Healthcare Services In Turkey Research Articles

The impact of the COVID-19 pandemic on satisfaction with healthcare services in Türkiye

ObjectivesThis study aims at evaluating whether the healthcare system in Turkey performed well or not from the perspective of patients during the COVID-19 pandemic. MethodsFor this purpose, we compare the satisfaction with healthcare services pre-pandemic and during the pandemic. We utilize the Life Satisfaction Survey conducted by Turkish Statistical Institute (TurkStat) between 2013 and 2021 and employ probit regression method. ResultsThe research results do not show any change in satisfaction with healthcare services in the pandemic years of 2020 and 2021. In addition, the satisfaction with healthcare services of people with health conditions, those without health insurance, and those whose premiums are covered by the state (green card holders) did not decrease during the pandemic period. The analysis results reveal that the satisfaction of people over 65 years old and those having health conditions with healthcare services increased during the pandemic period. ConclusionWhen the findings are evaluated as a whole, we can conclude that Turkey performed well from the users’ perspective during the pandemic. Public interest summaryThis study analyzes the impact of the pandemic on satisfaction with healthcare services in Turkey. To do this, we utilize Life Satisfaction Survey between 2013 and 2021. The regression results indicate that satisfaction with healthcare services has not changed during the pandemic. Moreover, we report an increase in satisfaction scores for elderly and those with health conditions in the pandemic years. We also find satisfaction of people without health insurance, and those whose premiums are covered by the state (green card holders) does not change. Our analysis points Turkey did well in managing pandemic period in terms of healthcare services satisfaction.

Electronic Health Record Adoption in Oral and Dental Health Centres in Turkey

The digitalisation studies in public hospitals in Turkey started with the Health Transformation Program in 2003. The Ministry of Health has been measuring the dissemination of meaningful usage and adoption of electronic health record (EHR) using Electronic Medical Record Adoption Model (EMRAM) and Outpatient Electronic Medical Record Adoption Model (O-EMRAM). Using a comprehensive survey, our study intends to measure the stage of EHR adoption in oral and dental health centres (ODHCs) providing primary healthcare services in Turkey. The results obtained were classified by basic and comprehensive EHR functions and benchmarked against the studies addressing EHR adoption in primary healthcare institutions of other countries. In 2021, 167 ODHCs/oral and dental health hospitals (ODHHs) actively operating in Turkey completed the O-EMRAM survey. The data obtained from the survey results were analysed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. It is observed that 59 (40.7%) of ODHCs/ODHHs have comprehensive EHR functions, while the remaining 86 (59.3%) have basic EHR functions. Under these circumstances, it can be stated that all ODHCs/ODHHs in Turkey use at least basic EHR functions. All ODHCs/ODHHs in Turkey have at least basic EHR functions. The integration of e-prescription, electronic authorisation system and e-Pulse used throughout Turkey and Health Information Management System Society (HIMSS) used in ODHCs/ODHHs can be listed as one of the decisive factors in this result. ODHCs/ODHHs still have a long way to go in adopting EHR, but the current circumstances are also promising. It is considered that this study will serve as a baseline for future measurements and produce a notable result for decision-makers.

LGBTI + Persons’ Experiences, Expectations, and Suggestions for Improving LGBTI + Healthcare Services in Turkey: A Qualitative Study

This study aimed to explore the experiences, expectations, and suggestions of LGBTI + persons from the health system in Turkey and their views on what kind of a health system they wish to have. Qualitative descriptive research was used as one of the qualitative research methods. Thirteen LGBTI + persons living in different provinces of Turkey were interviewed. While selecting the participants, the maximum diversity sampling method, one of the purposive sampling methods, was employed. Attention was paid to interview participants from different groups among LGBTI + persons (three gay men, five trans men, two trans women, one queer person, one lesbian person and one bisexual person). Thematic analysis was performed for the analysis of individual in-depth interviews. The expectations of the participants were grouped under three themes: (a) institutional functioning, (b) legal regulations, and (c) healthcare professionals. Each theme and 9 sub-themes demonstrate what kind of a health system LGBTI + persons want to have. Some of the common expectations of the participants are having LGBTI + friendly and free healthcare services, adoption of anti-discrimination laws, and receiving healthcare from professionals with LGBTI+-specific healthcare knowledge. Changes to be made by policy makers, hospital administrators and healthcare professionals in line with the results obtained from the research can improve the experiences of LGBTI + persons in terms of receiving a higher quality healthcare service.

Efficiency Analysis of Syrian Refugees' Healthcare Services in Turkey and Other 3RP States.

