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Arpacıoğlu S, Erzincan E, Ergelen M, Arpacıoğlu B, Paltun SC, Yalçın M, Bilici R. Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study. J Clin Med 2024; 13:3974. [PMID: 38999538 PMCID: PMC11242554 DOI: 10.3390/jcm13133974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of "all-or-nothing thinking" cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as "labeling", "mental filtering", "should statements" and "minimizing the positive" regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality.
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Affiliation(s)
- Selim Arpacıoğlu
- Psychiatry Department, Faculty of Medicine, Altınbaş University, Istanbul 34147, Turkey
| | - Erkal Erzincan
- Psychology Department, Faculty of Economics Administrative and Social Sciences, Gelişim University, Istanbul 34310, Turkey
| | - Mine Ergelen
- Psychiatry Department, Erenköy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul 34736, Turkey
| | - Beyza Arpacıoğlu
- Psychiatry Department, Erenköy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul 34736, Turkey
| | - Salih Cihat Paltun
- Psychiatry Department, Erenköy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul 34736, Turkey
| | - Murat Yalçın
- Psychiatry Department, Erenköy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul 34736, Turkey
| | - Rabia Bilici
- Psychology Department, Faculty of Humanities and Social Sciences, Istanbul Ticaret University, Istanbul 34445, Turkey
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Azimzadeh S, Azami-Aghdash S, Tabrizi JS, Gholipour K. Reforms and innovations in primary health care in different countries: scoping review. Prim Health Care Res Dev 2024; 25:e22. [PMID: 38651337 DOI: 10.1017/s1463423623000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health. METHODS This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings. RESULTS By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations). CONCLUSION The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.
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Affiliation(s)
- Solmaz Azimzadeh
- Health Policy, Department of Health Policy & Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Health Policy, Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Bozorgmehr K, McKee M, Azzopardi-Muscat N, Bartovic J, Campos-Matos I, Gerganova TI, Hannigan A, Janković J, Kállayová D, Kaplan J, Kayi I, Kondilis E, Lundberg L, Mata IDL, Medarević A, Suvada J, Wickramage K, Puthoopparambil SJ. Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100744. [PMID: 37927430 PMCID: PMC10625017 DOI: 10.1016/j.lanepe.2023.100744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. Funding No specific funding received.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Lancet Migration European Hub
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Medicine & Tropical Hygiene, London, UK
| | | | | | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | | | - Ailish Hannigan
- WHO Collaborating Centre for Migrant’s Involvement in Health Research, School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Daniela Kállayová
- Lancet Migration European Hub
- Department of Public Health, Screening and Prevention, Ministry of Health, Slovak Republic
- Trnava University, Trnava, Slovak Republic
| | - Josiah Kaplan
- UNICEF Global Office of Research and Foresight, Florence, Italy
| | - Ilker Kayi
- Department of Public Health, School of Medicine, Koç University, Istanbul, Türkiye
| | - Elias Kondilis
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lene Lundberg
- Lancet Migration European Hub
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Aleksandar Medarević
- Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut', Belgrade, Serbia
| | - Jozef Suvada
- St. Elizabeth University of Public Health and Social Work, Slovak Republic
- WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, and McMaster GRADE Centre, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Kolitha Wickramage
- UN Migration Agency Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany
| | - Soorej Jose Puthoopparambil
- WHO Collaborating Centre on Migration and Health Data and Evidence, Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Sweden
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Cai C, Xiong S, Millett C, Xu J, Tian M, Hone T. Health and health system impacts of China's comprehensive primary healthcare reforms: a systematic review. Health Policy Plan 2023; 38:1064-1078. [PMID: 37506039 PMCID: PMC10566320 DOI: 10.1093/heapol/czad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
China's comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included-all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
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Affiliation(s)
- Chang Cai
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
| | - Shangzhi Xiong
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- Global Health Research Centre, Duke Kunshan University, Academic Building 3038, No. 8 Duke Avenue, Kunshan, Jiangsu 215316, China
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
- Public Health Research Centre and Comprehensive Health Research Centre, NOVA National School of Public Health, NOVA University Lisbon, Avenida Padre Cruz, Lisbon 1600-560, Portugal
| | - Jin Xu
- China Center for Health Development Studies, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Maoyi Tian
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin 150081, China
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
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Henderson DAG, Donaghy E, Dozier M, Guthrie B, Huang H, Pickersgill M, Stewart E, Thompson A, Wang HHX, Mercer SW. Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China. BMC Med 2023; 21:319. [PMID: 37620865 PMCID: PMC10463288 DOI: 10.1186/s12916-023-03033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key 'components', impacts of new models of care, and barriers and facilitators to PCT implementation. METHODS We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym ). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed. RESULTS A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes. CONCLUSIONS Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.
