503666
2013
PED21110.1177/1757975913503666CommentaryA. K. Ozsahin
Commentary Family practice in Turkey Akatli Kursad Ozsahin
Abstract: The national project ‘Transformation in Health’ was started in 2005 to provide expert primary care by family physicians, and decrease expenses in Turkey. The number of family physicians was far below the need, so public physicians were promoted to family physician status after a 10-day intensive course. The government declared some satisfactory results, but privately paid family physicians were not accepted into the system. Furthermore, the government stopped paying for their services from private settings. Some family physicians became unemployed as the major payer for all forms of medical care in Turkey denied their services. The process showed it’s value in time. Nevertheless, family physicians should be the core of this transformation as family medicine is an academic and a scientific discipline and a primary care-oriented specialty with its own specific educational content, research and base of evidence, which cannot be achieved through standard medical education. (Global Health Promotion, 2014; 21(1): 59–62). Keywords: Education, family physician, healthcare, health promotion, primary care, Transformation in Health
Background Enormous costs of health with public murmurs about insufficient primary care led the Turkish government to take precautions to cover both grounds. They soon realized that they needed ‘a health care delivery system that features a cost effective and competent family practice primary care base that is integrated into the total health care system’ (1). Since the whole world was moving into a primary care-(mainly family medicine) based system, the road map was ready (2–7). In the early 2000s the current government initiated the project ‘Transformation in Health’. The key objectives included covering all the citizens with general health insurance, promoting mother and child health care, generalizing preventive healthcare and implementing family medicine (8). This care was at first planned to be based on Family Practice specialists, but unfortunately was based on the name of the specialty only. In Turkey, after six years of medical education one becomes a physician
and is called ‘Practitioner’ or ‘General Practitioner’ (GP). If one chooses to be a Family Practice Specialist, one must have a rotational education in internal medicine, general surgery, paediatrics, gynaecology and obstetrics and psychiatry for three years, according to the current curriculum. At the end of this period, after preparing a project and fulfilling a board exam one becomes a family physician or a Family Practitioner (FP). Most physicians in Turkey are public, that is, they work for the government and obtain a salary. Some physicians work privately either in their offices or in non-governmental facilities. These are paid either by their patients or mostly by the government on a feefor-service basis. At the moment the government is the major health payer in Turkey for all forms of medical care because insurance companies do not yet cover most health expenses. In the early 2000s most of the FPs in Turkey were publicly paid, working in health clinics, in emergency settings and in secondary care units and approximately 25% were privately paid.
Department of Family Medicine, Baskent University Faculty of Medicine, Turkey. Correspondence to: Akatli Kursad Ozsahin, Department of Family Medicine, Baskent University Faculty of Medicine, Dadaloglu mah, Serin Evler 39, Sokak no: 6, Yuregir 01250, Adana, Turkey. Email: [email protected] Global Health Promotion 1757-9759; 2014; Vol 21(1): 59–62; 503666 Copyright © The Author(s) 2013, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975913503666 http://ped.sagepub.com Downloaded from ped.sagepub.com by guest on April 13, 2015
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Turkey had multiple health clinics for primary care provided by GPs in every city (9). The service was unsatisfactory. As a result people went to secondary or tertiary care units even for their smallest complaints, which caused increased expenses and decreased quality of care in those settings.
