Health Workforce Policy in Turkey

49484 HNP DISCUSSION PAPER Public Disclosure Authorized Health Workforce Policy in Turkey Recent Reforms and Issues for the Future Public Disclosure Authorized About this series... This series is produced by the Health, Nutrition, and Population Family Marko Vujicic, Susan Sparkes, Salih Mollahaliloglu (HNP) of the World Bank’s Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to Public Disclosure Authorized the Editor Homira Nassery ([email protected]) or HNP Advisory Service ([email protected], tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/ hnppublications. THE WORLD BANK 1818 H Street, NW Public Disclosure Authorized Washington, DC USA 20433 Telephone: 202 473 1000 Facsimile: 202 477 6391 Internet: www.worldbank.org E-mail: [email protected] July 2009 HEALTH WORKFORCE POLICY IN TURKEY: Recent Reforms and Issues for the Future Marko Vujicic Susan Sparkes Salih Mollahaliloglu July, 2009 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual author(s) whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor, Homira Nassery ([email protected]). Submissions should have been previously reviewed and cleared by the sponsoring department, which will bear the cost of publication. No additional reviews will be undertaken after submission. The sponsoring department and author(s) bear full responsibility for the quality of the technical contents and presentation of material in the series. Since the material will be published as presented, authors should submit an electronic copy in a predefined format (available at www.worldbank.org/hnppublications on the Guide for Authors page). Drafts that do not meet minimum presentational standards may be returned to authors for more work before being accepted. For information regarding this and other World Bank publications, please contact the HNP Advisory Services at [email protected] (email), 202-473-2256 (telephone), or 202-522-3234 (fax). © 2009 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Health, Nutrition and Population (HNP) Discussion Paper Health Workforce Policy in Turkey: Recent Reforms and Issues for the Future Marko Vujicica Susan Sparkesb Salih Mollahalilogluc a Health, Nutrition and Population Department, World Bank, Washington DC, USA b Health, Nutrition and Population Department, World Bank, Washington DC, USA c Turkish Institute of Health, Ministry of Health, Ankara, Turkey Paper prepared as background note to Turkey health sector review. World Bank, Washington DC, USA Abstract: The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equity in access to health services. This note summarizes the main developments in the area of health workforce policy and how these have affected key health workforce performance outcomes. Specifically, the main objectives are to (i) Summarize trends in key health workforce outcomes (ii) Compare health workforce outcomes in Turkey to OECD and other countries (iii) Discuss the impact of recent reforms in the health sector on health workforce outcomes and (iv) Highlight key health workforce policy issues for the future. Acknowledgements An earlier draft of this paper was prepared as a background policy note for the joint World Bank/OECD review of the Turkish health system (Sarbani Chakraborty, TTL). The authors wish to thank Minister Dr. Recep Akdag, Undersecretary Dr.Nihat Tosun and Deputy Undersecretary Dr. Sabahattin Aydin from the Ministry of Health in Turkey for their support. The authors also thank Dr.Mustafa Kosdak and Sirin Ozkan for their assistance in collecting and analyzing data and information for several sections of the report. The paper benefited from comments from George Schieber, Sarbani Chakraborty, Andreas Seiter from the World Bank and Jeremy Hurst from the OECD. Emiliana Guanawan provided outstanding administrative support. Keywords: human resources for health, health workforce, health systems Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. iii Correspondence Details: Marko Vujicic, Economist, The World Bank, MSN. G 7- 701, 1818 H St. NW, Washington DC 20433 USA, tel: 202 473 6464, fax: 202 522 3234, [email protected], www.worldbank.org iv v Table of Contents ACKNOWLEDGEMENTS ......................................................................................... VII PREFACE.....................................................................................................................VIII PART I – BACKGROUND ON THE TURKISH HEALTH SYSTEM REFORM . 10 PART II – HEALTH WORKFORCE OUTCOMES IN TURKEY .......................... 12 OVERALL STAFFING LEVEL............................................................................................ 12 SKILL MIX...................................................................................................................... 17 GEOGRAPHIC DISTRIBUTION .......................................................................................... 19 PRODUCTIVITY ............................................................................................................... 24 QUALITY OF CARE.......................................................................................................... 26 PUBLIC PRIVATE MIX..................................................................................................... 29 PART III – REMUNERATION OF HEALTH WORKERS...................................... 31 PART IV - RECENT REFORMS AND HEALTH WORKFORCE OUTCOMES. 37 PERFORMANCE BASED PAYMENT SYSTEM ..................................................................... 37 COMPULSORY SERVICE REQUIREMENT .......................................................................... 41 FAMILY MEDICINE PROGRAM ........................................................................................ 44 POSSIBLE SUPPLY SIDE AND DEMAND SIDE CONSTRAINTS TO SCALING UP................... 47 PART V - SUMMARY OF KEY HEALTH WORKFORCE ISSUES FOR THE FUTURE ..........................................................................................................................53 REFERENCES................................................................................................................ 55 vi ACKNOWLEDGEMENTS An earlier draft of this paper was prepared as a background policy note for the joint World Bank/OECD review of the Turkish health system (Sarbani Chakraborty, TTL). The authors wish to thank Minister Dr. Recep Akdag, Undersecretary Dr.Nihat Tosun and Deputy Undersecretary Dr. Sabahattin Aydin from the Ministry of Health in Turkey for their support. The authors also thank Dr.Mustafa Kosdak and Sirin Ozkan for their assistance in collecting and analyzing data and information for several sections of the report. The paper benefited from comments from George Schieber, Sarbani Chakraborty, Andreas Seiter from the World Bank and Jeremy Hurst from the OECD. Emiliana Gunawan provided outstanding administrative support. The authors are grateful to the World Bank for publishing this report as an HNP Discussion Paper. vii PREFACE The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equity in access to health services. Health expenditures have

Load more