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Affiliation(s)
- D A G Henderson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Donaghy
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Dozier
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - B Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - H Huang
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Pickersgill
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - A Thompson
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - H H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - S W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
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6
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Akinwumi AI, OlaOlorun AD, Adesina SA, Durodola AO, Amole IO, Singer SR, Levine H. Strong primary care services, an important feature of primary health care: What can Nigeria learn from Israel? Front Public Health 2022; 10:1006095. [PMID: 36589941 PMCID: PMC9801635 DOI: 10.3389/fpubh.2022.1006095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Akinsola Idowu Akinwumi
- Department of Family Medicine, Afe Babalola University, Ado Ekiti, Nigeria,Department of Family Medicine, ABUAD Multi-System Hospital, Ado Ekiti, Ekiti, Nigeria,*Correspondence: Akinsola Idowu Akinwumi ; ;
| | - Akintayo David OlaOlorun
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Stephen Adesope Adesina
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Adewumi Ojeniyi Durodola
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Isaac Olusayo Amole
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Shepherd Roee Singer
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Hagai Levine
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Lhadon T, Kitreerawutiwong N. Assessment of competencies in the prevention and control of chronic diseases and their influencing factors among health assistants in Bhutan: a cross-sectional study. BMC Health Serv Res 2022; 22:1334. [PMID: 36357904 PMCID: PMC9647919 DOI: 10.1186/s12913-022-08747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background The morbidity and mortality of chronic diseases are increasing worldwide. The literature confirms that the prevention and control of chronic disease necessitates a robust primary health care system with a competent health care workforce. Studies on competencies in the prevention and control of chronic diseases and their determinants among health assistants (HAs) in Bhutan are scarce. This cross-sectional survey aimed to examine the level of competencies and investigate the factors influencing competencies in the prevention and control of chronic diseases among HAs. Methods The sample consisted of 330 HAs who were recruited through simple random sampling. A validated and reliable self-administered questionnaire was used to collect data through a web-based Google Form. Data were analysed using descriptive statistics and multiple regression analysis. Results The findings showed that the mean summed competency score was 191 (SD = 25.7). Approximately 96% of the participants perceived that they were competent in the prevention and control of chronic diseases. The multiple regression analysis indicated that work environment (β = 0.473), sex (β = 0.126), location of the health facility (β = − 0.114), and organizational support (β = 0.117) affected competencies in the prevention and control of chronic diseases by 31.4% with statistical significance (R2 = 0.314) (p < 0.05). Conclusions This study suggested that improving the number of staff and availability of learning resources, considering training for both sexes, especially female primary health care workers, enhancing mentorship and supervision in rural areas, and establishing the recognition and encouragement of primary health care workers are needed.
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Alyousef M, Naughton C, Bradley C, Savage E. Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review. Chronic Illn 2022; 18:469-487. [PMID: 34841923 PMCID: PMC9397395 DOI: 10.1177/17423953211059143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. METHODS A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. RESULTS A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. DISCUSSION A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
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Affiliation(s)
- Mohammed Alyousef
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland.,Department of Health Services Administration and Hospitals, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Corina Naughton
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
| | - Colin Bradley
- The Department of General Practice, 8795University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
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9
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Cinaroglu S. The interrelationship among health workforce, quality of care, and health outcomes in Turkey. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences (FEAS) Hacettepe University Beytepe Ankara Turkey
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10
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Cinaroglu S, Çalışkan Z. Distributive Pattern of Health Services Utilization Under Public Health Reform and Promotion in Turkey. Value Health Reg Issues 2022; 31:25-33. [PMID: 35378412 DOI: 10.1016/j.vhri.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Inclusive health policies and health promotion to ensure strong primary healthcare systems are main tenets of health reforms in developing countries, such as Turkey. Nevertheless, there has been a lack of interest regarding the assessment of equity in health services utilization under public health reform and promotion of primary care. This study aims to analyze equity by measuring deviations from proportionality in the relationship between the utilization of health services and income using indices and curve approaches. METHODS A cross-sectional national Turkey Health Survey used the years 2008, 2010, 2012, and 2014. Gini and Kakwani indices and concentration curves were estimated, and the degree of regressivity was analyzed to understand the sources of equity in health services utilization. RESULTS Health services utilization for inpatient and outpatient services and family medicine and general practitioner services were regressive between the years 2008 and 2014. The most regressive pattern was observed in the year 2014 regarding medicine usage (Kakwani index = -0.1808904). CONCLUSIONS Differences in the utilization of health services have increased, hurting the poorest during the health reform in Turkey. Policies focused on health promotion to strengthen the primary health system and continuous monitoring of health services utilization by vulnerable groups are essential for ensuring a fairer health service usage in developing countries.