Access to healthcare for refugees is often contextually and conceptually diverse. This study set out to evaluate the efficiency of the healthcare services provided for Syrian refugees in Turkey and other refugee response and resilience plan (3RP) states. Data envelopment analysis is utilized for efficiency analysis using primary healthcare system indicators. Efficiency is broken down into pure technical efficiency and scale efficiency to identify causes of inefficiency. Normative analysis is used to employ a teleological approach to better understand current refugee healthcare policies. The findings show a decline in the overall efficiency for Turkey and other 3RP states. However, Turkey's operational practices could be a model for other 3RP states due to its relatively high pure technical efficiency. Scale inefficiency negatively impacts the overall efficiency of Turkey's service, while other 3RP states exhibit a rather consistent performance. The study concludes that Turkey's healthcare system for refugees is inefficient, resulting in inadequate access for Syrian refugees. As such, operational and scale efficiency must be synergized for Turkey to fulfill its obligation to provide adequate healthcare for Syrian refugees. Additionally, COVID-19 was found to have exacerbated the challenges Syrian refugees face accessing healthcare. Policy recommendations have been made in line with the findings of the study.

A Glance Into Healthcare Delivery During COVID-19 Pandemic: A Survey Among Turkish Medical Doctors.

The coronavirus 2019 (COVID-19) pandemic had an enormous impact on healthcare delivery globally. We conducted a cross-sectional online survey in Turkey to evaluate the impact of COVID-19 on healthcare services in Turkey. A 35-item anonymized online survey was completed by HCPs (medical doctors, MD) who continued their clinical practice during the COVID-19 pandemic in Turkey, regardless of their specialties or degrees. Overall, 209 HCPs participated in the study. Forty-two percent of the participants stated that their current workload intensity has been increased compared with the pre-pandemic era. More than half of the participants (54.6%) were using telemedicine services during their clinical practice, however, the effectiveness of telemedicine for first-time patients and follow-up patients was rated as low. The majority of participants (59.3%) reported that during the peak period of the pandemic, they encountered only a small variety of cases, other than COVID-19. Fifty-two percent of the participants agreed that they occasionally had patients who received misdiagnosis in the first admission due to the suspicion of a possible COVID-19 infection predominating the diagnostic process (eg., not excluding COVID-19 even though the PCR test is negative). For the distribution of possible late-diagnosed diseases, 25.8% of HCPs selected chest diseases, followed by infectious diseases, heart diseases, and cancer. In general, participants agreed that there was an increase in the negligence in the follow-up of various diseases and/or complication rates due to COVID-19 pandemic. Sixty percent of the HCPs agreed that HCPs are being much more rigorous to diagnose/treating COVID-19 than other important diseases. Fifty-seven percent of the participants stated that the diagnosis and follow-up of chronic diseases are affected, while 57.9% of the HCPs stated that some diseases that show similar signs and symptoms as COVID-19 are not diagnosed correctly during COVID-19 pandemic. Findings from this study emphasize that COVID-19 pandemic has significantly caused delayed diagnoses and interruption in the management of chronic diseases, and also increased the risk of missing out the diagnosis of non-COVID-19 diseases. The study genuinely aims to yield the floor to a permanent improvement in post-pandemic clinical management and it also shows the need for a focused approach in distinct areas of medical care. Policymaking is required to drive changes to better support HCPs in Turkey.

The effect of hosting 3.4 million refugees on native population mortality

As of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was utterly broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives. We examine the effect of Syrian refugees on the health care resources in Turkey and on natives’ mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of an adverse effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the refugees’ pressure on the health care services in Turkey and the government's response to understand our findings on mortality outcomes.

Chronic and rare disease patients' access to healthcare services during a health crisis: The example of the COVID-19 pandemic in Turkey.

ObjectiveThe restructuring of healthcare provision for the coronavirus disease 2019 (COVID‐19) pandemic caused disruptions in access for patients with chronic or rare diseases. This study explores the experiences of patients with chronic or rare diseases in access to healthcare services in Turkey during the COVID‐19 pandemic.MethodsSemi‐structured interviews were conducted with representatives (n = 10) of patient organisations (n = 9) based in Istanbul. Thematic analysis with an inductive approach was conducted to analyse the responses obtained through the interviews.ResultsThe lack of clinical information at the beginning of the pandemic caused fear among patients with chronic or rare diseases. Patients experienced obstacles in access to healthcare services because of the overcrowding of hospitals with COVID‐19 patients. Some treatment procedures were cancelled or postponed by physicians. Of these procedures, some were medically vital for those patients, leading to or exacerbating further health problems. The most positive measures that patients identified were where the Social Security Institution introduced regulations to facilitate access to prescribed medicine for chronic patients. Information exchange between the doctors and their patients was important to alleviate the uncertainty and reduce the anxiety among patients.DiscussionAccess problems experienced by patients during the COVID‐19 pandemic were a complex mix of factors including shortages and physical barriers, but also perceptions of barriers. The findings of this study show that patient organisations can provide insights on disease‐specific experiences and problems that are very valuable to improve access to healthcare services to achieve the universal health coverage target. Hence, this study emphasises the inclusion of patient organisations in decision‐making processes during times of health crises.Public ContributionRepresentatives of patient organisations participated in the interviews.

