Quality Issues in General Practice at the Crossroads in Turkey

1. Quality Issues in General Practice at the Crossroads in Turkey Mustafa Taşdemir, Marmara UniversitySchool of Medicine, İstanbul ZekeriyaAktürk, Atatürk UniversitySchool of Medicine, Erzurum

2. Formersituation (before 2003) • General practice • Healthcentershavingproblems in coveringpopulation • Publichospitals • Belongingtovariousministriesand a socialsecurityinstitution • Healthinsurance • 3 separateinstitutionsfordifferentemploymentgroups

3. Themes of Health Transformation Program (2003) 1. Ministry of Health as the planner and supervisor 2. Universal health insurance gathering everyone under single umbrella 3. Widespread, easily accessible and friendly health service system a. Strengthened primary health care services and family medicine b. Efficient and gradual referral chain c. Health facilities having administrative and financial autonomy 4. Health manpower equipped with knowledge and skills and, working with highmotivation 5. Education and science institutions to support the system 6. Quality and accreditation for qualified and efficient health services 7. Institutional structuring in the rational management of medicine and supplies 8. Access to effective information at decision making process: health informationsystem

4. Currentsituation (2003---) • General practice • HealthCentershavingproblems in coveringpopulation • FamilyHealthCenters & CommunityHealthCenterscoveringpopulation • Publichospitals • Belongingtovariousministriesand a socialsecurityinstitution • BelongingtoMinistry of Health • Healthinsurance • 3 separate institutions for different employment groups • Singleinstitution: UniversalHealthInsurance

5. General Practice • FamilyHealthCenters • Teamscomposed of a familyphysician & a familyhealthworker • 3000-4000 personsperteam • CommunityHealthCenters • One in every district • Operating as local health authority • Deliveringcommunity healthservices • Providinglaboratory and imaging services to family health centers

13. Whatabout “quality”? • There are service quality standards for hospitals, but not for general practice. There are “performance evaluation guidelines” for general practice. However, the term “performance” is almost always associated with “supplementary payment to personnel” in today’s health care setting in Turkey.

14. Whatabout “quality”? • The criteria for grouping family health centers to four classes (A to D) were recently released. They are all related to the physical characteristics of practices. • Both patient and staff satisfaction surveys are periodically conducted in general practice.

15. Whatabout “quality”? • An admonitionpointslistwhich has beenbadlycriticizedbyfamilyphysicianswasrecentlyreleased. • “Sample” ImplementationGuideforFamilyHealthCenterswasreleasedmostrecently. • Hand-washing • Storingandtransportingvaccines • Breast-feeding • Sterilization & disinfection, etc.

16. Conclusion • Unfortunately, as in manycountries, quality comes after quantity, and general practice comes after hospital. • This is a weakness, but there are also opportunities. • Awareness and experience on health care quality improvement has significantly increased in the last two decades in Turkey. • There is more than enough place to expect quality soon after quantity in general practice following hospitals.

17. Thanks...