The ‘Transformation in Health’ project The original theme of the ‘Transformation in Health’ project was to use the FPs to give primary care (10). The project was started in the city of Duzce, which is between Ankara and Istanbul with a population around 300,000 at pretest (11). Financing was initiated with credit from the World Bank (12). A FP was thought to give care to a 2500–3000 population (maximum 3000), so 104 FPs were all the ministry needed to start things. However, at that time there were only three FPs in Duzce and about 1200 in the whole country (11,13). Approximately 20,000 FPs were needed nationally. The ministry had a response for that. They ruled that after attending a 10-day preliminary intensive educational course given by academics of Family Practice, any GP or any non-FP would be certified as an FP (11). Assuming this transformation would cover the whole country and over time create many advantages, some specialists from different branches, including obstetrics and gynaecology, cardiovascular surgery, urology and many preclinical branches took the preliminary course and became certified. In order to begin, all publicly paid physicians of a region who were certified had to resign and sign annual contracts if they agreed to join the system (11). Each physician would be assigned a list of a population (supplied from local election rolls) for which they should provide care. Patients were expected to go to their assigned physician whenever they sought medical help, but they were not obliged to do so. The patients were not inhibited from going to higher institutions. Using the system, physicians were expected to keep patients away from higher institutions and reduce health costs. Six months after the beginning, any patient would have the right to change assigned physician (11). The payment was planned to be motivating. A GP was paid approximately 1.5–2 billion Turkish Liras (1000–1300 USD) per month. The physicians in the
system would be paid approximately 2.5–3-fold this amount, depending on the number of people assigned to them. More patients meant a greater salary. The salary of FPs in the system would be 10% higher than GPs (11). A physician was required to keep the count over 1000 to preserve his contract (11). If publicly paid physicians did not join the system, they were moved to public health centres or emergency settings with the previous lower salary, but keeping a full work guarantee (14). The process began on 15 September 2005. The first impression was declared to be promising. Offices started to accept patients. The high salary was indeed a motivator and the number of patients seen started to grow dramatically (15,16).
Pitfalls Some bureaucrats pointed out that the new programme could face the same fate as a previous programme, ‘Socialization of Health Services’, which was withdrawn in the late 1960s due to financial difficulties. Some medical nongovernmental organizations (NGOs) called all physicians to refuse to enter the system. The FPs had another problem. Eastern provinces of Turkey lacked a sufficient number of physicians due to social and economic underdevelopment. Therefore, the Turkish Ministry of Health ruled a compulsory service for two years in the East for physicians at the end of their training before they were given their diploma (17). At the end of this period a physician could ask to be moved home provided that the staff positions in his or her city of choice were unoccupied. Otherwise options were limited: either to stay where he or she was, or go somewhere not of his or her choice, or leave (11,18). Publicly paid physicians of any city had the priority to choose the district to work in; other applicants had to work in unoccupied sites (11). If a private practising FP decided to be a publicly paid physician and join the system, he or she was appointed to a different city, generally in one of the far corners of the country. The ministry ruled all FPs had to work either in the system wherever he or she was assigned or in secondary or tertiary units out of the system on a privately paid basis. Shortly after that, the Turkish Treasury stopped paying the bills of FPs from those settings except for Emergency Room services. That
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Commentary
meant a farewell to private practice for FPs. Consequently, NGOs stopped employing FPs. By 2006 the process had covered 3.2 million people of the estimated population of 70 million. At the end of 2009 the project had covered 22.2 million people, or about 31.5% of the country. The total number of FPs in the system (certified and real) reached 6557, with 3385 people per FP. Forty-one more cities were included in early 2010 (19). According to a EuroPEP survey in 2008, 96% of the population had health insurance coverage and 80% were satisfied with health services. Mother and child health improved dramatically, and Turkey was on target to achieve Millennium Development Goals (MDGs) 4 and 5 (13). The project faced a real challenge when its final step for megacity Istanbul, with an estimated population of 13 million, was given a start; this called for approximately 3500 FPs and another 5% each consecutive year to keep up. The whole country was covered as the final seven cities were taken into the system in December 2010.
