Turkey's ruling Justice and Development Party (AKP) will plan the payment for the treatment of chronic diseases considering “quality and results”. Under the new regulation, the state will have right to reject the payment if, for example, a diabetic patient who has been receiving treatment for 20 years hasn’t shown enough improvement.
A short time ago, Social Security Institution, or SGK introduced a new “Model for Pricing to Prioritise Clinical Quality” which was developed to be implemented in all public hospitals. Diseases and disorders such as diabetes, stroke, hypertension, chronic obstructive pulmonary disease, and cardiovascular diseases, which have shown a rapid increase in recent years, are determined to be examined and evaluated by means of the new model.
The SGK and the Ministry of Health will perform quality assessments in the relevant clinics of the hospitals. Thus, a new period of “payment upon quality and result” will start. For instance, if 90 out of 100 patients who suffered heart attack are recovered in the Hacettepe University Hospital while 10 out of 100 patients of the same disease are recovered in the Istanbul University Hospital, patients in two hospitals will not be paid for in the same amount.
Introducing the new model, Orhan Koç, Vice-President of the SGK, said: “A registration system for these diseases will be created by assigned science commissions, which will include academic associations, determining the requested data in accordance with international standards. The science commission will examine the data collected in each year to evaluate the efficiency and the quality of the treatment. By this means, management of the diseases will be obtained. Registration forms that are generated will be associated to the refunding.”
Even though it is not possible to understand how clinical procedures following standard algorithms corresponding to diagnostic and therapeutic manuals will be affected from this attitude change, it is obvious that the health authority will take financial measures that couple the treatment quality onto cost efficiency rather than fighting against the root causes promoting occurrence of chronic diseases.
Koç indicated their goal as “to provide the opportunity to differentiate between citizens receiving diabetes treatment for 20 years that goes for routine check-ups, uses their medication, keeps a balanced diet, does regular physical exercise and the ones who does not display the same sensitivity, and to interfere in the halting points.”
It is suspensive how those halting points will be interfered in because, actually, there is no guarantee that the sanctions won’t be individualised when the chronic disease load becomes unbearable. The illusion that “one is fully responsible for one’s own health” is the all-time functional motto of capitalism and will remain a handy illusion unless the social determiners of health are revealed.
Incidence of diabetes has shown a significant increase in recent years such that it is regarded as an epidemic in certain sources. Not only the incidence of diabetes, but also those of chronic obstructive pulmonary disease, coronary artery disease, hypertension, and stroke have significantly increased.
Along with the gradual increase of the life expectancy at birth, metabolic and chronic disease load, too, unavoidably increases. On the other hand, individual suggestions serve only as advice and the macro-politics of health has to arrive at the legalities of capitalism. In the light of recent developments, it is understood that the health authority is going to take certain repressive measures in order to cut the costs.