Economic Growth and Health Expenditure Analysis for Turkey: Evidence from Time Series

This study aims to investigate the effects of health expenditure on economic growth in Turkey. For this purpose, time series data of Turkey over the period 1975–2018 were evaluated. Moreover, household consumption, life expectancy at birth, trade, and foreign direct investments were added as control variables. Cointegration analysis was performed to test whether all variables are cointegrated in the long term. Causality test was successfully employed to investigate the relationship between health expenditure and economic growth in the short term. The achieved results exhibited that Johansen Cointegration test results suggest the existence of cointegration among all variables in the long term. In addition, the Granger causality test results indicate unidirectional causality from health expenditure to economic growth in the short term. Existence of a long-term relationship among related variables and a short-term relationship between health expenditure and economic growth displays the importance of investments on health care services in Turkey. Therefore, investments in the health sector should be encouraged and the share allocated by the government for health expenditures from the budget should be increased in Turkey.

MARCOS technique under intuitionistic fuzzy environment for determining the COVID-19 pandemic performance of insurance companies in terms of healthcare services

Assessing and ranking private health insurance companies provides insurance agencies, insurance customers, and authorities with a reliable instrument for the insurance decision-making process. Moreover, because the world’s insurance sector suffers from a gap of evaluation of private health insurance companies during the COVID-19 outbreak, the need for a reliable, useful, and comprehensive decision tool is obvious. Accordingly, this article aims to identify insurance companies’ priority ranking in terms of healthcare services in Turkey during the COVID-19 outbreak through a multi-criteria performance evaluation methodology. Herein, alternatives are evaluated and then ranked as per 7 criteria and assessments of 5 experts. Experts’ judgments and assessments are full of uncertainties. We propose a Measurement of Alternatives and Ranking according to the Compromise Solution (MARCOS) technique under an intuitionistic fuzzy environment to rank insurance companies. The outcomes yielded ten insurance companies ranking in terms of healthcare services in the era of COVID-19. The payback period, premium price, and network are determined as the most crucial factors. Finally, a comprehensive sensitivity analysis is performed to verify the proposed methodology’s stability and effectiveness. The introduced approach met the insurance assessment problem during the COVID-19 pandemic very satisfactory manner based on sensitivity analysis findings.

An application of the behavioral model to the utilization of health care services in Turkey: A focus on equity

The aim of this study is to investigate the equity phenomenon, which can be defined as an equal treatment for equal need irrespective of socio-economic status, in the utilization of health care services in Turkey (for out-patient and in-patient treatment services, separately) in the context of the behavioral model. We have used the ?Health Surveys? obtained from the Turkish Statistical Institute for 2010, 2012 and 2014. The equity phenomenon and the determinants of the health care utilization are investigated by using the probit model. The findings indicate that the need variable has the largest marginal effect in magnitude for all types of health care. This implies that the health system structure in Turkey is based on need and, therefore, equity exists in the utilization of health care services. We have also found that health insurance has the second largest marginal effect after the need variable. This means that policy makers should focus on enabling factors, especially the coverage of health insurance and the level of income to increase health care utilization of the disadvantaged segments of the population.

Home Health Care Services in Turkey: The Sample of Bolu

Objective: This study was planned with the aim of determining the clinical characteristics of patients served by the Bolu Home Health Care Services (HHCS), their reasons for making use of home health care services, and the distribution of care. Method: The sample of this descriptive study consisted of 386 patients to whom service was being provided by Bolu HHCS. A Patient Information Form created by the researchers by examining the relevant literature was used to collect data. Numbers, percentages and mean distributions were used in the analysis of data. Results: The mean age of the individuals receiving HHCS who participated in the study was 61.6+10.4 years; a majority were female; 50.8% were married and 78.0% lived with their families, and for 70%, their children had applied to HHCS. It was found that most of the patients (96.1%) were satisfied with the home care services, 97.6% had no expectations beyond the current services, 80.1% had a chronic illness, with circulatory system diseases the most common; they most often made use of physical examination, blood collection and wound dressing services, and most were old and dependent patients. Conclusion: It was seen in the light of the results of the study that it is important to plan home health care services especially for dependent and semi-dependent old people, to develop protective health services relating to the risks of early stage stroke and cardiovascular disease, and to improve rehabilitation services.

