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Health Care Systems in Transition I Health Care Systems in Transition i Health Care Systems in Transition Written by B. Serdar Savas, Ömer Karahan and R. Ömer Saka Edited by Sarah Thomson and Elias Mossialos Tur key 2002 The European Observatory on Health Care Systems is a partnership between the World Health Organization Regional Office for Europe, the Government of Greece, the Government of Norway, the Government of Spain, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Turkey ii European Observatory on Health Care Systems Keywords DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration TURKEY © European Observatory on Health Care Systems, 2002 This document may be freely reviewed or abstracted, but not for commercial purposes. For rights of reproduction, in part or in whole, application should be made to the Secretariat of the European Observatory on Health Care Systems, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. The European Observatory on Health Care Systems welcomes such applications. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Care Systems or its participating organizations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this document are those which were obtained at the time the original language edition of the document was prepared. The views expressed in this document are those of the contributors and do not necessarily represent the decisions or the stated policy of the European Observatory on Health Care Systems or its participating organizations. Suggested citation: Savas, B. Serdar et al. In Thomson, S. and Mossialos, E., eds. Health care systems in transition: Turkey. Copenhagen, European Observatory on Health Care Systems, 4(4) (2002). European Observatory on Health Care Systems: WHO Regional Office for Europe Government of Greece Government of Norway Government of Spain European Investment Bank Open Society Institute World Bank London School of Economics and Political Science London School of Hygiene & Tropical Medicine EUR/02/5037245 (TUR) 2002 ISSN 1020-9077 Vol. 4 No. 4 Turkey Health Care Systems in Transition iii Contents Foreword ............................................................................................. v Acknowledgements .......................................................................... vii Introduction and historical background ......................................... 1 Introductory overview .................................................................... 1 Historical development of the health care system ....................... 16 Organizational structure and management .................................. 23 Organizational structure of the health care system ...................... 23 Planning, regulation and management ......................................... 23 Decentralization of the health care system .................................. 37 Health care financing and expenditure .......................................... 39 Main system of financing and coverage ...................................... 39 Complementary sources of financing .......................................... 48 Health care expenditure ............................................................... 54 Health care delivery system ............................................................ 63 Public health services ................................................................... 63 Primary health care ...................................................................... 66 Secondary aned tertiary care ........................................................ 69 Human resources and training ..................................................... 77 Pharmaceuticals ........................................................................... 85 Health care technology assessment .............................................. 86 Financial resource allocation .......................................................... 89 Payment of hospitals .................................................................... 89 Payment of doctors....................................................................... 91 Health care reforms ......................................................................... 93 Conclusions ....................................................................................... 97 References ......................................................................................... 99 Bibliography ................................................................................... 101 Appendix: List of terms ................................................................ 105 Turkey iv European Observatory on Health Care Systems Turkey Health Care Systems in Transition v Foreword he Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system Tand of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Care Systems. HiTs seek to provide relevant comparative information to support policy- makers and analysts in the development of health care systems in Europe. The HiT profiles are building blocks that can be used: • to learn in detail about different approaches to the organization, financing and delivery of health services; • to describe the process, content and implementation of health care reform programmes; • to highlight challenges and areas that require more in-depth analysis; and • to provide a tool for the dissemination of information on health care systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries. The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides the detailed guidelines and specific questions, definitions and examples needed to compile a HiT. This guidance is intended to be flexible to allow authors to take account of their national context. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on the health care system and the impact of reforms. Due to the lack of a uniform data source, Turkey vi European Observatory on Health Care Systems quantitative data on health services are based on a number of different sources, including the WHO Regional Office for Europe health for all database, Organi- sation for Economic Cooperation and Development (OECD) Health Data and data from the World Bank. Data collection methods and definitions sometimes vary, but typically are consistent within each separate series. The HiT profiles provide a source of descriptive information on health care systems. They can be used to inform policy-makers about experiences in other countries that may be relevant to their own national situation. They can also be used to inform comparative analysis of health care systems. This series is an ongoing initiative: material is updated at regular intervals. Comments and suggestions for the further development and improvement of the HiT profiles are most welcome and can be sent to [email protected]. HiTs and HiT sum- maries are available on the Observatory’s website at www.observatory.dk. A glossary of terms used in the HiTs can be found at www.euro.who.int/ observatory/Glossary/Toppage. Turkey Health Care Systems in Transition vii Acknowledgements he HiT for Turkey was written by B. Serdar Savas (Chief Executive Officer (CEO), United Health Systems), Ömer Karahan (CEO, Group THealth Management Inc) and R. Ömer Saka (Project Assistant, United Health Systems and Research Assistant, LSE Health and Social Care), and edited by Sarah Thomson and Elias Mossialos. The research director for the Turkish HiT was Elias Mossialos. The European Observatory on Health Care Systems is grateful to Gazanfer Aksakoglu (Professor and Head, Department of Community Medicine, Dokuz Eylul University, Izmir), Dogan Fidan (Health Economist, United Kingdom National Institute for Clinical Excellence) and Salih Mollahaliloglu (Deputy Coordinator, Health Project General Coordination Unit, Turkish Ministry of Health) for reviewing the report; Meltem Ceylan (Dr Siyami Ersek Hospital, Turkish Ministry of Health) for her comments on an earlier draft; and the Turkish Ministry of Health for their support. The Observatory is a partnership between the WHO Regional Office for Europe the Governments of Greece, Norway and Spain, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. The Observatory team working on the HiT profiles is led by Josep Figueras, Head of the Secretariat, and research directors Martin McKee, Elias Mossialos and Richard Saltman. Technical coordination is carried out by Suszy Lessof. Jeffrey V. Lazarus managed the dissemination, production and copy-editing,
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