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Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey.
| | - Zafer Çalışkan
- Department of Economics, Faculty of Economics and Administrative Sciences Hacettepe University, Ankara, Turkey
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11
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Bowser DM, Agarwal-Harding P, Sombrio AG, Shepard DS, Harker Roa A. Integrating Venezuelan Migrants into the Colombian Health System during COVID-19. Health Syst Reform 2022; 8:2079448. [PMID: 35675560 DOI: 10.1080/23288604.2022.2079448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Colombia provides a unique setting to understand the complicated interaction between health systems, health insurance, migrant populations, and COVID-19 due to its system of Universal Health Coverage and its hosting of the second-largest population of displaced persons globally, including approximately 1.8 million Venezuelan migrants. We surveyed 8,130 Venezuelan migrants and Colombian nationals across 60 municipalities using a telephone survey during the first wave of the pandemic (September through November 2020). Using self-reported enrollment in one of the several Colombian health insurance schemes, we analyzed the access to and disparities in the use of health-care services for both Colombians and Venezuelan migrants by insurance status, including access to formal health services, virtual visits, and COVID-19 testing for both groups. We found that compared with 3.6% of Colombians, 73.6% of Venezuelan telephone survey respondents remain uninsured, despite existing policies that allow legally present migrants to enroll in national health insurance schemes. Enrolling migrants in either the subsidized or contributory regime increases their access to health-care services, and equality between Colombians and Venezuelans within the same insurance schemes can be achieved for some services. Colombia's experience integrating Venezuelan migrants into their current health system through various insurance schemes during the first wave of their COVID-19 pandemic shows that access and equality can be achieved, although there continue to be challenges.
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Affiliation(s)
- Diana M Bowser
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Priya Agarwal-Harding
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Anna G Sombrio
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Donald S Shepard
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Arturo Harker Roa
- School of Government Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
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12
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Preker AS, Cotlear D, Kwon S, Atun R, Avila C. Universal health care in middle-income countries: Lessons from four countries. J Glob Health 2021; 11:16004. [PMID: 34912557 PMCID: PMC8645236 DOI: 10.7189/jogh.11.16004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In this paper, we review lessons learned about Universal Health Coverage (UHC) in middle-income countries, with specific reference to achievements and challenges observed during recent years in four middle-income to upper-middle-income countries - Mexico, Turkey, The Republic of Korea and Ukraine. Three of these countries - Mexico, the Republic of Korea, Turkey are members of the Organization for Economic Cooperation and Development (OECD). Ukraine has aspired to join Western institutions like the OECD since its independence in 1991. METHODS The research included a combination of cross-sectional and longitudinal reviews of both statistical and contextual data, available from both published sources and available "grey literature" reports. RESULTS Based on the research, we conclude the following. First, reaching UHC is achievable in middle-income and upper-middle-income countries. It is not an unattainable goal reserved for upper income countries. Second, successes and failures are evident both in the case of countries that pursue a contributory health insurance path to UHC and those that pursue a core government funding path. Third, the devil is often in the detail. De jure constitutional guarantees and national health legislation are often a necessary but do not constitute a guaranteed path to success without accompanying institutional measure to secure sustainability (political and economic) and supply and demand constraints in service provision and consumer/patient behavior. De facto, in most countries expansion in health insurance coverage does not happen "with the stroke of a pen" but require years of commitment and efforts to change the supply and demand after critical legislation has been enacted. Fourth, two major approaches dominate: incremental and "big bang" health system reforms. CONCLUSIONS We caution against the pitfalls of over-attribution from drawing too strong conclusion from individual longitudinal country experiences ("over-determinism") and over-generalization from broad sweeping cross-sectional statistical analysis ("reductionism"). Every country is different and needs to find its own path towards UHC considering their contextual specificities, learning from the achievements and failures of others, but not try to copy their experiences.
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Affiliation(s)
| | | | - Soonman Kwon
- Graduate School of Public Health, Department of Health Policy and Management, Professor and Former Dean, Seoul National University, Seoul, South Korea
| | - Rifat Atun
- T.H. Chan School of Public Health, Department of Global Health and Population, Director of Global Health Systems Cluster/Professor of Global Health Systems, Harvard University, Boston, Massachusetts, USA
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Özçelik EA, Massuda A, Castro MC, Barış E. A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care? Health Syst Reform 2021; 7:e1939931. [PMID: 34402403 DOI: 10.1080/23288604.2021.1939931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.
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Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adriano Massuda
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Enis Barış
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
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Cinaroglu S. Health behaviors and health services accessibility factors associated with diabetes: a propensity score matching analysis. Expert Rev Endocrinol Metab 2021; 16:19-24. [PMID: 33427542 DOI: 10.1080/17446651.2021.1853526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Background: Despite the increasing burden of diabetes in Turkey, there is a lack of information regarding behaviors and accessibility factors associated with diabetes. This study aims to explore diabetes prevalence and to identify the associated health behaviors and accessibility factors. Research design and methods: Data was gathered from TurkStat-Health Survey for the year 2014. 1996 individuals who had reported diabetes were matched to similar non-diabetes participants in terms of socio-demographic characteristics and comorbidities by using 1:1 nearest matching based on estimated propensity scores. Results: The weighted point prevalence of diabetes among adults was 8.98%. Compared with smokers, non-smokers were less likely to develop diabetes (OR:0.96; 95% CI:0.95-0.97). Individuals engaging in regular physical activity were less likely to have experienced diabetes than individuals not engaging in any physical activity (OR:0.51; 95% CI:0.41-0.52). Conclusions: Improving the health behaviors of individuals and promoting a culture of exercise, healthy food consumption and better planning of preventive services are necessary strategies to fight against diabetes in Turkey. Collaboration between health professionals will result in effective clinical decision making and the development of diabetes self-management programs.
