Health Services Pricing in Turkey

Abstract

One of the most important and complex decisions that public services managers have to make is pricing. This is especially difficult within public health care because pricing decisions are influenced by a myriad of ideological, political, economic and professional arguments. In Turkey the majority of health care services are provided under public auspice; however, recent changes in governmental policy have led to increased competition among hospitals in both the public and private sector. Therefore, all institutions are being watched and remain open to government scrutiny and regulation. The aim of the study is to analyze how the private and governmental hospitals determine pricing or the actual cost of services in Turkey. Also, comparisons are made between health services expenditures and the Consumer Price Index with suggestions provided for public and private hospital managers in regard to the general cost of health services.     

The precarious pricing system for hospital services

Over the past twenty-five years, the average ratio of hospital charges for services (gross revenues) to payments received (net revenues) has grown from 1.1 to 2.6. This reflects a transition from predominantly cost- and charge-based payment systems to regulated and negotiated fixed payments. Hospitals have been able to squeeze additional revenues from remaining charge-based payers and services by sharply increasing charges, negatively affecting the uninsured. Although protection of the uninsured seems warranted, it might be difficult to regulate hospital pricing systems in isolation from other controversial issues, such as the acceptability of cross-subsidies and the role of market forces.     

Health and social inequities in Turkey

Social and economic policies of governments directly influence the health of the people. These policies, in turn, are determined by the national and foreign controllers of power. Economic and social factors in Turkey during the late 1970s led to a new modelling of the economic system, from a Keynesian to a market-oriented and monetarist model. The state mechanism was also altered to form a centralized, authoritarian regime in order to enforce the requirements of the economy. As a result, the middle class diminished in size, inequalities in income distribution increased, unemployment climbed, the purchasing power of wage earners decreased, government spending for education and health was cut and new oppressive laws were enacted. Health services were already urban-biased and hospital-oriented, but new free-market measures were instituted which promoted private health institutions and attempted to transform state-owned and financed hospitals into self-supporting, independent business enterprises. The only school of public health was closed down; preventive medicine expenditures were lowered while hospital rates and drug prices were increased. All these changes affected the health status of the population. Mortality and morbidity inequalities had already existed between the rich and the poor, men and women, urban and rural settlements, educated and illiterate, West and East, always in favour of the former. However, the new policies exacerbated the inequities. Infectious diseases including tuberculosis increased, nutrition worsened, occupational diseases and work accidents rose to be the highest in Europe. The power-holding minority is not interested in the health of populations and is committed to pursue its social and economic policies. Ad hoc research, especially cross-sectional mortality studies repeated at regular intervals can provide data on the most vulnerable groups as no other valid information exists. There is little hope of these data being used for intervention unless democratic changes take place.     

Health services inequalities in Nigeria

The paper gives a brief overview of the growth and development of health services in Nigeria in the period after independence. A large part of the paper concentrates on the discussion of various forms of health services inequalities in Nigeria. Regional and rural-urban inequalities which are usually cited by Nigerian health critics to justify health inequalities have been considered. However, the paper, concludes that class inequalities are the most serious forms of inequality affecting the distribution and utilization of health resources in Nigeria.     

Assessment of the efficiency of dental services in Turkey

Aim

The present study aimed to measure the efficiency of dental services at the provincial level in Turkey and to identify the potential areas of improvement.

Health systems and services

Since 1/6 of the world population lives in India, the health status of Indians significantly affects the global health situation. India is also a country of contrasts with some states having levels of health similar to the best of other developing countries, to other states having levels of health similar to the worst of other developing countries. India's health system is based on centuries of social tradition; however, it wasn't until this century, that it became clear that the health of workers was directly related to production capacity and thus to the national economy. After independence infant/child mortality was 162/1000 for 1 year olds, the maternal mortality rate was 20/1000, and malaria accounted for 1 million deaths out of 100 million cases. Through an integrated approach to prevention and treatment, these figures have dropped 35.2/1000 for infant mortality. Now, there are other problems like the declining sex ration. In 1901 there were 972 girls/1000 boys, by 1991 this figure dropped to 929. Currently 90% of the population knows about their Public Health Centers, but only 31% utilize the formal health care system, of these 9-23% are dissatisfied.     

Health information services technologies

Increasing demands for provider profiling have led to the growth of health information services units within payers and health plans. An important decision faced by these groups is whether to buy or build the information infrastructure necessary to support the activities of the department. The article offers an overview of a system that was collaboratively designed and built by Blue Cross and Blue Shield of Iowa and the Dartmouth Medical School. A case study illustrating the flexibility of the information system in adapting ambulatory care groups to the fee-for-service payer industry is reviewed.