OECD Reviews of Health Care Quality

2227-0485 (online)
2227-0477 (print)
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These reviews examine the quality of health care in various countries, highlight best practices, and provide a series of targeted assessments and recommendations for further improvements to quality of care in the subject country.

OECD Reviews of Health Care Quality: Turkey 2014

OECD Reviews of Health Care Quality: Turkey 2014

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25 Nov 2014
9789264202054 (PDF) ;9789264202047(print)

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Turkey underwent a very ambitious reform programme  in 2003, the so-called "Health Transformation Programme". Access to healthcare in Turkey has greatly increased with the attainment of Universal Health Coverage, as also demonstrated by improvement in health outcomes, most notably around maternal and child health and infectious diseases. However, despite these significant achievements, Turkey has a significant way to travel to deliver high-quality health services to its population. Governance of the health system is highly centralised and typified by directive control from the Ministry of Health, and information collected in different part of the system is not always fully exploited.

The OECD Review of Health Care Quality in Turkey recommends a number of changes to address these shortcomings. The key recommendations are that: i) Turkey needs to develop robust systems to standardise and monitor the quality of care, encourage continuous professional development and incorporate patient views; ii) some loosening of the governance structure would be welcome, to allow regions greater flexibility to assess and respond to local health needs and to continue to provide health workers with incentives for improve quality; iii) data on health sector activity and outcomes need to be made more available and more usable for individual patients and clinicians, while greater effort is needed to increase the robustness of Turkey’s information systems at national level and harmonise performance measures to OECD and other international comparators.

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  • Foreword

    This report is the sixth of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

  • Acronyms and abbreviations
  • Executive summary

    Over the past decade, Turkey has implemented remarkable health-care reforms, achieving universal health coverage in 2003, and dramatically expanding access to care for the population. Accompanied by significant investment in the hospital sector and the establishment of a family physician system, the Health Transformation Programme (HTP) has delivered a high level of activity in the health system. The reforms benefitted from ambitious leadership and a clear set of priorities (focused on expanding health insurance and improving access and, in the clinical domain, on maternal and child health). An evaluation culture built in from the beginning and a willingness to open up the reform process to external scrutiny were also fundamental elements. Centralisation and rationalisation of the health system’s governance was critical in achieving recent health-care successes. A maturing system, however, might now benefit from a less directive approach. Indeed, the centre should now feel confident enough to relax control, and instead set out the broad ambitions and get the right incentives in place, focussing on a quality governance role. The Ministry of Health is, it should be noted, taking some steps to devolve responsibility for providing hospital services and focus instead on its regulatory, oversight, and quality governance functions.

  • Assessment and recommendations

    Driven by clear vision and strong leadership, the first ten years of Turkey’s Health Transformation Programme have dramatically expanded access to health care. Accompanied by significant investment in the hospital sector, the establishment of a family physician system and payment reforms, the Health Transformation Programme (HTP) has delivered better access and a high level of activity in the health system. To build on its success, it is time for Turkey to shift the emphasis from encouraging high volume of care to delivering high-quality health services.

  • Quality of care in Turkey's health system

    This chapter provides an overview of policies and strategies to improve the quality of care in Turkey’s health system. It seeks to profile key quality of care policies and benchmark the extent to which policies to monitor and improve quality in the Turkish health system are being employed. In describing the quality governance structure and the role of the Ministry of Health and affiliated organisations, the chapter highlights how Turkey needs to continue steps towards more devolved governance, and work to align public hospital and public health system governance. Addressing the quality of inputs into the health system, the chapter recommends that Turkey continue the impressive work begun on quality standards and accreditation while working to build good patient safety and quality assurance systems. The chapter concludes with a recommendation that Turkey develop a coherent policy on how to strengthen the Turkish information infrastructure to facilitate the use of quality indicators.

  • Primary care in Turkey

    As a result of the Health Transformation Programme, supply and access to primary care services in Turkey have both greatly increased. Health outcomes have also improved, most notably around maternal and child health and infectious diseases. Whilst this should be celebrated, thus far relatively little policy attention is paid to some other primary care functions. Published national health outcomes, for example, neglect the real and pressing challenge of longterm conditions such as heart disease or diabetes. Now, there is a need to focus on the quality of services, particularly around the emerging challenge of noncommunicable diseases.

  • Improving hospital care in Turkey

    Like other OECD countries, Turkey is grappling with the challenge of improving the quality of hospital care in a context of rising hospital activity and a diversified hospital sector. Over the past ten years, the Turkish hospital sector, and particularly private hospitals, have experienced one of the strongest growths in activity across OECD countries. This followed the successful attainment of universal health coverage, as well as reforms that encouraged hospital productivity. As a complement to the discussion on hospitals in Chapter 1, this chapter focuses principally on the diversity of the structure of the hospital sector, including the significant role that private hospitals are coming to play, and how to drive improvement for the sector as a whole. The chapter starts by describing the Turkish hospital system, its structure, and development. It then considers way to strengthen quality governance in the sector. The chapter finishes by suggesting the need for a shift from a focus on productivity to a focus on keeping people out of hospitals in the first place.

  • Paying for health care in Turkey

    This chapter focuses on the role of payment systems in supporting the development of Turkey’s health-care system and improving the health of the Turkish people. The last decade of health reform in Turkey has seen high levels of spending directed at maximising the services delivered by a low number of health professionals. A key feature of Turkish health policy has been the use of performance-based payments that link the salaries of specialists working in public hospitals to the number of services they deliver. The approach has been different in primary care, where steep financial penalties have been introduced where doctors do not deliver a basic set of child and maternal health services. The combination of these reforms has served its purpose in achieving one of the more remarkable extensions of health care to the population in the last half century. To prepare the health-care system for tomorrow’s challenges, policy makers now need to grapple with how payment systems can sensibly evolve to reward quality and not just quantity.

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