A comparative analysis of the European Union's and Turkey's health status: how health-care services might affect Turkey's accession to the EU

Declining Public Health Protections within Autocratic Regimes: Impact on Global Public Health Security, Infectious Disease Outbreaks, Epidemics, and Pandemics

Public health emergencies of international concern, in the form of infectious disease outbreaks, epidemics, and pandemics, represent an increasing risk to the worldʼs population. Management requires coordinated responses, across many disciplines and nations, and the capacity to muster proper national and global public health education, infrastructure, and prevention measures. Unfortunately, increasing numbers of nations are ruled by autocratic regimes which have characteristically failed to adopt investments in public health infrastructure, education, and prevention measures to keep pace with population growth and density. Autocratic leaders have a direct impact on health security, a direct negative impact on health, and create adverse political and economic conditions that only complicate the crisis further. This is most evident in autocratic regimes where health protections have been seriously and purposely curtailed. All autocratic regimes define public health along economic and political imperatives that are similar across borders and cultures. Autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or the impact on their population. A cross section of autocratic nations currently experiencing the impact of COVID-19 (coronavirus disease 2019) are reviewed to demonstrate the manner where self-serving regimes fail to manage health crises and place the rest of the world at increasing risk. It is time to re-address the pre-SARS (severe acute respiratory syndrome) global agendas calling for stronger strategic capacity, legal authority, support, and institutional status under World Health Organization (WHO) leadership granted by an International Health Regulations Treaty. Treaties remain the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world.

“Honesty is worth a lot more than hope…” The Economist, February 17, 2020.

European Union state of health from 1990 to 2017: time trends and its enlargements' effects

OBJECTIVES

We aimed to study health status' time trends in the European Union (EU) during 1990-2017 and its enlargements' impact.

METHODS

Using estimates from the Global Burden of Disease 2017 study and calculating age-sex-standardized rates, we have described time trends and analysed the differences between EU groups regarding the state of health. Interrupted time-series analyses were also performed in order to assess the enlargement impact in the EU state of health.

RESULTS

All age-sex-standardized rates (mortality, years of life lost, years lived with disability and disability-adjusted life years) declined (annualized rates of change of - 1.7%, - 1.52%, - 0.06% and - 1.01%, respectively) between 1990 and 2017 (except between 2014 and 2015). For EU-28, life expectancy and healthy life expectancy increased 5.9 and 4.6 years, respectively. With the EU-25 and EU-27 enlargements, all age-sex-standardized rates and life expectancies worsened (with statistical significance). The EU-28 enlargement revealed the same tendency, contrasting with the EU-15 one.

CONCLUSIONS

Overall, the EU health status is improving, despite changes in its composition over the years. However, the average EU state of health declined with the 2004, 2007 and 2013 EU enlargements.

Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders' views in Turkey

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.

Markets, modernisation and national interest: three faces of patient choice policy in Turkey

This article discusses three faces of patient choice policy in a developing country, Turkey. As part of its wider health transformation programme (HTP), Turkey has created a purchaser/provider system in which a single public purchaser channels funding to a range of public and private hospitals, and patients--in theory at least--are given significant freedoms to choose their hospital and physician. At the same time, marketisation has been softened by an emphasis on the creation of 'human-centred' services, resulting in a variety of initiatives to enhance patient rights and using a similar rhetoric to that employed in modernising 'third-way' reforms in countries such as the United Kingdom. We argue that neither markets nor modernisation fully explain the specifics of Turkish choice policy, which is also driven by the strong political imperative arising from Turkey's proximity to the European Union and its accession ambitions. Europeanisation represents an approach to markets softened by social solidarity, and gives the Turkish reforms a very different profile from neo-liberal reforms implemented in other middle income countries. However, in practice, medical workforce shortages, the uneven distribution of resources across the nation, and the lack of systematic information on provider outcomes limit the scope of choice for much of the population. In this situation, a planned allocation of resources to support equity of provision has advantages over a system where resource flows to providers are determined by individual patient choices.