tatar - non communicable diseases en

7/27/2019 Tatar - Non Communicable Diseases En

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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



Agenda

• Economic burden of chronic diseases• Risk Factors

• Status of healthcare services• What should be the transformation’s direction?



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



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



Agenda





Demographic Panorama 2000/2011

Ministry of Health 2012

Age Group

Popuation



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 )

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)



Age 60+ International Comparison (%), 2010


European Union TurkeyWorldHigh Income Group

Countries

Mid- High Income

Group Countries

WHO Europe

Region



Obesity rates (%)



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%



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


Turkey WorldHigh Income Group

Countries

Mid- High Income

Group CountriesEurope Region

Female Male



Persons using tobacco products daily (%)


TotalFemaleMale



Agenda





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



# of medical advice sought according to stages


Stage 1 Stages 2 & 3



Referral rates of Stage 1 institutions (%)


Yıl



Infant Mortality Rate Mortality Rate for Ages < 5

Maternal Mortality RateMinistry of Health 2012



Health Promotion and DevelopmentProgram

Population with diabetes over age 20 (%)

Turkish DiabetesPrevention and ControlProgram



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





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



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.



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



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



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?



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



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)



Thank You ……..

[email protected]

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