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OECD Reviews of Health Care Quality: Turkey 2014

Raising Standards

image of OECD Reviews of Health Care Quality: Turkey 2014

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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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.

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