Conclusion
flow of patients has to be from primary care to secondary and tertiary units to reduce costs, provided the project has sufficient qualified instruments such as family physicians. However, the chain of referral could not be implemented and is being postponed continuously, reasoning that it would downgrade the motivation of physicians and reduce their competence (22). With the evidence from the EuroPEP survey in 2008 (13) that the country is being well served by the new system of GPs, we believe that the real innovation is the system of payment to persuade physicians to practise in all parts of the country. The designation of GPs as family physicians after only two weeks of training is a weakness that will not bring positive results over the long term. Employing a sufficient number of family physicians and using the available ones as team leaders may be the only road map to strengthen primary care and promote health, because family medicine is an academic and a scientific discipline and a primary care-oriented specialty with its own specific educational content, research and base of evidence (23). Funding
The 7th Global Conference on Health Promotion was held in Nairobi, 26–30 October 2009. Health promotion was seen in this conference to be an essential, effective approach in line with the renewal of primary healthcare as endorsed by the Executive Board of the World Health Organization (WHO) (20). Promoting health by improving primary care with reduced costs and favourable outcomes is essential for any country, but unfortunately this whole project in Turkey has been a transformation or promotion of practitioners into family physicians with minimal training. The most challenging diagnoses are those for diseases or disorders in their early, undifferentiated stage, when there are often only subtle differences between serious disease and minor ailments (21). This is exactly what the FPs were trained for. We believe Rakel did not mean a certification programme for GPs when he wrote, ‘The greater the number of family physicians in a country, the lower the mortality rates and the lower the cost. The opposite is true when number of specialists increase’ (21). We doubt if raising ranks of former public physicians through a short training can help Turkey over the long term. As for reducing the costs, the
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Ishibashi Y. Why is family medicine needed in Japan? J Fam Pract. 1987; 25: 83–86. 2. Seifert B, Svab I, Madis T, Kersnik J, Windak A, Steflova A, et al Perspectives of family medicine in Central and Eastern Europe. Fam Pract. 2008; 25: 113–118. 3. Goh LG, Fabb W. Family medicine development in Asia Pacific Region. Singapore Fam Physician. 2001; 27: 31–36. 4. Fry D, Furler J. General practice, primary health care and population health interface. General Practice in Australia. 2000; 389. 5. Parkerson G, Monteiro F, Pepper C, Pavlik V, Spann S. The status of family health care and family medicine in the region of the Americas. A joint project of the Pan American Health Organization and the Department of Family and Community Medicine of Baylor College of Medicine. Unpublished report submitted to the Pan American Health Organization, 2001. 6. Hakansson A, Kvamme O, Magnusson S, Noren I, Olesgaard P, Winell K. Trends and traditions in Nordic family medicine. Nord Med. 1995; 110: 287–9, 291. IUHPE – Global Health Promotion Vol. 21, No. 1 2014
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7. Ad Hoc Committee on Education for Family Practice. Meeting the Challenge of Family Practice. Chicago, IL: American Medical Association; 1966. 8. Ministry of Health. The Progress so Far – Health Transformation Program in Turkey. Ankara, Turkey: November 2002–June 2007. 9. Saglik Hizmetlerinin Sosyallestirildig˘ i Bölgelerde Hizmetin Yürütülmesi Hakkındaki Yönetmelik. RG: 09 / 09 / 1969 Regulation on the Administration of the Healthcare Services in Correspondent Regions. Published in Official Gazette, 09/09/1969. 10. Aydin S. Aile Hekimlig˘ i Modeli (Family Practice Model). Ankara, Turkey: T.C. Saglik Bakanligi (Ministry of Health); 2004. 11. Aile Hekimlig˘ i Pilot Uygulamasi Hakkindaki Yonetmelik. RG: Ankara 06/07/200525867. Regulation on the Pilot Application Family Physician Services, Published in Official Gazette No: 25867 Date: 06/07/2005. 12. The World Bank. Turkey: Achieving Results for Turkey’s Future: Sustainable and Equitable GrowthIBRD results. The World Bank; 2010. 13. Dl Saglik Mudurlugu Kayitlari (Records of City Health Directorate). Duzce, Turkey; 2005. 14. 657 Sayili Devlet Memurlari Kanunu. KabulTarihi: 14/07/1965, RG: 23/07/1965 – 12056 Law on Government Officials. Law No: 657. Published in Official Gazette No: 12056. Date: 14/07/1965 as amended. 15. Duzce I˙linde Aile Hekimligi Pre-Pilot Uygulamasinda Kullanilan Veri Kalitesinin Degerlendirilmesi – Nihai Analiz Raporu (The evaluation of the data quality used in Duzce family practice pre-pilot application – Final analysis report). Hazirlayan: Talat Bahcebasi Sy; pp.4-5. 16. Bahçebas¸i T. Aile Hekimlig˘ i Pilot Uygulamasının Düzce ili Sag˘ lık Hizmetlerine Etkisi (The Effect of Family Practice Pilot Application on Duzce Health Services). Duzce, Turkey: 81’in 80 inden Farkı, Yavuz Ofset; 2007.