Exploring Patient Experiences of the Internal Market for Healthcare Provision in Turkey: Publicness under Pressure

Abstract The establishment of internal markets for healthcare provision in publicly-funded healthcare systems brings forth a number of new regulatory challenges. During the 2003 healthcare reform in Turkey, universal health coverage (UHC) was implemented concurrently with the establishment of an internal market for service provision, resulting in an increase in private sector activity. In this context, this paper explores how, in the Turkish case, the macro-level adoption of an internal market model for healthcare provision has shaped patient experiences at the micro-level in their ability to receive treatment in private hospitals offering publicly-funded services (PHOPS). It also examines the influence of the internal market on the realised publicness of healthcare services in Turkey. Data for the study were obtained from patient complaints that appeared on a private online platform and 20 patient interviews. These showed that patients sometimes face significant challenges, including pressure to make informal payments, when accessing their entitlements, which is evidence of the erosion of publicness in a hybrid healthcare system. These challenges emerge from information asymmetry between patients and providers; a large space for PHOPS to manoeuvre when deciding to register patients as insurance holders or private patients; and the ineffective public regulation of the internal market.

Equity in utilization of health care services in Turkey: an index based analysis.

Equity in the use of health care services is an issue which has increasingly been on the health policy agenda over recent years in both middle- and low-income countries. The purpose of this study was to investigate the degree and progress of equity in health care utilization in Turkey during 2008-2012. Wed use data from health surveys (2008, 2010, 2012) conducted by the Turkish Statistical Institute. The concentration index (CI) and the horizontal equity index (HI) were calculated as a measure of equity, and a Blinder-Oaxaca decomposition analysis was applied. The general practitioner (GP), specialist and inpatient visits display a pro-poor orientation. Averages of the CI and HI indices for 2008-2012 were 0.74 and -0.17 for GP visits, 0.75 and -0.13 for specialist visits, 0.83 and -0.31 for inpatient visits. Our findings indicate that health care utilization in Turkey appears to have become equitable over the years; however, the sustainability of equity is an issue of concern.

Evaluating the performance of primary health care services in Turkey and the use of the Primary Care Assessment Tool (PCAT): lessons from Brazil in a national random household survey

Like Brazil, Turkey spends about $1,200 percapita on health. In demographic terms, othersimilarities can be observed: the populationover 65 years old is close to 9.0% in bothcountries, away from the demographic trendof aging in Europe, where the OECD averagefor a set of 36 countries is 17.4%.However, the share of healthexpenditure in relation to GDP is different: inthe first 9.2% and in the second only 4.2%,although, this percentage in the case of Turkeyconsiders that most of the spending comesfrom public sources (about 80%), while inBrazil only 43%

Sağlık Hizmetlerinde Yerinden Yönetimin Hizmet Performansı Üzerindeki Etkisi: Türkiye Örneği

The research object of the current study is to examine the impact of regional decentralization model on the performance of public healthcare services in Turkey. The efficiency of public hospitals has been determined by the type of healthcare services, “general healthcare” and “oral-dental healthcare”, with Data Envelopment Analysis at the level of 81 provinces (NUTS-3) for 2014 and 2017. By continuing the transition to decentralization in public health services, the possible effects on the regional health level were analyzed. Notably, this study proposes a two-dimensional approach, one of them is to determine public hospital performance at province level, and the other one is to examine whether the decentralization of health services had a significant effect on the efficiency of bounder (contiguity) provinces other means to catch spillover between performance scores. In the results of the study, the efficiency scores of 81 province hospitals differed significantly according to the provision of service patterns. And the relative efficiency scores are increasing with decentration approaches when is compared 2014 and 2017. Furthermore, there is a positive spatial spillover between every two types of hospital service province unit among public hospitals. This means that the hospital efficiency in the contiguous province has an effect of increasing the efficiency score of the region. This suggests that the decentralization model in public health services may have the potential tool to create a positive impact on the health level in the future if supported by progressive economic and health policies for developing countries.

The Effect of Hosting 3.4 Million Refugees on the Health System in Turkey and Infant, Child, and Elderly Mortality Among Natives

As of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was completely broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives (5.3 to 2.3). We examine the effect of Syrian refugees on the health infrastructure in Turkey and on natives' mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of a negative effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the pressure that the refugees put on the health care services in Turkey, as well as the government's response, to understand our findings on mortality outcomes.

