Budget deficits, lack of oversight and unstable system swamp health sector in 2009

The government, in order to raise revenues from patients seeking treatment and limit the number of people seeking treatment at hospitals for minor issues, implemented a patient contribution fee of TL 3 for patients applying for treatment at government hospitals, TL 4 at research hospitals, TL 6 at university hospitals and TL 10 at private hospitals in October 2008. Total hospital fees for services provided at private hospitals were covered on a percentage basis, with the government footing the majority of the total bill and the patient covering the rest. This patient contribution scheme enraged private hospitals as the number of patients seeking private treatment decreased significantly. This was overturned by the Council of State on grounds of inequitableness in April 2009, and the participation fee was reduced to TL 2 across the board. The SGK in September enacted a TL 3 fee for prescriptions and changed the patient contribution scheme: TL 8 at government and university hospitals, and TL 15 at private hospitals.

Oversight needed

Moreover, reports that hospitals were fraudulently ordering unnecessary tests and check-ups in order to obtain money from the SGK also drew the ire of the government. To control the heavy burden of the health budget in 2010, the central government decided to limit the amount of spending of private hospitals on a per-patient basis in its 2010 budget. “Health is not an economic policy tool,” said Mahmut Kaçar, chairman of the Turkish Health Union (Sağlık-Sen), speaking to Sunday’s Zaman. “If hospitals are defrauding the government, then the government should inspect and audit every single book in the institution. Instead of presenting a strong auditing system, it’s restricting vital services for patients by limiting the amount that can be spent per patient.”

Kaçar, noting that the SGK should audit hospitals if it wants to prevent fraud, also criticized the patient participation scheme, stating that it left patients in a difficult position, putting them face-to-face with fees in both private and government hospitals, which were completely free of charge before the October 2008 law. Kaçar noted that the strict money-saving and revenue-generating policies of the administration are a direct byproduct of its not implementing budget controlling measures when first designing the system. “The administration has a serious problem with controlling the budget. The health administration took great steps in opening doors for private healthcare in the last seven years, but it slammed on the brakes and backtracked on these reforms at the first sign of trouble. Why? Because it saw that on a per-person basis, private hospitals were spending more than government ones. Instead of completely destroying the system and starting from scratch every few months, they should have put in budgetary control measures before implementing reforms. It’s not that the system needs a bigger budget, it just needs better measures to control spending,” Kaçar noted.

He added that a health card system that was supposed to be implemented four years ago to reduce costs by aggregating patient information, prevent unnecessary, duplicate and possibly fraudulent tests from being ordered and make it easier for the SGK administration to control patient activity has yet to come to fruition -- a tool that would greatly help control ballooning costs and maybe could have even prevented the budget problems the administration is now facing, according to Kaçar.

Hüseyin Demirdizen, the general secretary of the İstanbul Medical Chamber (İTO), speaking to Sunday’s Zaman also criticized the patient contribution fee, adding that it created undue financial stress on low-income families. It also caused patients to mistrust health workers, Demirdizen noted, and the fact that the administration was not auditing for unnecessary and fraudulent tests led to a further lack of trust by patients who were bombarded with repetitive procedures. Patients thus decided to turn to rumors about serious health issues rather than listening to health workers who, they thought, may have defrauded them. Kaçar noted that politicians, academics and so-called experts had confused the public about vital interventions such as the swine flu vaccine, creating mistrust in health workers’ suggestions. He added, however, that despite this mistrust the swine flu pandemic had been mostly thwarted in Turkey because of the effectiveness of the Ministry of Health’s precautionary policies. He revealed that he was recently informed at a meeting with Health Minister Recep Akdağ that the number of people in Turkey with the H1N1 virus decreased in December and that the number of people seeking emergency care concerned that they have the virus had also decreased.

Increasing costs of over-consumption

Touching on pharmacists striking after facing the bill resulting from price cuts for medicine in 2009, the threat of non-prescription medication in supermarkets and the increasing health costs of the over-consumption of medication, Demirdizen stated that “there isn’t any medicine that doesn’t harm the body.” Speaking about Prime Minister Recep Tayyip Erdoğan’s recently announced initiative to bring non-prescription drugs to supermarkets, Demirdizen said this would only lead to higher and unnecessary consumption of drugs, lead to various illnesses and create further financial stress on the health sector. He said even in societies with a more formal education in drug use, there are still serious health problems arising from over-consumption of medicine. “It is not possible to overlook these facts when thinking about implementing a measure like this. … It will definitely increase health costs,” he said.