Health Transformation Program Research Articles

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.

How do Public-Private Partnerships Affect Public Service Principles? A Case of City Hospitals in Türkiye

Public-private partnership (PPP) policies have been on the Turkish Government’s healthcare agenda for a long time. Türkiye has implemented a series of policies with various elements of neoliberal reforms over the last 20 years and the Turkish Government initiated the PPP policy in 2013 as the final step of the Health Transformation Program. This article reviews the policy process that led to extensive collaboration with the private sector in public health and also examines the effect of the policy on the principles of public service. Türkiye’s policy experience has elements that reinforce the principles of continuity, variability, and equality in many ways. However, this policy was found to have weakened the long-term financial viability of healthcare and led to its fragmentation and the government eventually abandoned this policy in the construction of new hospitals. Türkiye’s experience demonstrates that governments seeking to establish sustainable PPP policies for healthcare must consider the unique dynamics inherent to public service.

AN EVALUATION OF THE TURKISH GENERAL HEALTH INSURANCE WITHIN THE SCOPE OF THE HEALTHCARE REFORM

In line with the recommendations of the World Bank, the Health Transformation Program [Sağlıkta Dönüşüm Programı] was accepted in Türkiye in 2003. Within this scope, reform movements in healthcare delivery were initiated. A universal health insurance model (named general health insurance) was accepted with the Social Insurance and General Health Insurance Act No. 5510 [5510 sayılı Sosyal Sigortalar ve Genel Sağlık Sigortası Kanunu] adopted in 2006. General health insurance, which came into effect gradually since 2008, fundamentally changed the system of benefiting from health services, which had been built as employment-oriented until then. General health insurance aimed to cover not only those included by social insurance but also all citizens or foreigners residing in Türkiye. In the general health insurance system, the principle of purchasing health services from health service providers (providing the financing of health services) has been adopted instead of providing them by the Social Security Institution [Sosyal Güvenlik Kurumu]. This study aims to evaluate the healthcare reform carried out in Türkiye through general health insurance. Therefore, the study first includes the healthcare (and social security) reform in Türkiye and then explains the implementation of general health insurance. Afterward, the study evaluates whether general health insurance meets the healthcare reform targets today and determines the problematic aspects of general health insurance.

The Relationship Between the Health Transformation Program and Health Expenditures: Evidence From an Autoregressive Distributed Lag Testing Approach

ObjectivesAs health expenditure increases every year, countries try to provide accessible health services to society and try to protect individuals from the expenses they cannot overcome by investigating the reason for this increase. Especially with the arrangements made in the health systems in developing countries such as Turkey, it has been tried to take the control of dramatic increases in health expenditure. Based on this issue, in this study, we aimed to evaluate the effect of income per capita, annual inflation, and health reform called as Health Transformation Program on the health expenditure per capita in Turkey. MethodsThis study reflected the effects of income, inflation, and the reform on the total health expenditure through the autoregressive distributed lag. This study covered the years between 1985 and 2016 for Turkey. ResultsAs a result of this study, there was a positive relationship between health expenditure and income and a negative relationship with the reform (P < .05). ConclusionAccording to the results of this study, it is suggested that health expenditures can be kept under control with improvements such as encouraging individuals to use more primary healthcare services than curative health services and increasing the quality of service without compromising the equity in financing.

Basic electronic health record (EHR) adoption in **Türkiye is nearly complete but challenges persist

BackgroundThe digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals’ electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021.MethodsIn 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured.ResultsWe found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%).ConclusionsAlthough there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye.