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Affiliation(s)
- Songul Cinaroglu
- Faculty of Economics and Administrative Sciences (FEAS), Department of Health Care Management, Hacettepe University , Ankara, Turkey
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İNCESOY ÖZDEMİR S, TAÇYILDIZ N, VARAN A, KEBUDİ R, ZÜLFİKAR B, CELKAN T, ŞAHİN G, ÇORAPÇIOĞLU F, KESKİN YİLDİRİM Z, PINARLI FG, OLGUN N, SARI N, DAĞDEMİR A, ÖZYÖRÜK D, EREN T, ÇAKIR FB, ADAKLI AKSOY B, BOZKURT C, GÜLER E, ÖZGÜVEN AA, ERBEY F, BERBER M, DİNÇASLAN H, ÜNAL E, KANTAR M. Cross-sectional study: long term follow-up care for pediatric cancer survivors in a developing country, Turkey: current status, challenges, and future perspectives. Turk J Med Sci 2020; 50:1916-1921. [PMID: 32628434 PMCID: PMC7775715 DOI: 10.3906/sag-1911-193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/04/2020] [Indexed: 11/03/2022] Open
Abstract
Aim The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey. Material and methods A questionnaire was e-mailed to the directors of 33 pediatric oncology centers (POCs) registered in the Turkish Pediatric Oncology Group (TPOG). Of these 33 active TPOG institutions, 21 participated in the study and returned their completed questionnaires. Results Only 1 of the 21 participating centers had a separate LTFU clinic. The remaining centers provided LTFU care for childhood cancer survivors at the pediatric oncology outpatient clinic. Of these centers, 17 (80.9%) reported difficulty in transition from the pediatric clinic to the adult clinic, 14 (66.6%) reported insufficient care providers, and 12 (57.1%) reported insufficient time and transportation problems. As neglected late effects, 16 (76.1%) centers reported psychosocial and getty job problems and 11 (52.3%) reported sexual and cognitive problems. None of the centers had their own LTFU guidelines for their daily LTFU practice Conclusion This study was the first to gain an overview of the needs of POCs and the gaps in survivorship services in Turkey. The results from this study will help to develop a national health care system and national guidelines for pediatric cancer survivors.
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Affiliation(s)
- Sonay İNCESOY ÖZDEMİR
- Department of Pediatric Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, AnkaraTurkey
| | - Nurdan TAÇYILDIZ
- Department of Pediatric Oncology, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Ali VARAN
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Rejin KEBUDİ
- Institute of Oncology, İstanbul University, İstanbulTurkey
| | | | - Tiraje CELKAN
- Department of Pediatric Hematology Oncology, Faculty of Medicine, İstanbul University, İstanbulTurkey
| | - Gürses ŞAHİN
- Department of Pediatric Oncology, Dr. Sami Ulus Children’s Hospital, AnkaraTurkey
| | - Funda ÇORAPÇIOĞLU
- Department of Pediatric Oncology, Faculty of Medicine, Kocaeli University, KocaeliTurkey
| | - Zuhal KESKİN YİLDİRİM
- Department of Pediatric Oncology, Faculty of Medicine, Atatürk University, ErzurumTurkey
| | - Faruk Güçlü PINARLI
- Department of Pediatric Oncology, Faculty of Medicine, Celal Bayar University, ManisaTurkey
| | - Nur OLGUN
- Department of Pediatric Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Neriman SARI
- Department of Pediatric Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, AnkaraTurkey
| | - Ayhan DAĞDEMİR
- Department of Pediatric Oncology, Faculty of Medicine, Ondokuz Mayıs University, SamsunTurkey
| | - Derya ÖZYÖRÜK
- Department of Pediatric Oncology, Ankara Children’s Hematology and Oncology Training and Research Hospital, AnkaraTurkey
| | - Tuba EREN
- Department of Pediatric Oncology, Faculty of Medicine, Trakya University, EdirneTurkey
| | - Fatma Betül ÇAKIR
- Department of Pediatric Hematology Oncology, Faculty of Medicine, Bezmiâlem Vakıf University, İstanbulTurkey
| | - Başak ADAKLI AKSOY
- Department of Pediatric Hematology Oncology, Faculty of Medicine, Medeniyet University, İstanbulTurkey
| | - Ceyhun BOZKURT
- Department of Pediatric Hematology Oncology, Faculty of Medicine, Istinye University, Bahçelievler Medikal Park Hospital, İstanbulTurkey
| | - Elif GÜLER
- Department of Pediatric Oncology, Faculty of Medicine, Akdeniz University, AntalyaTurkey
| | - Ali Aykan ÖZGÜVEN
- Department of Pediatric Oncology, Faculty of Medicine, Celal Bayar University, ManisaTurkey
| | - Fatih ERBEY
- Department of Pediatric Hematology Oncology, Faculty of Medicine, Koç University, AnkaraTurkey
| | - Melda BERBER
- Department of Pediatric Oncology, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Handan DİNÇASLAN
- Department of Pediatric Oncology, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Emel ÜNAL
- Department of Pediatric Oncology, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Mehmet KANTAR
- Department of Pediatric Oncology, Faculty of Medicine, Ege University, İzmirTurkey
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16
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Aygün A. Are family medicine centres achieving their target in Turkey: Impact on health care utilization of mothers and infants. Int J Health Plann Manage 2020; 36:189-208. [PMID: 32985746 DOI: 10.1002/hpm.3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 08/29/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022] Open
Abstract