17. Saglik Hizmetleri Temel Kanunu, Saglik Personelinin Tazminat ve Çalısma Esaslarına Dair Kanun, Devlet Memurları Kanunu ve Tababet ve Suabatı Sanatlarının Tarzı I˙ crasına Dair Kanun ile Sag˘ lık Bakanlıg˘ ının Teskilat ve Görevleri Hakkında Kanun Hükmünde Kararnamede Deg˘ isiklik Yapılmasına Dair Kanun. No: 5371. (Law Amending the Law of Foundation of Healthcare Services, Law on Conduct of Service and Compensation of Healthcare Personnel, Law on Government Officials, Law on Conduct of Medical Profession [of Medicine] and Branches and Decree by Law on the Organization and the Duties of Ministry of Healthcare. Law No: 5371). 18. Aile Hekimlig˘ i Uygulamalarında Pilot il Dısından Yerlestirme I˙sleminde Uyulacak Esaslar (Principles on out of Pilot Province Allocation in Family Medicine Application). T.C. Sag˘ lık Bakanlıg˘ ı Temel Sag˘ lık Hizmetleri Genel Müdürlüg˘ ü. 19. T.C. Sag˘ lık Bakanlıg˘ ı Temel Sag˘ lık Hizmetleri Genel Müdürlüg˘ ü -Aile Hekimlig˘ i Geçig˘ Tarihleri, TSH: B.10.0, TSE:0.20.00.01 / 3075 (Ministry of HealthLaw of Foundation of Healthcare Services-Dates of Transition to Family Practice’). 20. World Health Organization. 7th Global Conference on Health Promotion - 7GCHP. Promoting Health and Development: Closing the Implementation Gap. Nairobi, Kenya: 2009. 21. Rakel R. Textbook of Family Medicine. 7th ed. Philadelphia, PA: Saunders Elsevier; 2002. Chapter 1, The Family Physician; p.3. 22. 2008 Yılı Sosyal Güvenlik Kurumu Sag˘ lık Uygulama Teblig˘ inde Deg˘ isiklik Yapılmasına Dair Teblig˘ , RG: 7. Mükerrer Sayı. (Communiqué Amending the Communiqué on Social Security Agency Healthcare). Implementation of Year 2008, Published in Official Gazette Date: 14/07/1965 as amended. 23. WONCA. European Definition of GP/FM. WONCA; 2002.
IUHPE – Global Health Promotion Vol. 21, No. 1 2014
Downloaded from ped.sagepub.com by guest on April 13, 2015
2013
PED21110.1177/1757975913503666CommentaryA. K. Ozsahin
Commentary Family practice in Turkey Akatli Kursad Ozsahin
Abstract: The national project ‘Transformation in Health’ was started in 2005 to provide expert primary care by family physicians, and decrease expenses in Turkey. The number of family physicians was far below the need, so public physicians were promoted to family physician status after a 10-day intensive course. The government declared some satisfactory results, but privately paid family physicians were not accepted into the system. Furthermore, the government stopped paying for their services from private settings. Some family physicians became unemployed as the major payer for all forms of medical care in Turkey denied their services. The process showed it’s value in time. Nevertheless, family physicians should be the core of this transformation as family medicine is an academic and a scientific discipline and a primary care-oriented specialty with its own specific educational content, research and base of evidence, which cannot be achieved through standard medical education. (Global Health Promotion, 2014; 21(1): 59–62). Keywords: Education, family physician, healthcare, health promotion, primary care, Transformation in Health
Background Enormous costs of health with public murmurs about insufficient primary care led the Turkish government to take precautions to cover both grounds. They soon realized that they needed ‘a health care delivery system that features a cost effective and competent family practice primary care base that is integrated into the total health care system’ (1). Since the whole world was moving into a primary care-(mainly family medicine) based system, the road map was ready (2–7). In the early 2000s the current government initiated the project ‘Transformation in Health’. The key objectives included covering all the citizens with general health insurance, promoting mother and child health care, generalizing preventive healthcare and implementing family medicine (8). This care was at first planned to be based on Family Practice specialists, but unfortunately was based on the name of the specialty only. In Turkey, after six years of medical education one becomes a physician
and is called ‘Practitioner’ or ‘General Practitioner’ (GP). If one chooses to be a Family Practice Specialist, one must have a rotational education in internal medicine, general surgery, paediatrics, gynaecology and obstetrics and psychiatry for three years, according to the current curriculum. At the end of this period, after preparing a project and fulfilling a board exam one becomes a family physician or a Family Practitioner (FP). Most physicians in Turkey are public, that is, they work for the government and obtain a salary. Some physicians work privately either in their offices or in non-governmental facilities. These are paid either by their patients or mostly by the government on a feefor-service basis. At the moment the government is the major health payer in Turkey for all forms of medical care because insurance companies do not yet cover most health expenses. In the early 2000s most of the FPs in Turkey were publicly paid, working in health clinics, in emergency settings and in secondary care units and approximately 25% were privately paid.