Palyatif Bakımda Sosyal Çalışmacı Varlığı

The employment of social workers in the health sector, who work in different institutions in terms of service areas, increased with the Health Transformation Program that started in the 2000s. There are some regulations that are accepted as a turning point in terms of the existence of social work in health institutions. The Patient Rights Regulation published in 1998 is one of them. Between 1998 and 2011, social workers were actively engaged in patient rights practices. In the process that started with the publication of the Medical Social Work Implementation Directive in 2011, the way for social workers to engage in professional interventions within the scope of medical social work has been paved. Today, there are issues regarding the units that social workers will take part in, in the published guidelines for the delivery of specific health services and in the standards determined for total quality management in health. Therefore, the need for specialization in the field of medical social work is increasing day by day. In this study, explanations about the field in the medical social work literature, the legislation on palliative care services and the standards regarding total quality management practices were examined. With this study, it is aimed to bring up the specialization and supervision needs of the social work profession, whose existence is accepted in the field of palliative care, and to emphasize the necessity of improving the professional infrastructure for the planned services. Keywords: Medical Social Work, Palliative Care, End of Life Care, Quality Standards in Health

Assessment of the Turkish Health Transformation Program With Data Envelopment Analysis

Governments are obliged to deliver basic healthcare to individuals in an equal, safe, and efficient environment. Therefore, they occasionally make improvements and reforms in the health policy. The health transformation program (HTP) is the most comprehensive reform about the health sector in Turkey. In this article, the aim of our article is to analyze the success, efficiency, and sustainability of HTP; in this context, we discussed two different case studies. First, Turkey's efficiency was evaluated during the years 2003–2016 in the health sector with data envelopment analysis. According to the first case study, Turkey was inefficient during the years 2003–2012 because of the investments, the following years, these investments returned and it became efficient. In the second case study, we handled Turkey and nine organization for economic cooperation and development (OECD) countries, which are similar in terms of gross domestic product. We compared relative efficiencies of Turkey with mentioned OECD countries and observed that Turkey is efficient except in 2007. The main reason for this is that the health and financial expenditures took the highest value in that year. Besides, Turkey took fifth place in the ranking among ten countries in terms of the average efficiency score.

Innovation efforts in the supply of health services after the Health Transformation Program in Türkiye

Health innovation is defined as innovations and improvements in health policies, health system, health products and services, health technologies and service delivery methods in order to improve people’s health. The emphasis on innovation in healthcare has been increasing in recent years due to challenges such as rising costs and an aging population. Innovation, which is of vital importance for the health sector, becomes one of the main determinants of social welfare and quality of life with the innovations and advances it brings. Innovative products and services increase the possibilities of early diagnosis and treatment, thus preventing future costs. In this way, alternative solution options can be created for the benefit of the patient, with the increase efficiency of the health system in the long term. In addition, positive externalities can be provided to many health related sectors. With innovation, it is possible to produce cheap and accessible solutions by using advanced technologies in health services where resources are very limited.In this study, it is aimed to draw a conceptual framework on innovation and health innovation and to explain the innovations in health service supply within the framework of the Health Transformation Program put into practice in 2003. In recent years, significant changes have been made in the Turkish health system, especially in the financing, presentation and organization of the service within the scope of health innovation. Although significant progress has been made in the health system with the impact of these changes, there is still some work to be done. As a result of the study, what has been done has been evaluated and recommendations and suggestions have been made about what should be done.

ANALYSIS OF THE SOCIAL SECURITY INSTITUTION’S HEALTH SPENDING: AN ARDL BOUNDS TEST APPROACH

ANALYSIS OF THE SOCIAL SECURITY INSTITUTION’S HEALTH SPENDING: AN ARDL BOUNDS TEST APPROACH&#x0D; Yunus Emre KARATAŞ, Metin DİNÇER &#x0D; &#x0D; With the health transformation program, universal health insurance was introduced. Thus, it became the most significant health service purchaser social security institution. The services provided by hospitals began to occupy an important place in the expenditures of the social security institution. Thus, the study aims to predict and model the effect of functional characteristics of health facilities on Social Security Institution (SSI) health expenditures in Turkey. While collecting the data used in the study, the hospital’s service levels as functional characteristics were considered, and the data between 01/2009 and 05/2020 were analyzed. Auto-Regressive Distributed Lag Model (ARDL) bounds test was used to analyze the presence of cointegration between variables in the short and long run. Long-run predictions show that while the secondary-level state hospitals reduce the health expenditure of the SSI, the tertiary-level state, university, and secondary-level private hospitals increase the SSI health expenditure. Measuring the services provided by hospitals and the benefits they provide to patients according to objective criteria will be the most significant indicator of the appropriateness of health expenditures.&#x0D; Keywords: ARDL Bounds Test, Reimbursement, Health Spending, Health Insurance, Social Security Institution&#x0D; Jel Codes: C32, G22, G28, H51, I13

