BUILDING AN IMPROVED PRIMARY HEALTH CARE SYSTEM IN TURKEY THROUGH CARE INTEGRATION BY SAFIR SUMER JOANNE SHEAR AHMET LEVENT YENER JULY 17, 2019 © 2019 The World Bank 1818 H Street NW, Washington DC 20433, USA. Telephone: 202-473-1000; Internet: www.worldbank.org. Some rights reserved The report entitled Building an Improved Primary Health Care System in Turkey through Care Integration has been produced under the grant received from the Japan Policy and Human Resources Development (PHRD) Technical Assistance Program which is financed by the Government of Japan. This work is a product of the staff and consultants of the World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. Rights and Permissions The material in this work is subject to copyright. 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Table of Contents List of Abbreviations ................................................................................................................................................................................ 3 Executive Summary .................................................................................................................................................................................. 5 1. Introduction ........................................................................................................................................................................................... 9 2. Background and Context for Integrated Care in Turkey ........................................................................................................ 11 2.1. Turkish PHC System (in a nutshell) ................................................................................................................................. 11 2.2. NCD Burden ....................................................................................................................................................................... 12 2.3. The Need for Change in Care Delivery Structures ................................................................................................... 15 2.4. Integrated Care at Higher Policy Level in Turkey .................................................................................................... 16 3. Essential Components of Integrated Care: Overview, Country Examples, Status of Turkey, and Recommendations 19 3.1. Fundamentals of Change .............................................................................................................................................. 21 3.1.1 Engaged Leadership and Shared Vision ......................................................................................................... 21 3.1.1.1 Overview and Country Examples ................................................................................................................. 21 3.1.1.2 Current State in Turkey ................................................................................................................................... 24 3.1.1.3 Recommendations on Integration within Primary Care Level ................................................................... 25 3.1.2 Patient Focus and Engagement .......................................................................................................................... 25 3.1.2.1 Overview and Country Examples ................................................................................................................. 25 3.1.2.2 Current State in Turkey .................................................................................................................................... 28 3.1.2.3 Recommendations on Integration within Primary Care Level ................................................................. 30 3.2. Organizational Change .................................................................................................................................................. 31 3.2.1 Regulatory Frameworks ....................................................................................................................................... 32 3.2.1.1 Overview and Country Examples ................................................................................................................. 32 3.2.1.2 Current State in Turkey ................................................................................................................................... 33 3.2.1.3 Recommendations on Integration within Primary Care Level ................................................................... 34 3.2.2 Creating an Enabling Environment .................................................................................................................... 34 3.2.2.1 Overview and Country Examples ................................................................................................................. 34 3.2.2.2 Current State in Turkey ................................................................................................................................... 36 3.2.2.3 Recommendations on Integration within Primary Care Level ................................................................. 37 3.2.3 Alignment of Financing and Incentives .............................................................................................................. 38 3.2.3.1 Overview and Country Examples ................................................................................................................. 38 3.2.3.2 Current State in Turkey ................................................................................................................................... 39 3.2.3.3 Recommendations on Integration within Primary Care Level ................................................................. 40 1 3.2.4 Monitoring and Performance Improvement ..................................................................................................... 40 3.2.4.1 Overview and Country Examples ................................................................................................................. 40 3.2.4.2 Current State in Turkey ................................................................................................................................... 44 3.2.4.3 Recommendations on Integration within Primary Care Level ................................................................. 44 3.3. Care Delivery.................................................................................................................................................................... 46 3.3.1 Multidisciplinary Teams and Standardized Training ..................................................................................... 46 3.3.1.1 Overview and Country Examples ................................................................................................................. 46 3.3.1.2 Current State in Turkey ................................................................................................................................... 49 3.3.1.3 Recommendations on Integration within Primary Care Level ................................................................. 50 3.3.2 Care Coordination ................................................................................................................................................ 52 3.3.2.1 Overview and Country Examples ................................................................................................................. 52 3.3.2.2 Current State in Turkey ................................................................................................................................... 54 3.3.2.3 Recommendations on Integration within Primary Care Level ................................................................... 57 3.3.3 Evidence-Based Pathways and Protocols ........................................................................................................ 61 3.3.3.1 Overview and Country Examples ................................................................................................................. 61 3.3.3.2 Current State in Turkey ................................................................................................................................... 63 3.3.3.3 Recommendations on Integration within Primary Care Level ................................................................. 64 3.4. Use of Technology ............................................................................................................................................................ 65 3.4.1 Health Information Systems ................................................................................................................................. 65