HOW TO ENSURE TRANSFORMATION IN FIGHTING CHRONIC DISEASES

Prof. Dr. Mehtap TATAR

Hacettepe University Faculty Economic and Administrative Sciences Department of Healthcare Management

Agenda
Economic burden of chronic diseases

Risk Factors
Status of healthcare services What should be the transformations

direction?

Distribution of DALYs lost among fundamental disease groups (%), Turkey 2000

Urinary System Diseases Diabetes Sensory Organs Nutritional Deficiencies

Musculoskeletal System Diseases

Digestive System Diseases Respiratory System Diseases Cancer Perinatal (Maternal) Reasons Infections Excluding HIV/AIDS Neuropsychiatric Diseases Injuries Cardiovascular Diseases

Female

Erkek Male

Ministry of Health, Bakent University, 2004

Economic burden of chronic diseases

Total burden of chronic diseases is equivalent

to the 6.5 million DALY lost annually + Neuropsychiatric diseases = 8 million DALY Each DALY lost = $10 00 (GDP per capita) = $65 billion loss 8-10% of GDP

Agenda
Economic burden of chronic diseases

Risk Factors
Status of healthcare services What should be the transformations

direction?

Demographic Panorama 2000/2011

Age Group

Popuation

Ministry of Health 2012

Demographic Indicators
Total Population Rural Population (%) Urban Population (%)

Rate of Age 0-14 (%)

Rate of Age 65 and over (%) Dependency Rate of Youth (Age 0-14 ) Dependency Rate of Elderly (Age 65+ ) Total Age Dependency Rate Annual Population Increase Rate () Rough Birth Rate () Rough Death Rate () Total Fertility Rate (Per Woman)

Ministry of Health 2012

Age 60+ International Comparison (%), 2010

European Union

High Income Group Countries

WHO Europe Region

Mid- High Income Group Countries

World

Turkey

Ministry of Health 2012

Obesity rates (%)

Economic impact of obesity

Condition Ischemic heart disease Hypertensive heart disease Ischemic stroke Diabetes Osteoarthritis DALY 346 294 61 796 146 930 152 240 61 035 Total Economic Impact (2004) $ 2 009 825 330 358 652 377 852 754 122 883 572 364 354 235 676 Total Economic Impact (2012) $ 5 980 104 427 1 067 146 798 2 537 314 373 2 629 012 047 1 054 005 191

Breast cancer
Colon and rectum cancer Corpus uteri cancer Total

8.859
7 300 2 730 787 184

51 415 972
42 367 829 15 844 407 4 568 668 076

152 984 877

126 062 716 47 144 002 13 593 774 432

Total Economic Impact / GDP (2004): 1.16% Total Economic Impact / GDP (2012): 1,73%

International comparison of obese individuals (BMI 30) based on sex 2010

Turkey

Mid- High Income

Europe Region

High Income Group

World

Group Countries

Countries
Female Male

Ministry of Health 2012

Persons using tobacco products daily (%)

Male

Female

Total

Ministry of Health 2012

Agenda
Economic burden of chronic diseases

Risk Factors
Status of healthcare services What should be the transformations

direction?

Physician visits per person

2011 2010
2009

3,3 4,9 2,7 4,6

2,8 4,5

8,2 7,3
7,3

2008
2007 2006

2,5 4,2 2,2 3,9

1,9 3,4 5,3

6,7 6,1 4,7 3,8

3,4

2005
2004

1,7 3,0 1,3 2,4

1,3 2,1

2003 2002

1,1 2,0 0,0

3,2 5,0
Stage 1 Birinci basamak

10,0
2 kinciStage basamak

15,0
Kii ba ziyaret Visit per person

20,0

Ministry of Health 2012

# of medical advice sought according to stages

Stage 1 Ministry of Health 2012

Stages 2 & 3

Referral rates of Stage 1 institutions (%)

Yl

Ministry of Health 2012

Infant Mortality Rate

Mortality Rate for Ages < 5

Ministry of Health 2012

Maternal Mortality Rate

Health Promotion and Development Program

Population with diabetes over age 20 (%)

Turkish Diabetes Prevention and Control Program

Programs by the Ministry of Health

Obesity Control Program

Diabetes Control Program

Tobacco Control Program Program for the Prevention and Control of Cardiovascular

Diseases Mental Health Control Program Nursing At Home

Agenda
Economic burden of chronic diseases

Risk Factors
Status of healthcare services What should be the transformations

direction?

Primary Health Care: Definition

Comprehensive Definition Narrow Definition

A philosophy and perspective for the improvement of health status

Primary health care services offered in the first tier

Social participation Decentralization Cooperation Across Sectors

Family physician as a first call doctor

Primary Health Care

Comprehensive Primary Health Care

Selective Primary Health Care

Integrated Primary Health Care

The service provision model where the individual or the family visits the local first tier unit or the family physician within the healthcare system. The first call doctor either treats the patients, or refers the patient to a specialist.

Use of private health care providers Pilot family physician practice

Transfer of SSK Hospitals

Access of SSK patients to private pharmacies

Universal Health Insurance

Expansion of the family physician practice to the whole country Medical Campuses 2010 2011

2003

2004

2005

2008

Performance based bonus system

Expansion of the Green Cards scope

Health coverage for population under 18 years of age

Full-time and performance based premium system at the universities

Attempts for basic reform

Before Transformation Health Group Directorates Health Center Maternal and Infant Care Center Tuberculosis Control Dispensary Agency Physician Medical Cabin SSK Dispensary SSK Medical Station

After Transformation

Community Health Center Family Health Center

Integrated health care in Turkey?

No first-call physician function
The costs are unknown
The impact on the quality of care is unknown

No integration with second or third tier Continuity in care is at the whim of the

family physician Role of disease management?

Obstacles before integrated health care system

Lack of physicians and other medical personnel
Potential decrease of patients to visit hospital Paradigm change regarding the presentation and

organization of health care services

Ready for a paradigm change?

Helping people stay healthy and live a good life

Future of services provided by pharmacists and by family physicians connected to it?

Acute disease model (Institutional Care Social role suspended)

Traditional hospital services institution based, medicine oriented

Chronic disease model (Community carenormal social roles)

Future of modernized Stage 1 and interconnected Stage 2 healthcare services?

Treating patients

Thank You ..
mtatar@hacettepe.edu.tr