Türk Sağlık Sisteminde İhtiyaç Duyulan Yeni Nesil Sağlık Reformları

Türk sağlık sisteminde 2000’li yılların başında Sağlıkta Dönüşüm Programı ile birlikte başlayan köklü değişim ve dönüşümlerin üzerinden 20 yıla yakın zaman geçmiş, bu süre zarfında yeni uygulamaları sistem test etmiştir. Yine bu sürede Türkiye’de ve dünyada sağlık sistemlerini etkileyecek önemli değişimler yaşanmıştır. Sağlık sisteminin dinamik yapısı sebebiyle sağlık reformları belli zamanlarda gündeme gelmektedir. Bu araştırmada, sağlık yönetimi alanında çalışan akademisyenlerin görüşleri çerçevesinde Türk sağlık sisteminde ihtiyaç duyulan yeni nesil sağlık reformu alanları tespit edilmeye çalışılmıştır. Yarı yapılandırılmış görüşme formlarıyla katılımcılara Türk sağlık sisteminin sorunları ve bu sorunları çözmek için hangi alanlarda reform yapılması gerektiği sorulmuştur. Bu kapsamda Türkiye’deki üniversitelerde çalışan 50 akademisyene ulaşılmış ve katılımcıların görüşleri tematik analize tabi tutulmuştur. Katılımcıların %94’ü sağlık sisteminin reforma ihtiyacı olduğunu belirtmiştir. Ortaya konulan sorunlardan hareketle reform alanları belli temalar altında toplanmış ve bu temalar üst başlıklarla ilişkilendirilmiştir. Sonuç olarak Türk sağlık sisteminde sağlık reformu ihtiyacı bulunmaktadır ve bu ihtiyaçlar yönetim ve örgütlenme, hizmet sunumu, ekonomi ve finansman, insan kaynakları ve mevzuat başlıkları altında toplanmıştır.

Does family medicine reduce household health expenditures: evidence from Türkiye.

Türkiye introduced a family medicine-centered primary healthcare model in 2005 as part of the Health Transformation Program, which aimed to reduce household healthcare expenditures, improve access to health services, and reduce the crowding-out effect in first-stage hospital institutions. We investigate the impact of the family medicine program on household healthcare expenditures in Türkiye, focusing on doctor visits, medication prescriptions, and hospitalization expenditures. Using data from a large representative household survey, we employ a difference-in-differences approach combined with the entropy-balancing matching technique. Our robust findings show that living in a province exposed to the family medicine program reduced household doctor visit expenditures by over 40 percent. We also find a significant negative association between the family medicine program and expenditures regarding doctor visits and medication prescriptions in the long run. Greater efforts are now needed to ensure the quality of services offered by family health centers, such as improving the doctor-to-patient ratio.

Health Transformation Program in Turkish Health System Reforms and Policy Processes

Health Transformation Program in Turkish Health System Reforms and Policy Processes