The family medicine (FM) system was introduced as the main source of primary care in Turkey as a component of the Health Transformation Program reforms. During a gradual implementation process, provinces switched to the FM system at different points in time between 2005 and 2010. In this paper, we use a micro-level data set to test whether the health care utilization of mothers during pregnancy, childbirth and the postnatal period is affected by the program. Using a difference-in-differences method for estimation, we find that the program is only effective for pregnant women who lived in provinces with a limited availability of specialist doctors. As a result of the FM program, women are likely to have their first prenatal consultancy earlier and their probability of seeing a doctor during their prenatal visit and receiving an ultrasound and blood and urine sample checks increases if they live in a province with a low number of specialists per 10,000 people. We find that the impact of the FM program decreases as the rate of specialists in a province increases, which negates any positive effect of the program on health care use.
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Affiliation(s)
- Aysun Aygün
- Department of Economics, İstanbul Teknik Üniversitesi, İstanbul, Turkey
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17
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Başar D, Öztürk S. Assessing Horizontal Equity in the Utilization of Mental Healthcare Services in Turkey: A Gender Perspective. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:299-309. [PMID: 31535351 DOI: 10.1007/s40258-019-00519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Equity in healthcare services utilization is on the agenda for both research and policy makers, especially after the Millennium Development Goals. Despite the recognition of the importance of mental health services utilization, equity in terms of access has not been widely researched. OBJECTIVE This study aims to investigate the degree and progress of equity in mental healthcare services utilization in Turkey from a gender perspective. METHODS The Horizontal Inequity (HI) index is calculated using a nationally representative dataset from the Health Surveys (2014 and 2016) conducted by the Turkish Statistical Institute. The index is calculated for males, females, and all individuals separately to identify gender differences. RESULTS The results from the HI index indicate pro-poor inequities in the utilization of mental healthcare services in Turkey for both 2014 and 2016. For all individuals, the standardized HI indices were found to be - 0.3320 and - 0.3374 for 2014 and 2016, respectively. In 2014, the standardized HI indices were calculated to be - 0.3504 and - 0.3173 for males and females, respectively. In 2016, the HI indices were found to be - 0.3241 and - 0.3541 for females and males, respectively. CONCLUSIONS There is a great need for gender-focused policies to improve horizontal equity in mental healthcare services utilization.
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Affiliation(s)
- Dilek Başar
- Department of Economics, Faculty of Administrative Sciences, Hacettepe University, Beytepe Campus, Ankara, Turkey.
| | - Selcen Öztürk
- Department of Economics, Faculty of Administrative Sciences, Hacettepe University, Beytepe Campus, Ankara, Turkey
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18
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Cinaroglu S. Prevalence of upper respiratory tract infections and associated factors among children in Turkey. J SPEC PEDIATR NURS 2020; 25:e12276. [PMID: 31742870 DOI: 10.1111/jspn.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/27/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Upper respiratory tract infections (URIs) are the most common diseases observed in children aged 0-6 years in Turkey. This study was conducted to investigate URIs in 0-6 year-old children in Turkey. DESIGN AND METHODS Data of children aged 0-6 years who were included in the 2014 Turkey Health Survey conducted by the Turkish Statistical Institute were collected from their parents. RESULTS In total, 1,293 and 1,732 children with and without URIs, respectively, were identified. The weighted point prevalence of URIs was 42.23%. Compared with the uninsured and female children belonging to high-income families, insured male children belonging to low-income families were more likely to develop URIs (p < .001). Moreover, comorbidities such as communicable diseases, anemia and diarrhea, and factors like health services utilization were associated with URIs. Analysis of health services utilization highlights that URIs were reported more among the children who had not visited a hospital than among those who had visited a hospital, with an odds ratio of 1.23. CONCLUSIONS The results of this study provide a deeper understanding of sociodemographic, comorbid, and health services utilization factors associated with URIs. These results provide useful insights for pediatric nursing professionals to improve the quality and efficiency of pediatric respiratory nursing services. PRACTICE IMPLICATIONS Collaborative networks with other health professionals, parents, and public health policy-makers are essential to decrease the prevalence of URIs in Turkey. These study results provide several insights for health professionals to improve pediatric action plans for ultimately improving child health status.