Department of Family Medicine, Baskent University Faculty of Medicine, Turkey. Correspondence to: Akatli Kursad Ozsahin, Department of Family Medicine, Baskent University Faculty of Medicine, Dadaloglu mah, Serin Evler 39, Sokak no: 6, Yuregir 01250, Adana, Turkey. Email: [email protected] Global Health Promotion 1757-9759; 2014; Vol 21(1): 59–62; 503666 Copyright © The Author(s) 2013, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975913503666 http://ped.sagepub.com Downloaded from ped.sagepub.com by guest on April 13, 2015
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A. K. Ozsahin
Turkey had multiple health clinics for primary care provided by GPs in every city (9). The service was unsatisfactory. As a result people went to secondary or tertiary care units even for their smallest complaints, which caused increased expenses and decreased quality of care in those settings.
The ‘Transformation in Health’ project The original theme of the ‘Transformation in Health’ project was to use the FPs to give primary care (10). The project was started in the city of Duzce, which is between Ankara and Istanbul with a population around 300,000 at pretest (11). Financing was initiated with credit from the World Bank (12). A FP was thought to give care to a 2500–3000 population (maximum 3000), so 104 FPs were all the ministry needed to start things. However, at that time there were only three FPs in Duzce and about 1200 in the whole country (11,13). Approximately 20,000 FPs were needed nationally. The ministry had a response for that. They ruled that after attending a 10-day preliminary intensive educational course given by academics of Family Practice, any GP or any non-FP would be certified as an FP (11). Assuming this transformation would cover the whole country and over time create many advantages, some specialists from different branches, including obstetrics and gynaecology, cardiovascular surgery, urology and many preclinical branches took the preliminary course and became certified. In order to begin, all publicly paid physicians of a region who were certified had to resign and sign annual contracts if they agreed to join the system (11). Each physician would be assigned a list of a population (supplied from local election rolls) for which they should provide care. Patients were expected to go to their assigned physician whenever they sought medical help, but they were not obliged to do so. The patients were not inhibited from going to higher institutions. Using the system, physicians were expected to keep patients away from higher institutions and reduce health costs. Six months after the beginning, any patient would have the right to change assigned physician (11). The payment was planned to be motivating. A GP was paid approximately 1.5–2 billion Turkish Liras (1000–1300 USD) per month. The physicians in the
system would be paid approximately 2.5–3-fold this amount, depending on the number of people assigned to them. More patients meant a greater salary. The salary of FPs in the system would be 10% higher than GPs (11). A physician was required to keep the count over 1000 to preserve his contract (11). If publicly paid physicians did not join the system, they were moved to public health centres or emergency settings with the previous lower salary, but keeping a full work guarantee (14). The process began on 15 September 2005. The first impression was declared to be promising. Offices started to accept patients. The high salary was indeed a motivator and the number of patients seen started to grow dramatically (15,16).
Pitfalls Some bureaucrats pointed out that the new programme could face the same fate as a previous programme, ‘Socialization of Health Services’, which was withdrawn in the late 1960s due to financial difficulties. Some medical nongovernmental organizations (NGOs) called all physicians to refuse to enter the system. The FPs had another problem. Eastern provinces of Turkey lacked a sufficient number of physicians due to social and economic underdevelopment. Therefore, the Turkish Ministry of Health ruled a compulsory service for two years in the East for physicians at the end of their training before they were given their diploma (17). At the end of this period a physician could ask to be moved home provided that the staff positions in his or her city of choice were unoccupied. Otherwise options were limited: either to stay where he or she was, or go somewhere not of his or her choice, or leave (11,18). Publicly paid physicians of any city had the priority to choose the district to work in; other applicants had to work in unoccupied sites (11). If a private practising FP decided to be a publicly paid physician and join the system, he or she was appointed to a different city, generally in one of the far corners of the country. The ministry ruled all FPs had to work either in the system wherever he or she was assigned or in secondary or tertiary units out of the system on a privately paid basis. Shortly after that, the Turkish Treasury stopped paying the bills of FPs from those settings except for Emergency Room services. That
IUHPE – Global Health Promotion Vol. 21, No. 1 2014
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Commentary
meant a farewell to private practice for FPs. Consequently, NGOs stopped employing FPs. By 2006 the process had covered 3.2 million people of the estimated population of 70 million. At the end of 2009 the project had covered 22.2 million people, or about 31.5% of the country. The total number of FPs in the system (certified and real) reached 6557, with 3385 people per FP. Forty-one more cities were included in early 2010 (19). According to a EuroPEP survey in 2008, 96% of the population had health insurance coverage and 80% were satisfied with health services. Mother and child health improved dramatically, and Turkey was on target to achieve Millennium Development Goals (MDGs) 4 and 5 (13). The project faced a real challenge when its final step for megacity Istanbul, with an estimated population of 13 million, was given a start; this called for approximately 3500 FPs and another 5% each consecutive year to keep up. The whole country was covered as the final seven cities were taken into the system in December 2010.