A Content Analysis For News Sites On The Operation Of The E-Pulse System

Günümüzde sağlık hizmetleri profesyonel işletmecilik bakış açısı ile şekillenmekte, bu anlamda organizasyonel ilerlemeler hızla artmaktadır. Ülkemizde 2003 yılında Sağlıkta Dönüşüm Programı ile birlikte güncel, teknolojik birçok yeni uygulamaya başlanmıştır. Sağlıkta Dönüşüm Programı’nın en önemli uygulamalarından biri de e-Nabız uygulamasıdır. Bu çalışmada 2015-2020 yıllara arasında ulusal web sayfalarında e-Nabız hakkında yapılan haberlere yer verilerek e-Nabız ile ilgili değerlendirmeler yapılmıştır. Çalışmada verilerin analizinde içerik analizi kullanılmıştır. Bu amaçla Google arama motoruna ‘e-Nabız’ anahtar kelimesi girilerek elde edilen 102 haber analize tabi tutulmuştur. Araştırma sonucunda, 9 farklı temaya yer verilmiştir. Haberlerde en fazla yer alan tema “fayda” ve en az yer alan ise “şikayet ve ödüller” olarak belirlenmiştir.

Assessing the Health-economic Crisis: The Case of Turkey

With the transition to neoliberalism, health has tended to be less regarded as a social obligation and become instead an individual responsibility. Hence, the issue of healthcare has gained a “health-economic” character by increasingly integrating health systems into the existing economic situation and market dynamics. Introduced in the 2000s, the Health Transformation Program (HTP) represents such an approach in Turkey. This article reports on field research carried out in Istanbul into the consequences of the HTP through a survey focusing on healthcare facility preferences and perceptions of the most critical problems of the healthcare system. The survey was carried out in 2019 with 5002 participants aged 25-65 using the face-to-face technique and frequency and Pearson chi-square analyses to summarise the findings. The privatisation trend is shown by public-to-private comparisons of health expenditures, hospital beds and admissions to hospitals, while the shift toward private hospitals is mitigated by participant preferences for the public healthcare schema, which remains the central pillar of the system. This preference is mainly based on the economical services provided in public hospitals, while the shift to the private system is argued to be largely impelled by increased patient density in the public system resulting from the neoliberal logic of the HTP. In conclusion, the need for a new reform program that will invest in the public nature of the Turkish health system is identified and addressed.

Analysing the implications of the Health Transformation Program on perceptions of the welfare state and public services in Turkey

Abstract The neoliberal structural adjustment policies in Turkey moved on to a new phase with the Health Transformation Program (HTP) that came into effect in 2003. In this study, 5,002 people, who used the services of the public hospitals in Istanbul, participated in a face-to-face survey to find out the impact of the HTP on the public's understanding of the welfare state and also the impact on their opinions over the healthcare services offered by the state. The data were classified into two topics: First, the transformation of the welfare state and second, the adequacy of the public healthcare services. Interestingly, the participants took a much more explicit stance against the neoliberal transformation of the welfare state than against the adequacy of the public healthcare service provision. The primary purpose of this research was to expose this paradox.

An Efficient Financial Profitability Performance Analysis of ODHCs Distribution in Turkey in the GIS Environment

Increased number of Oral and Dental Health Centers (ODHC) constracted underthe Health Transformation Program (HTP) in Turkey meets an important healthcare service requirement (Islıcık &amp;amp; Yar, 2018). to Evenly distribution of these dental services all over the country facilitates the public access and allows these services to gain continuity. Accesibility to sufficiently distributed dental service centers increases citizens physical and also mental well-beings , which is the therapeutic aspect of providening such public helth servises. Services social contribution is uncountable in terms of health issues for the people of the country. On the other hend they need quite amount og finantial support. Therefore, autorities in the country, especially healt service autority shoult consider running a financial performance analysis plan. In ODHC system, dentists are the main component for keeping the system running to provide an uninterrapted, continues and regular dental health services. For this reason, in the study, financial performance analyzes of existing ODHCs w.r.t the profitability per dentist were carried out by the help of Geographical Information Systems (GIS). Inverse Distance Weighting-IDW analyse technique provided by GIS is used to creat several performans distribution maps were produced w.r.t the several factors per dentist which are effective on the financial performans of ODHCs. For the seak of understandability, two most effective factors and the profitability as target factor are assigned to three primary colors for an effective visial interpretation of the relationship between the these most effective factors in terms of profitability per dentest in GIS enviroment. When the outputs are evaluated, a more understandable results on the relationship between the factors effecting the ODHCs’ financial performance are obtained by this visualiation techniqu for128 public ODHCs in Turkey, and the importance levels of the variables are then revealed in terms of ODHCs financial performances w.r.t. the locational data.

