and carrying out authorizations and certification proceedings for imported medical devices (Decree No. 181, Article 10, 1983).Öğe Preface(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaThe Health Systems in Transition (HiT) series consists of country-based reviews that provide a detailed description of a health system and of reform and policy initiatives in progress or under development in a specific country. Each review is produced by country experts in collaboration with the Observatory’s staff. In order to facilitate comparisons between countries, reviews are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a report.Öğe Principal health reforms(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaHealth care reform has been given the utmost importance on Turkey’s policy agenda since the late 1980s. In 1989, the SPO’s Master Plan Study (SPO, 1990), which was developed through a World Bank loan, introduced new concepts to the Turkish health care system. The Plan suggested splitting the functions of purchasing and provision, developing an internal market, implementing general health insurance, formulating a family medicine system at the primary health care level and giving autonomy to state hospitals. From 1990 to 1993, intensive efforts were undertaken to reshape the health care system in a way that reflected global trends and approaches. The World Bank had an important role in developing this process. The National Health Policy (Ministry of Health, 1993) presented the first comprehensive analysis of priority health care policies and also set out future strategies. However, a decade of political and economic instability (1993–2003) led to reform proposals that remained as blueprints with no concrete steps for implementation.Öğe Provision of services(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaThe Constitution gives the Ministry of Health the responsibility to protect and improve public health in Turkey. However, certain aspects of public health require intersectoral collaboration. As will be discussed below, the Ministry of Health leads the process in areas where this collaboration is needed. The Ministry of Health undertakes this responsibility both through its centralized departments and through the provincial health directorates. Prior to the full implementation of the family practitioner scheme nationwide (at the end of 2010), health posts and health centres in rural areas undertook the majority of disease prevention, health education and other public health-related measures. Now, these activities are carried out by population health centres. Centrally, both the General Directorate of Primary Health Care Services and the General Directorate of Maternal and Child Health and Family Planning are responsible for public health. In addition to these, the departments for malaria control, cancer control and tuberculosis control in the Ministry of Health and the Refik Saydam Hygiene Centre Presidency also undertake public health measures.Öğe Regulation and planning(WHO Regional Office for Europe, 2011) Tatar, Mehtap; Mollahaliloğlu, Salih; Şahin, Bayram; Aydın, Sabahattin; Maresso, Anna; Hernández-Quevedo, CristinaThis chapter outlines the principles and practice of regulation and planning in the Turkish health care system. Table 4.1 outlines the main legislative arrangements upon which the health care system is based. As can be seen from Table 4.1, some of the basic legislation used in health care is quite old; however, the dates mentioned are the acceptance dates of the laws and each has undergone several revisions over time, reflecting changes in the health care environment. In the Turkish health care system, decrees and directives also play an important role. Laws create the main legislative framework, and successive decrees and directives may be issued for the purposes of implementation.
