Quality issues in general practice at the crossroads in turkey
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Quality Issues in General Practice at the Crossroads in Turkey. Mustafa Taşdemir , Marmara University School of Medicine , İstanbul Zekeriya Aktürk , Atatürk University School of Medicine , Erzurum. Former situation ( before 2003). General practice

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Quality issues in general practice at the crossroads in turkey

Quality Issues in General Practice at the Crossroads in Turkey

Mustafa Taşdemir, Marmara UniversitySchool of Medicine, İstanbul

ZekeriyaAktürk, Atatürk UniversitySchool of Medicine, Erzurum

Former situation before 2003
Formersituation (before 2003)

  • General practice

    • Healthcentershavingproblems in coveringpopulation

  • Publichospitals

    • Belongingtovariousministriesand a socialsecurityinstitution

  • Healthinsurance

    • 3 separateinstitutionsfordifferentemploymentgroups

Themes of health transformation program 2003
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

Current situation 2003
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

General practice
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

What about quality
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.

What about quality1
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.

What about quality2
Whatabout “quality”?

  • An admonitionpointslistwhich has beenbadlycriticizedbyfamilyphysicianswasrecentlyreleased.

  • “Sample” ImplementationGuideforFamilyHealthCenterswasreleasedmostrecently.

    • Hand-washing

    • Storingandtransportingvaccines

    • Breast-feeding

    • Sterilization & disinfection, etc.


  • 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.