Job satisfaction in primary care after the health reform in a province of Turkey.

Health care reform, which started to be restructured after the Alma Ata Declaration, positively contributed to the development of primary health care administrations around the world. In Turkey, the Ministry of Health launched a "Health Transformation Program" by initiating the "Family Medicine Model" that influenced the working conditions and job satisfaction of primary health care workers (PHCWs). In this cross-sectional study, we evaluated job satisfaction levels of PHCWs and the factors affecting these levels a decade after the introduction of the health care reform in a province of Turkey. A total of 223 PHCWs participated in the study and completed a structured questionnaire that probed their views regarding their jobs and working conditions. Additionally, the short version of the Minnesota Satisfaction Questionnaire (MSQ) was administered to each participant. Participants were also asked to indicate whether they had any intention to quit their job, whether they liked their profession and workplace, and whether they were satisfied with their job. Bivariate analysis and binary logistic regression analysis were performed to determine predictors of job satisfaction. PHCWs were found to be generally dissatisfied with their working conditions and they declared that they were not sufficiently qualified to work in primary care. Their overall satisfaction was found to be moderate (3.21±0.67 out of 5) and the most important predictor for job satisfaction was found to be "Liking the workplace" (OR=3.07; 95% CI=1.46-6.45). The results indicated that environmental factors for job-related issues need to be examined more intensively for future planning and policy making in primary care.

Türkiye'de Sağlıkta Dönüşüm Üzerine Tarihsel Bakış

Turkey has undertaken major reforms since 2003 to transform and improve its healthcare system and health outcomes. This historical evaluation aims to shares experiences gained from Turkey’s Health Transformation Program (HTP) with scholars, policymakers, and the public. Until today from the establishment of the Republic of Turkey, the legal regulations and practices for improving health services have been explained, and the results have been evaluated from a historical perspective. Our review shows that HTP has created a model that achieved goals for universal health insurance, family medicine, access to health services, and service quality. HTP increased access to health services and affected service quality. However, it has not achieved full decentralization of secondary and tertiary healthcare providers. Public hospital associations and public health directorates were reunited under the Provincial Health Directorate. It is stated that various factors such as having three different bodies in administration, problems with the competence of appointed managers, unsettled organizational structure, more than one managers being appointed and frequent changes in office, dissatisfaction of healthcare workers, and problems in communication and coordination. Countries wishing to reform may be more productive in implementing decentralization considering in their own circumstances.

Regional Health Disparities in the Aftermath of Health System Reforms in Turkey

Starting in 2003, Turkey introduced major health system reforms through the Health Transformation Program (HTP). The HTP aimed to address inequities in health care services across Turkey. This study explores whether regional disparities in several health care indicators persist ten years after the HTP. For this purpose, we use administrative records and individual-level data from the only regionally representative survey, Life Satisfaction Survey, undertaken by the Turkish Statistical Institute in 2013. First, the disadvantaged North-East, Middle-East, and South-East Anatolia regions experienced the most substantial increases in all health inputs and the odds of receiving the non-contributory Green Card insurance was also higher in these regions. Yet, there is still substantial disparity across regions in many health care access and satisfaction indicators. Especially, the disadvantaged regions still have lower utilization, lower satisfaction with healthcare, and lower subjective health scores in 2013 even after accounting for a wide range of control variables. While the HTP enabled the provision of a generous insurance benefits package, there is still room for progress in regional distribution of other major indicators such as subjective assessment of health, healthcare utilization, and satisfaction with health services. To further reduce health inequities across regions, the quality aspect of healthcare provision needs to be prioritized.

Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England

BackgroundThe English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service.ObjectiveThis study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge.MethodsWe conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding.ResultsWe conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas.ConclusionsKnowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing.