In Turkey, New Goals for Health Care

Abstract

In Turkey, New Goals for Health Care The opportunity and ability to enjoy a healthy life is, indisputably, a basic human right. As a consequence, governments are responsible for delivering health care to all. Within this framework, physicians must assume the ethical responsibility for doing their utmost to achieve this goal. Health Care Delivery in Turkey In the early years of the Turkish republic, founded in 1923, health resources were extremely limited and epidemics repeatedly scourged the nation. The early governments of the new republic gave priority to controlling communicable diseases and improving the health care system. Basic health care resources have been greatly expanded. Despite a nearly fourfold increase in Turkey's population between 1927 and 1987, the overall physician-patient ratio has improved dramatically, from one physician per 12,842 persons in 1927 to one per 1,360 in 1987. There has been an equally significant improvement in the ratio of nurses and midwives to patients (from 1:8,935 to 1:764), and the number of available hospital beds has risen from 3,615 to 128,146.[1] At present, the system of health care delivery in Turkey is reasonably well-organized. The 3,142 Ministry of Health-sponsored health centers in the rural areas deliver integrated preventive and curative services. Each center serves an average population of 7,000 and is staffed by one physician and three to five nurse-midwives.[2] Primary health care in the cities and towns, on the other hand, is delivered by private practitioners in their offices, in dispensaries, and in the out-patient units of hospitals. Secondary care is administered by publicly owned hospitals. They include the hospitals of the Ministry of Health (MOH), Armed Forces, State Universities, and Social Security Agency (SSA). Only 4 percent of the hospital beds in Turkey are in private health care institutions. Both the government and the SSA employ physicians and other health personnel on a salaried basis. Sixty-seven percent (two-thirds) of Turkey's physicians are in government employ, but retain the right to practice privately after working hours. One-third of Turkey's total number of physicians work exclusively in private offices or in private hospitals. Sixty percent of the population is fully insured, either by the government or the SSA. Public servants, public pensioners, and their dependents enjoy free-of-charge care in hospitals affiliated with the MOH. To enjoy similar service in hospitals and dispensaries belonging to the SSA, one must be employed on a wage basis; pensioners and dependents may also avail themselves of these services. As for the urban self-employed, their social security organization, BAG-KUR, pays the MOH or SSA hospitals for service delivered to their members, pensioners, and dependents. The rural population and transiently employed individuals in the cities and towns are not insured at present, though the government plans to incorporate them into the insurance scheme in the near future. Patients, insured or not, who are willing and able to pay for health care may freely choose their own physicians or hospital. They have access to care at no cost, but they may not choose their physicians or hospitals if they wish to enjoy free-of-charge care. Persons insured by the SSA must apply to SSA hospitals and dispensaries. Public servants are served in the health centers and hospitals of the MOH. Ambulatory care for noninsured persons is free of charge in the health centers of the MOH, except medication. They must also pay for hospital care if they cannot demonstrate indigence. The costs of hospital care are assessed on a uniform fee-for-service basis regardless of who pays for care. Personnel shortages and lack of health facilities are not the primary limiting factors in the satisfactory provision of health care for all. Rather, inadequate finances, poor management, and limited popular use of available services are the major problems to be resolved if the health standards prevailing in Turkey are to be elevated. …