2009年-世界发展银行全球_Health_Workforce_Policy_in_Turkey___Recent_Reforms_and_Issues_for_the_Future_60页_2mb

Summary of Health Workforce Policy in Turkey: Recent Reforms and Issues for the Future

Core Content

This document provides an analysis of recent health workforce reforms in Turkey and highlights key challenges and issues for the future. It is part of a background note for the World Bank's health sector review and outlines trends in health workforce outcomes, comparisons with OECD countries, and the impact of policy changes on the health system.

Main Objectives

• Summarize trends in key health workforce outcomes
• Compare Turkey's health workforce outcomes with OECD and other countries
• Discuss the impact of recent reforms on health workforce outcomes
• Highlight key health workforce policy issues for the future

Key Health Workforce Outcomes in Turkey

Overall Staffing Levels

• Turkey has the lowest number of physicians and nurses per capita among OECD countries.
• In 2005, Turkey had 1.5 physicians per 1000 population, compared to the OECD average of 3.0.
• In 2005, Turkey had 1.8 nurses per 1000 population, compared to the OECD average of 8.9.
• From 2001 to 2007, both physician and nurse numbers per capita increased, but still lag behind OECD levels.
• General practitioner staffing levels declined, while specialist and residency assistant numbers increased.

Skill Mix

• Turkey has a low nurse to physician ratio, which is a significant imbalance.
• In 2006, the ratio was 1.4 nurses per physician, compared to the OECD average of 3.1.
• The proportion of specialists to general practitioners increased from 1.48 in 2001 to 2.14 in 2007.
• The trend of physician to nurse and midwife ratio remained relatively constant.

Geographic Distribution

• There is significant geographic imbalance in the distribution of health workers across provinces.
• In 2007, the highest to lowest ratios were:
  • 4.5 to 1 for specialists
  • 2.7 to 1 for GPs
  • 4.3 to 1 for nurses/midwives
• The variation in health worker distribution is strongly correlated with provincial economic development.
• The Ministry of Health has been working to address these imbalances, particularly in underserved regions.

Productivity

• Workforce productivity has been increasing, as measured by consultations per physician.
• In 2006, Turkey had 3,179 consultations per physician, higher than the OECD average of 2,510.
• This growth accelerated from 2004, with consultations per physician reaching 3,630 in 2007.
• Annual growth in consultations per physician was 6.2% in Turkey, compared to a 0.5% decline in OECD countries.

Public-Private Mix

• The public-private mix in health services has been evolving.
• Private facilities, though present, are not always effectively regulated.
• The government has been working to integrate services and improve access and efficiency.

Recent Reforms and Their Impact

Performance-Based Payment System

• A shift from fee-for-service to performance-based payment systems has been implemented.
• This aims to improve efficiency and quality of care by linking payments to performance metrics.

Compulsory Service Requirement

• A compulsory service requirement has been introduced to ensure that health workers serve in underserved areas.
• This is intended to address geographic imbalances and improve access to care in rural and low-density regions.

Family Medicine Program

• A family medicine program has been launched to promote primary health care.
• It aims to increase the number of family physicians and improve the skill mix.
• Despite efforts, only 3% of physicians were classified as family physicians in 2007.

Constraints to Scaling Up

• Both supply-side and demand-side constraints may hinder the scaling up of the health workforce.
• Supply-side issues include difficulty in recruiting and retaining staff in remote areas.
• Demand-side issues involve low utilization of primary health care services due to perceived low quality.

Key Health Workforce Policy Issues for the Future

• Skill mix imbalances: The increasing trend of specialization and the decline in general practitioners and nurses raise concerns about the sustainability of the health system.
• Geographic disparities: Continued efforts are needed to address uneven distribution of health workers across regions.
• Remuneration strategies: Contract-based employment is being used to attract staff to underserved areas, but this requires careful management.
• Primary health care focus: Emphasis on primary care and family medicine is critical for improving health outcomes and reducing the burden on higher-level facilities.
• Productivity and quality: Enhancing productivity while maintaining quality of care remains a key challenge.
• Integration and coordination: Ensuring integration of health services and systems is essential for achieving universal access and efficiency.

Conclusion

Turkey has made notable progress in expanding health insurance coverage and improving access to health services. However, significant challenges remain in terms of health workforce density, skill mix, geographic distribution, and the efficiency of service delivery. Future policy must focus on addressing these imbalances through targeted investments, training, and remuneration strategies to ensure a sustainable and equitable health workforce.