Strength of primary care in Turkey

Abstract

Strong primary care is assumed to contribute positively to health system goals including equity in population health, sustainable health care expenditures, and responsiveness of care. During the last decade a health reform program called Health Transformation Program (HTP) was conducted step by step in Turkey, yielding important changes for the national health system. One of the important components of this program is the introduction of Family Medicine Scheme. The aim of this paper is to evaluate the strength of primary care in Turkey regarding structural and procedural features, with respect to evidence in the literature and also to discuss whether HTP is primary care oriented or not, as long as outcomes achieved by 2014 are concerned. Despite all structural and procedural reforms of HTP, recent literature claims that process and structure of primary care in Turkey is not as strong as most of the countries in Europe. Basic problems are: lack of manpower in primary care both quantitatively and qualitatively, high number of patients per family physician, lack of procedures supporting team and multidisciplinary work, recommendations of NGOs and other stakeholders regarding health politics are not taken into account. Besides lack of supporting environment for family physicians to coordinate health service, existing alternatives for first contact of care other than primary care, lack of organization for primary care service delivery out of office hours and need of expansion of comprehensiveness for health services delivered by primary care teams are other important problems. As a conclusion, HTP reforms are not primary care oriented, but more supportive for usage of technology and specialist care. These circumstances reveal the high risk of dysfunctional primary care service transformed to “sauce” of the health system and also very high health expenditures.