tatar - non communicable diseases en
TRANSCRIPT
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HOW TO ENSURE TRANSFORMATION IN
FIGHTING CHRONIC DISEASES
Prof. Dr. Mehtap TATAR
Hacettepe UniversityFaculty Economic and Administrative SciencesDepartment of Healthcare Management
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Agenda
• Economic burden of chronic diseases• Risk Factors
• Status of healthcare services• What should be the transformation’s direction?
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Distribution of DALYs lost among fundamental diseasegroups (%), Turkey 2000
Ministry of Health , Başkent University, 2004
Female Erkek
Male
Urinary System Diseases
Diabetes
Sensory Organs
Nutritional Deficiencies
Musculoskeletal System Diseases
Digestive System DiseasesRespiratory System Diseases
Cancer
Perinatal (Maternal) Reasons
Infections Excluding HIV/AIDS
Neuropsychiatric Diseases
Injuries
Cardiovascular Diseases
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Economic burden of chronic diseases
• Total burden of chronic diseases is equivalentto 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
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Agenda
• Economic burden of chronic diseases• Risk Factors
• Status of healthcare services• What should be the transformation’s direction?
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Demographic Panorama 2000/2011
Ministry of Health 2012
Age Group
Popuation
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Demographic Indicators
Ministry of Health 2012
Total Population
Rural Population (%)
Urban Population (%)
Rate of Age 0-14 (%)
Rate of Age 65 and over (%)
Dependency Rate of Youth (Age 0-14 )
Annual Population Increase Rate ( ‰ )
Dependency Rate of Elderly (Age 65+ )
Total Age Dependency Rate
Rough Birth Rate ( ‰ )
Rough Death Rate ( ‰ )
Total Fertility Rate (Per Woman)
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Age 60+ International Comparison (%), 2010
Ministry of Health 2012
European Union TurkeyWorldHigh Income Group
Countries
Mid- High Income
Group Countries
WHO Europe
Region
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Obesity rates (%)
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Economic impact of obesity
Condition DALY Total EconomicImpact (2004) $ Total EconomicImpact (2012) $
Ischemic heart disease 346 294 2 009 825 330 5 980 104 427
Hypertensive heart disease 61 796 358 652 377 1 067 146 798
Ischemic stroke 146 930 852 754 122 2 537 314 373
Diabetes 152 240 883 572 364 2 629 012 047Osteoarthritis 61 035 354 235 676 1 054 005 191
Breast cancer 8.859 51 415 972 152 984 877
Colon and rectum cancer 7 300 42 367 829 126 062 716
Corpus uteri cancer 2 730 15 844 407 47 144 002Total 787 184 4 568 668 076 13 593 774 432
Total Economic Impact / GDP (2004): 1.16%Total Economic Impact / GDP (2012): 1,73%
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International comparison of obese individuals (BMI≥30) based on sex 2010
Ministry of Health 2012
Turkey WorldHigh Income Group
Countries
Mid- High Income
Group CountriesEurope Region
Female Male
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Persons using tobacco products daily (%)
Ministry of Health 2012
TotalFemaleMale
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Agenda
• Economic burden of chronic diseases• Risk Factors
• Status of healthcare services• What should be the transformation’s direction?
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Physician visits per person
1,1
1,3
1,3
1,7
1,9
2,2
2,5
2,8
2,7
3,3
2,0
2,1
2,4
3,0
3,4
3,9
4,2
4,5
4,6
4,9
3,2
3,4
3,8
4,7
5,3
6,1
6,7
7,3
7,3
8,2
0,0 5,0 10,0 15,0 20,0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Birinci basamak İkinci basamak Kişi başı ziyaretMinistry of Health 2012 Stage 1 Stage 2 Visit per person
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# of medical advice sought according to stages
Ministry of Health 2012
Stage 1 Stages 2 & 3
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Referral rates of Stage 1 institutions (%)
Ministry of Health 2012
Yıl
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Infant Mortality Rate Mortality Rate for Ages < 5
Maternal Mortality RateMinistry of Health 2012
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Health Promotion and DevelopmentProgram
Population with diabetes over age 20 (%)
Turkish DiabetesPrevention and ControlProgram
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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
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Agenda
• Economic burden of chronic diseases• Risk Factors
• Status of healthcare services• What should be the transformation’s direction?
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Primary Health Care: Definition
Comprehensive Definition Narrow Definition
Primary health careservices offered in the
first tier
Family physician as afirst call doctor
A philosophy andperspective for the
improvement of healthstatus
Social participationDecentralization
Cooperation AcrossSectors
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Primary Health Care• Comprehensive Primary Health Care• Selective Primary Health Care• Integrated Primary Health Care
The service provision model where the individual or thefamily visits the local first tier unit or the family physician
within the healthcare system. The first call doctor either treatsthe patients, or refers the patient to a specialist.
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Use of privatehealth care
providers
2003
Performance
based bonussystem
2004
Pilot familyphysicianpractice
2005
Expansion
of the GreenCard’sscope
Transfer of SSK Hospitals
2008
Health
coverage for populationunder 18years of age
2010
Expansion of thefamily physicianpractice to thewhole country
2011
Full-time and
performancebased premiumsystem at theuniversities
UniversalHealthInsurance
MedicalCampuses
Attempts for basic reform
Access of SSKpatients toprivatepharmacies
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Community Health Center
Family Health Center
Health Group DirectoratesHealth Center Maternal and Infant Care Center Tuberculosis Control Dispensary
Agency PhysicianMedical CabinSSK DispensarySSK Medical Station
Before Transformation After Transformation
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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 thefamily physician
• Role of disease management?
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Obstacles before integrated health caresystem
• Lack of physicians and other medical personnel
• Potential decrease of patients to visit hospital
• Paradigm change regarding the presentation andorganization of health care services
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Ready for a paradigm change?
Helping people stay healthy and live a good life
Future of services provided by pharmacists and by family physiciansconnected to it?
Chronic disease model(Community care-normal social roles)
Future of modernized Stage 1 and interconnected Stage 2 healthcareservices?
Traditional hospital services – institution based, medicine oriented
Treating patients
Acute disease model(Institutional Care -Social rolesuspended)
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Thank You ……..