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Health economics in Turkey and in the world | Whitepaper


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Health economics in TurkeyNowadays health is increasingly concerning all societies and countries of any development, and the resultant increase in requirements and health spending renders “Health Economics” as a branch of science that requires more and more importance.

The basic study subject of health economics is healthcare services. Owing to peculiar characteristics of healthcare services, health economics, too, is a peculiar issue. The key characteristic of healthcare service is that it is uncertain and unpredictable. Demand for healthcare services is incidental and emerges only when certain conditions are met. Naturally, there exists a difference in the level of information between the physician and the patient. Physicians can, or at least have the potential to create or act as drivers of demand while providing healthcare services at the same time. On the other hand, patients often fail to fully and objectively evaluate the quality of healthcare services due to their limited and/or inadequate information. Being a basic requirement, healthcare service is also of a social and public service nature.

Fast developing healthcare technology and costs ensuing from new and expensive pharmaceuticals placed on the market in recent years, combined with the rising life expectancies of people, cause optimization problems, which have become increasingly harder for solution, in health systems. In this context, the science of health economics is used as an essential means to support decision-making authorities, in particular, in developed countries. At this point, health economics could be considered as a branch of science providing guidance as to what choices could be made to get as largest health returns as possible from available resources.

Owing to its importance in the world, health economics has undergone a number of developments also in Turkey in recent years and, in particular, since 2003. Major developments could be listed as follows:

  1. With the “Communiqué regarding Procedures and Guidelines for Patient Referrals made for Diagnosis and Treatment to Private Healthcare Institutions and Organizations”, put into force as from June 1, 2003, it has been made possible for public employees to receive treatments at private healthcare organizations, as well.
  2. The “Governmental Decree on the Pricing of Medical Products for Human use” issued in 2004 introduced a reference price practice, aiming at cheap supply of human and medical products, mostly pharmaceuticals, without compromising quality.
  3. Under the reform “Transformation in Healthcare”, all the healthcare service operations within SSK (the Social Insurances Organization) as well as healthcare facilities operated by public organizations were transferred to the Ministry of Health as from January 1, 2005 with a view to gathering healthcare services under a single roof, removing differences in practice, establishing common standards for services, and using resources of public healthcare operations to a maximum extent.
  4. As from January 1, 2005, it became possible for SSK member employees and pensioners to get prescription pharmaceuticals from contracted pharmacies.
  5. Starting from the year 2005, the “positive list” application was introduced in the pharmaceutical reimbursement system. This has enabled the government to control pharmaceutical spending and the society to get pharmaceuticals from a wider list.
  6. Efforts were made to get the social security system under a single roof, bringing the three individual social security organizations – then operating under the names of “Emekli Sandığı (Pension Fund)”, “SSK (Social Insurances Organization)” and “Bağ-Kur” – together under the name the “Social Security Organization” through Law No. 5502 issued in May 2006.
  7. Legislative initiative has been made on a “Universal Health Insurance System”, but the system still was not put into practice due to the Constitutional Court’s decree of suspension as to the effective date of Social Insurance and Universal Health Insurance Law No.5510. After necessary revisions the final version of the Law was passed in the Assembly. Some provisions were again referred to the Constitutional Court. Save for a new decision for the suspension of enforcement, the Law is expected to come into force on October 1, 2008.

It is no doubt there are many differences between Turkey and developed countries in terms of practices in health economics. Health must be so important in our developing country as it is in developed countries such as the USA and Germany. As care about human and economical awareness increase, so will the importance and value attached to health and to the criticality of healthcare services, thus, helping the science health economics attain the interest and development that it desires, in Turkey, as well.

This report, which discusses highlights from health economics practices both in the USA and the EU Member States, as the world healthcare leaders, and in Turkey, essentially attempts to focus on the current condition of health economics in Turkey, compared with practices in the world, and its future. I would like to express my gratitude to the economist Mr. Can Buharal for his great contributions during the preparation of this report, and hope that it will be useful for everyone having an interest in health economics and will stimulate inspirations for new developments.

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