Conclusion
flow of patients has to be from primary care to secondary and tertiary units to reduce costs, provided the project has sufficient qualified instruments such as family physicians. However, the chain of referral could not be implemented and is being postponed continuously, reasoning that it would downgrade the motivation of physicians and reduce their competence (22). With the evidence from the EuroPEP survey in 2008 (13) that the country is being well served by the new system of GPs, we believe that the real innovation is the system of payment to persuade physicians to practise in all parts of the country. The designation of GPs as family physicians after only two weeks of training is a weakness that will not bring positive results over the long term. Employing a sufficient number of family physicians and using the available ones as team leaders may be the only road map to strengthen primary care and promote health, because family medicine is an academic and a scientific discipline and a primary care-oriented specialty with its own specific educational content, research and base of evidence (23). Funding
The 7th Global Conference on Health Promotion was held in Nairobi, 26–30 October 2009. Health promotion was seen in this conference to be an essential, effective approach in line with the renewal of primary healthcare as endorsed by the Executive Board of the World Health Organization (WHO) (20). Promoting health by improving primary care with reduced costs and favourable outcomes is essential for any country, but unfortunately this whole project in Turkey has been a transformation or promotion of practitioners into family physicians with minimal training. The most challenging diagnoses are those for diseases or disorders in their early, undifferentiated stage, when there are often only subtle differences between serious disease and minor ailments (21). This is exactly what the FPs were trained for. We believe Rakel did not mean a certification programme for GPs when he wrote, ‘The greater the number of family physicians in a country, the lower the mortality rates and the lower the cost. The opposite is true when number of specialists increase’ (21). We doubt if raising ranks of former public physicians through a short training can help Turkey over the long term. As for reducing the costs, the
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Ishibashi Y. Why is family medicine needed in Japan? J Fam Pract. 1987; 25: 83–86. 2. Seifert B, Svab I, Madis T, Kersnik J, Windak A, Steflova A, et al Perspectives of family medicine in Central and Eastern Europe. Fam Pract. 2008; 25: 113–118. 3. Goh LG, Fabb W. Family medicine development in Asia Pacific Region. Singapore Fam Physician. 2001; 27: 31–36. 4. Fry D, Furler J. General practice, primary health care and population health interface. General Practice in Australia. 2000; 389. 5. Parkerson G, Monteiro F, Pepper C, Pavlik V, Spann S. The status of family health care and family medicine in the region of the Americas. A joint project of the Pan American Health Organization and the Department of Family and Community Medicine of Baylor College of Medicine. Unpublished report submitted to the Pan American Health Organization, 2001. 6. Hakansson A, Kvamme O, Magnusson S, Noren I, Olesgaard P, Winell K. Trends and traditions in Nordic family medicine. Nord Med. 1995; 110: 287–9, 291. IUHPE – Global Health Promotion Vol. 21, No. 1 2014
Downloaded from ped.sagepub.com by guest on April 13, 2015