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Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
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Öztürk S, Başar D, Özen İC, Çiftçi AÖ. Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey. Daru 2019; 27:735-742. [PMID: 31732873 PMCID: PMC6895375 DOI: 10.1007/s40199-019-00311-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Demographic and socio-economic factors determine pharmaceutical health care utilization for individuals. Prescription and non-prescription medicine use are expected to have different determinants. Even though prescription and non-prescription medicine use is being well researched for developed countries, there are only a few studies for developing countries. OBJECTIVES This paper aims to analyze the socio-economic and individual characteristics that determine the use of prescription and non-prescription medicine. We examine the issue for the specific case of Turkey since Turkey's health system has undertaken significant changes in the last two decades and especially after 2003 with the "Health Transformation Programme". METHODS Data from the nationally representative "Health Survey" are used in the analysis. The data set covers the 2008-2016 period with two-year intervals. Pooled multivariate logistic regression is employed to identify the underlying determinants of prescription and non-prescription medicine use. RESULTS When compared to 2008, non-prescription medicine use decreases until 2012, however, an increasing trend appears after 2012. For prescription medicine use, a decreasing trend emerges after 2012. Findings from the marginal effects indicate that for non-prescription medicine use, the highest effect stems from the health status. For prescription medicine use, the highest marginal effects arise from age, health and employment status indicating the importance of the need and predisposing factors. CONCLUSION Decreasing non-prescription medicine use largely depends on easier access to health care service utilization. Although having a health insurance has a positive relationship with prescription medicine use, there is still a problem for individuals living a rural area and heaving a lower income level since they are more likely to use non-prescription medicine.
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Affiliation(s)
- Selcen Öztürk
- Department of Economics, Faculty of Administrative Sciences, Health Economics and Health Policy Research and Application Center, Hacettepe University, Ankara, Turkey
| | - Dilek Başar
- Department of Economics, Faculty of Administrative Sciences, Health Economics and Health Policy Research and Application Center, Hacettepe University, Ankara, Turkey
| | - İlhan Can Özen
- Department of Economics, Faculty of Administrative Sciences, Middle East Technical University, Ankara, Turkey
| | - Arbay Özden Çiftçi
- Department of Pediatric Surgery, Faculty of Medicine, Health Economics and Health Policy Research and Application Center, Hacettepe University, Ankara, Turkey
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20
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Erus B. Out of pocket health expenditures in Turkey following introduction of co-payments along with improved primary care services. Int J Health Plann Manage 2019; 35:433-440. [PMID: 31701574 DOI: 10.1002/hpm.2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/13/2019] [Indexed: 11/09/2022] Open
Abstract
In 2002, Turkey started to implement reforms in health care aiming to improve access and increase efficiency. Reforms increased health insurance coverage and resulted in higher number of outpatient and inpatient treatments at both public and private hospitals. Later, to change preference towards the use of secondary and tertiary care over primary care and rein in increasing health expenditures, a series of co-payments were instituted along with an extension of primary care services through a family-medicine system that provided free access to all. This work aims to measure the impact of these two simultaneous policy measures on out-of-pocket expenditures. We find that while contributory payments resulted in higher OOP health expenditures, especially for lower income households, the impact was small. We also observe that inability to consult a physician and to visit a hospital, especially for monetary reasons, was reduced after the policy change.
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Affiliation(s)
- Burcay Erus
- Department of Economics, Bogazici University, Istanbul, Turkey
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21
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Sparkes SP, Bump JB, Özçelik EA, Kutzin J, Reich MR. Political Economy Analysis for Health Financing Reform. Health Syst Reform 2019; 5:183-194. [DOI: 10.1080/23288604.2019.1633874] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Susan P. Sparkes
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Jesse B. Bump
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ece A. Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Joseph Kutzin
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Michael R. Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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22
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Evaluating the Provision of Health Services and Barriers to Treatment for Chronic Diseases among Syrian Refugees in Turkey: A Review of Literature and Stakeholder Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152660. [PMID: 31349639 PMCID: PMC6696441 DOI: 10.3390/ijerph16152660] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 01/02/2023]
Abstract
Background: While Turkey hosts the largest number of Syrian refugees, the provision of health services for chronic disease among Syrian refugees in Turkey has been inadequate and understudied. This paper explores Turkish healthcare policies surrounding Syrian refugees’ access to health services for chronic diseases. Methods: We conducted a literature review and supplementary stakeholder interviews to evaluate the provision of chronic health services and the most common barriers to healthcare access among Syrian refugees in Turkey. Results: Though access to treatment for displaced Syrians has improved throughout the past five years, five primary barriers persist: registration procedure regulations, navigation of a new health system, language barriers, fear of adverse treatment, and cost. Conclusions: To drive improvements in healthcare for chronic diseases among Syrian refugees in Turkey, we recommend making registration procedures more accessible, developing more healthcare options in patients’ native language, increasing human resources, and advocating for more research surrounding chronic health conditions among refugees.
