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 – Health centers having problems in covering population Public hospitals – Belonging to various ministries and a social security institution Health insurance – 3 separate institutions for different employment groups 2

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 high motivation 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 information system 3

Current situation ( ) General practice – Health Centers having problems in covering population – Family Health Centers & Community Health Centers covering population Public hospitals – Belonging to various ministries and a social security institution – Belonging to Ministry of Health Health insurance – 3 separate institutions for different employment groups – Single institution: Universal Health Insurance 4

General Practice Family Health Centers – Teams composed of a family physician & a family health worker – persons per team Community Health Centers – One in every district – Operating as local health authority – Delivering community health services – Providing laboratory and imaging services to family health centers 5

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What about “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. 13

What about “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. 14

What about “quality”? An admonition points list which has been badly criticized by family physicians was recently released. “Sample” Implementation Guide for Family Health Centers was released most recently. – Hand-washing – Storing and transporting vaccines – Breast-feeding – Sterilization & disinfection, etc. 15

Conclusion Unfortunately, as in many countries, 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. 16

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