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7. Ad Hoc Committee on Education for Family Practice. Meeting the Challenge of Family Practice. Chicago, IL: American Medical Association; 1966. 8. Ministry of Health. The Progress so Far – Health Transformation Program in Turkey. Ankara, Turkey: November 2002–June 2007. 9. Saglik Hizmetlerinin Sosyallestirildig˘ i Bölgelerde Hizmetin Yürütülmesi Hakkındaki Yönetmelik. RG: 09 / 09 / 1969 Regulation on the Administration of the Healthcare Services in Correspondent Regions. Published in Official Gazette, 09/09/1969. 10. Aydin S. Aile Hekimlig˘ i Modeli (Family Practice Model). Ankara, Turkey: T.C. Saglik Bakanligi (Ministry of Health); 2004. 11. Aile Hekimlig˘ i Pilot Uygulamasi Hakkindaki Yonetmelik. RG: Ankara 06/07/200525867. Regulation on the Pilot Application Family Physician Services, Published in Official Gazette No: 25867 Date: 06/07/2005. 12. The World Bank. Turkey: Achieving Results for Turkey’s Future: Sustainable and Equitable GrowthIBRD results. The World Bank; 2010. 13. Dl Saglik Mudurlugu Kayitlari (Records of City Health Directorate). Duzce, Turkey; 2005. 14. 657 Sayili Devlet Memurlari Kanunu. KabulTarihi: 14/07/1965, RG: 23/07/1965 – 12056 Law on Government Officials. Law No: 657. Published in Official Gazette No: 12056. Date: 14/07/1965 as amended. 15. Duzce I˙linde Aile Hekimligi Pre-Pilot Uygulamasinda Kullanilan Veri Kalitesinin Degerlendirilmesi – Nihai Analiz Raporu (The evaluation of the data quality used in Duzce family practice pre-pilot application – Final analysis report). Hazirlayan: Talat Bahcebasi Sy; pp.4-5. 16. Bahçebas¸i T. Aile Hekimlig˘ i Pilot Uygulamasının Düzce ili Sag˘ lık Hizmetlerine Etkisi (The Effect of Family Practice Pilot Application on Duzce Health Services). Duzce, Turkey: 81’in 80 inden Farkı, Yavuz Ofset; 2007.
17. Saglik Hizmetleri Temel Kanunu, Saglik Personelinin Tazminat ve Çalısma Esaslarına Dair Kanun, Devlet Memurları Kanunu ve Tababet ve Suabatı Sanatlarının Tarzı I˙ crasına Dair Kanun ile Sag˘ lık Bakanlıg˘ ının Teskilat ve Görevleri Hakkında Kanun Hükmünde Kararnamede Deg˘ isiklik Yapılmasına Dair Kanun. No: 5371. (Law Amending the Law of Foundation of Healthcare Services, Law on Conduct of Service and Compensation of Healthcare Personnel, Law on Government Officials, Law on Conduct of Medical Profession [of Medicine] and Branches and Decree by Law on the Organization and the Duties of Ministry of Healthcare. Law No: 5371). 18. Aile Hekimlig˘ i Uygulamalarında Pilot il Dısından Yerlestirme I˙sleminde Uyulacak Esaslar (Principles on out of Pilot Province Allocation in Family Medicine Application). T.C. Sag˘ lık Bakanlıg˘ ı Temel Sag˘ lık Hizmetleri Genel Müdürlüg˘ ü. 19. T.C. Sag˘ lık Bakanlıg˘ ı Temel Sag˘ lık Hizmetleri Genel Müdürlüg˘ ü -Aile Hekimlig˘ i Geçig˘ Tarihleri, TSH: B.10.0, TSE:0.20.00.01 / 3075 (Ministry of HealthLaw of Foundation of Healthcare Services-Dates of Transition to Family Practice’). 20. World Health Organization. 7th Global Conference on Health Promotion - 7GCHP. Promoting Health and Development: Closing the Implementation Gap. Nairobi, Kenya: 2009. 21. Rakel R. Textbook of Family Medicine. 7th ed. Philadelphia, PA: Saunders Elsevier; 2002. Chapter 1, The Family Physician; p.3. 22. 2008 Yılı Sosyal Güvenlik Kurumu Sag˘ lık Uygulama Teblig˘ inde Deg˘ isiklik Yapılmasına Dair Teblig˘ , RG: 7. Mükerrer Sayı. (Communiqué Amending the Communiqué on Social Security Agency Healthcare). Implementation of Year 2008, Published in Official Gazette Date: 14/07/1965 as amended. 23. WONCA. European Definition of GP/FM. WONCA; 2002.
IUHPE – Global Health Promotion Vol. 21, No. 1 2014
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