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Cinaroglu S. Integrated k-means clustering with data envelopment analysis of public hospital efficiency. Health Care Manag Sci 2019; 23:325-338. [PMID: 31325003 DOI: 10.1007/s10729-019-09491-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
Abstract
The goal of this study is to integrate k-means clustering with data envelopment analysis to examine technical efficiencies in public hospitals in Turkey. A two-step analysis procedure involving provinces and public hospitals is applied in this study. The first step examines similar provinces in terms of welfare state indicators by using k-means clustering and silhouette (Sil) cluster validity index measures. Then, the efficiencies of public hospitals in different groups of provinces are determined. The data are taken from the Turkish Statistical Institute and the 2017 Public Hospitals Statistical Year Book for eighty-one provinces and 688 public hospitals. Study results show that, relative to similarities of welfare state indicators, there are five province groups (Sil = .58). The number of technically inefficient public hospitals is greater than the number of technically efficient public hospitals in all groups. Study results emphasize that incorporated methodology of k-means clustering with data envelopment analysis is useful to identify efficiencies of public hospitals located in provinces that have similar welfare status.
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Affiliation(s)
- Songul Cinaroglu
- Faculty of Economics and Administrative Sciences (FEAS), Department of Health Care Management, Hacettepe University, 06800, Beytepe, Ankara, Turkey.
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24
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Espinosa-González AB, Normand C. Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders' views in Turkey. BMJ Open 2019; 9:e027492. [PMID: 31326929 PMCID: PMC6661696 DOI: 10.1136/bmjopen-2018-027492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to assess the implementation of the Family Medicine Programme (FMP), which has taken place in Turkey from 2005 to 2010 as a set of comprehensive primary health care (PHC) reforms and involved changes in professional organisation (eg, family medicine specialisation) and service provision (eg, patients' registration list). Our particular interest is to identify the challenges and limitations that PHC physicians and academicians have encountered in the implementation of the FMP which could have influenced the delivery of care and utilisation of services. DESIGN We applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data. SETTING PHC centres and academic departments from five Turkish provinces. PARTICIPANTS PHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews. RESULTS Shortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in healthcare emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians' ethical values as well as perceptions of organisational injustice among healthcare workers were contributing challenges. CONCLUSIONS A systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy-making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.
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Affiliation(s)
| | - Charles Normand
- Professor of the Economics of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
- Centre for Health Policy and Management, Trinity College, University of Dublin, Dublin, Ireland
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25
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Caner A, Cilasun SM. Health Care Services and the Elderly: Utilization and Satisfaction in the Aftermath of the Turkish Health Transformation Program. Gerontol Geriatr Med 2019; 5:2333721418822868. [PMID: 30733976 PMCID: PMC6343442 DOI: 10.1177/2333721418822868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/16/2022] Open
Abstract
With the implementation of the health transformation program, Turkey has gone through substantial changes in its health system in the last decade. This study relies on two nationally representative data sets to investigate health service utilization and satisfaction of the elderly. In particular, it examines the share of elderly who have an unmet need for medical care and who could not afford a medical examination or treatment over the years 2006 to 2015, using data from the Turkish Survey of Income and Living Conditions. It also examines the utilization of health services and satisfaction from these services by the elderly in years 2004 to 2015 using data from the Turkish Life Satisfaction Survey. This study finds that utilization has increased and, coinciding with the introduction of the family medicine system, the percentage of patients choosing primary care facilities has increased. The share of the elderly with unmet need and those who could not afford health care have declined. Notwithstanding, overall satisfaction increased only until 2011-2012. Understanding the utilization and satisfaction of the elderly is important, because along with many other countries, the population is aging in Turkey. In the near future, health care needs of the elderly will have a higher priority on the agenda of policy makers.