Assessing Horizontal Equity in the Utilization of Mental Healthcare Services in Turkey: A Gender Perspective.

Equity in healthcare services utilization is on the agenda for both research and policy makers, especially after the Millennium Development Goals. Despite the recognition of the importance of mental health services utilization, equity in terms of access has not been widely researched. This study aims to investigate the degree and progress of equity in mental healthcare services utilization in Turkey from a gender perspective. The Horizontal Inequity (HI) index is calculated using a nationally representative dataset from the Health Surveys (2014 and 2016) conducted by the Turkish Statistical Institute. The index is calculated for males, females, and all individuals separately to identify gender differences. The results from the HI index indicate pro-poor inequities in the utilization of mental healthcare services in Turkey for both 2014 and 2016. For all individuals, the standardized HI indices were found to be - 0.3320 and - 0.3374 for 2014 and 2016, respectively. In 2014, the standardized HI indices were calculated to be - 0.3504 and - 0.3173 for males and females, respectively. In 2016, the HI indices were found to be - 0.3241 and - 0.3541 for females and males, respectively. There is a great need for gender-focused policies to improve horizontal equity in mental healthcare services utilization.

Evaluation of individuals’ satisfaction with health care services in Turkey

ObjectivesTo demonstrate whether features related to the institution and service provider affect individuals’ level of satisfaction regarding the public health care services they receive. MethodsThis study used hierarchical regression analysis and data from the Life Satisfaction Statistics survey implemented by the Turkish Statistical Institute, with 9,397 people in 2015. Level of satisfaction with public health care services was the dependent variable. Having any problems with securing an appointment for examination and analyses, cleanliness/hygiene, attitudes of physicians and nurses/caregivers towards patients, costs of examination and analyses, prices of medications, queuing for examination and/or analyses, co-payments for examination, and if they think the number of physicians and medical personnel is adequate were the independent variables. ResultsSecuring appointments, costs of examinations and analyses, inadequate number of physicians and medical personnel, prices of medications, queuing, cleanliness/hygiene, attitudes of physicians and nurses/caregivers, and co-payments were important determinants of individuals’ level of satisfaction with health care services. ConclusionsThis study revealed that despite the development in the health care sector in Turkey, individuals continue to experience problems with various areas related to health care services, and accordingly, further improvements are needed.

LGBT+ Individuals' Perceptions of Healthcare Services in Turkey: A Cross-sectional Qualitative Study.

When accessing healthcare services, LGBT+ individuals are often exposed to segregating and marginalizing discourses. Knowledge about how such experiences are reflected in the moral world of LGBT+ individuals living in Turkey is limited. This study examined LGBT+ individuals' lived experiences when utilizing healthcare services. The findings are discussed in terms of moral discourses related to LGBT+ individuals' gender identity and sexual orientation. A qualitative field study was conducted using semi-structured interviews with fifty-five LGBT+ individuals from Turkish cities who were in contact with various non-governmental organizations that conduct studies on gender identity and sexual orientation. A questionnaire was administered with items on participants' demographic information, experiences, behavioural patterns, and knowledge regarding healthcare services. The data were analysed thematically. The findings were evaluated within the framework of "access to healthcare service" theme related to "healthcare service demand" context. Additionally, the "interaction with physicians" theme was addressed in the context of "physician-patient/counselee relationship." LGBT+ individuals state that they are exposed to stigmatizing and segregating discourses by healthcare professionals, which might pose an obstacle for adaptive health-seeking behaviours. These results suggest that physicians' professional approach has a considerable influence on LGBT+ individuals' capacity for utilizing healthcare services.

An Assessment of the Refugees' Access to Labor and Housing Markets and Healthcare Services in Turkey from Syrian Refugees' Perspective

In March 2011, Syrians engaged in peaceful protests as a means of demanding socioeconomic reform. However, the regime’s response prompted the start of a civil war, which has caused hundreds of thousands of civilians to lose their lives and millions more to seek asylum in neighboring countries, with Turkey serving as the destination for most of Syria’s refugees. This study assesses the Syrian refugees’ experiences as they attempt to navigate the Turkish labor and housing markets and access healthcare services. By conducting semi-structured interviews with 60 Syrian refugees in Hatay and Gaziantep provinces of Turkey, this study has determined that the Syrian refugees in Turkey have been forced to work for less pay than the country’s citizens and without insurance, expected to pay high rents and deposits for housing, and they have experienced numerous problems in accessing healthcare services in Turkey such as having difficulty in accessing proper translation services.