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Affiliation(s)
- Asena Caner
- Department of Economics, TOBB University of Economics and Technology, Ankara, Turkey
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26
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Cinaroglu S. Politics and health outcomes: A path analytic approach. Int J Health Plann Manage 2018; 34:e824-e843. [PMID: 30408228 DOI: 10.1002/hpm.2699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/07/2022] Open
Abstract
Social and health policies and political participation are associated with each political tradition related to public health outcomes. However, there is a lack of evidence for the relationship between policy and outcomes. This study seeks to determine the relationship between politics, labour and welfare state indicators, economic inequality, and health outcome indicators. Data to test the model was obtained from the Turkish Statistical Institute (TurkStat) that belongs to the 81 provinces of Turkey. Path analysis was used to model the associations between policy, labour and welfare states, economic inequality, and health outcomes. To test the goodness of fit of the model, multiple criteria of model fit indices were utilised. The fit of the respecified path analytic model data is good (normed fit index [NFI] is 0.91, comparative fit index [CFI] is 0.92, goodness of fit index [GFI] is 0.91, and adjusted goodness of fit index [AGFI] is 0.93). Study results illustrate a strong relationship between voter partisanship, employment rate, satisfaction from both social security and health services, and life expectancy at birth and mortality. These results represent an important step towards understanding the elusive relationship between policy and health outcomes. Designing socially inclusive policies, considering labour market opportunities, and enhancing the population's well-being are advisable strategies for policymakers who wish to optimise public health outcomes.
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Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences (FEAS), Hacettepe University, Ankara, Turkey
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Akpinar Y, Demirci H, Budak E, Baran AK, Candar A, Ocakoglu G. Why do patients with minor complaints choose emergency departments and does satisfaction with primary care services influence their decisions? Prim Health Care Res Dev 2018; 19:398-406. [PMID: 29248028 PMCID: PMC6452945 DOI: 10.1017/s1463423617000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 11/07/2022] Open
Abstract
AimTo identify the reasons why patients with minor complaints choose emergency departments (EDs) as a first contact of care and whether dissatisfaction with primary care services influences their decisions. METHODS In this study, a self-completed survey called EUROPEP was given to 535 outpatients who were admitted to the Bursa Yuksek Ihtisas Training and Research Hospital in Bursa and examined in the green zone in July 2015. Patients were asked about their complaints and why they preferred EDs as a first contact of care. RESULTS EDs were the first contact of care in 87.8% of cases. In all, 9% of patients registered to family physicians who were working outside the city of Bursa. There was no relationship between patient satisfaction and the number of previous visits to EDs in last 12 months (P=0.09). The main reasons for admitting to the emergency services were feeling excessive pain (20.4%), perception of urgency (14.5%) and that the family doctor services were closed outside working hours (13.2%). The mean patient satisfaction with family practice offices was calculated to be 68.1%. CONCLUSIONS The frequency of admission to EDs as a first contact of care was extremely high in the absence of a referral system. Patients who did not have family doctors in the settlement where they live put an extra burden on the EDs. Overall, patient satisfaction with their GPs did not influence the number of visits to EDs but accessibility remains a big challenge.
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Affiliation(s)
- Yakup Akpinar
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ersin Budak
- Department of Psychology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ayse Karalar Baran
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ali Candar
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics, Uludag University, Bursa, Turkey
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Abstract
Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani's government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the "Health System Transformation Plan" (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran. Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts - policy- and decisionmakers, professors and academicians, health department workers, health activists, journalists. Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran's HSTP was revised, finalized and then performed. Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved.
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Atas H, Sahin AA, Barutçu Atas D, Sunbul M, Kepez A, Agirbasli M. Potential Causes and Implications of Low Target Therapeutic Ratio in Warfarin-Treated Patients for Thrombosis Prophylaxis: A Single-Center Experience. Clin Appl Thromb Hemost 2017; 24:536-541. [PMID: 28301912 DOI: 10.1177/1076029617695484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Time in therapeutic range (TTR) of international normalized ratio is crucial for the safety and efficacy of anticoagulation with warfarin and it is influenced by many factors. There are limited data about the quality of warfarin therapy and its effects on clinical outcomes in Turkey. The aim of this study is to demonstrate the quality of anticoagulant therapy with warfarin and evaluate the parameters that affect the quality of warfarin therapy. A total of 170 patients with atrial fibrillation (AF; mean age: 62.2 ± 13.3; 69.2% female) treated with warfarin were included in this study. The mean follow-up period was 20 ± 8.4 months. The mean TTR levels of all patients were found to be 54.2% ± 21.4%. The TTR levels were similar in patients with valvular AF (VAF) and nonvalvular AF (NVAF). Logistic regression analysis revealed that elderly, heart failure (HF), and renal dysfunction were independent predictors of lower TTR. There were no significant differences between the VAF and NVAF subgroups regarding the incidence of mortality, stroke, and myocardial infarction. Cox regression analysis revealed that HF, coronary artery disease, and renal dysfunction were independent predictors of clinical outcomes in addition to lower TTR. Our results provide data regarding the quality of anticoagulation with warfarin from a single tertiary center in Istanbul, Turkey. The questions remain in seeking quality improvement in anticoagulation.
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Affiliation(s)
- Halil Atas
- 1 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Anıl Sahin
- 1 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Dilek Barutçu Atas
- 2 Division of Nephrology, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- 1 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Alper Kepez
- 1 Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Agirbasli
- 3 Department of Cardiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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