Türkiye'de Sağlık Reformları ve Sağlık Harcamalarının Değerlendirilmesi

Türkiye, 2003 yılında uygulanmaya konulan Sağlıkta Dönüşüm Programı ile birlikte ilaç politikalarında büyük bir değişime gitmiştir. Örneğin, maliyet bazlı fiyatlama sisteminden dış referans fiyatlamaya geçilmiş, geri ödeme komisyonu kurulmuş, tekil bir pozitif liste oluşturulmuştur. Ayrıca, neredeyse tüm nüfusu kapsayan Genel Sağlık Sigortası hayata geçirilmiştir. 2003-2009 yılları arasında, kamu ilaç harcamaları reel olarak yıllık ortalama %7'den fazla büyümüştür. Buna istinaden, bürokratlar 2009 yılı sonuna doğru 3 yıllık ilaç global bütçe anlaşmasını, sağlık hizmetlerinden aşırı yararlanmayı dizginleyen katılım payı uygulaması ve ilaç fiyatlarını aşağı çeken kamu iskontoları ile birlikte duyurmuştur. Uygulanan bu politikalar kamu ilaç harcamalarını azaltma konusu ciddi başarı sağlamış ve harcama 3 yıllık süreçte reel olarak %28 düşmüş, yaklaşık 14 milyar TL tasarruf sağlanmıştır. Ayrıca, 2009 yılında kamu sağlık harcamalarının gayrisafi yurtiçi hasıla içindeki payı %1,7'den 2012 yılında %1 seviyelerine gerilemiş ve 2013-14 yıllarında %1 seviyesinde sabitlenmiştir. Ama, Türkiye ilaç harcamasını istikrarlı bir seviyede tutmak ve geri ödeme kararlarının kredibilite, şeffaflık ve tutatlılığını artttırmak için yeni düzenlemeleri yapmak zorundadır. Geri ödeme kararları için daha şeffaf bir yaklaşımın tasarlanması, pozitif listenin yeniden gözden geçirilmesi, risk paylaşımı anlaşmaları gibi yeni geri ödeme yöntemlerinin belirlenmesi, jumbo fiyatlama sisteminin uygulanması, yeni bir jenerik fiyatlama politikasının benimsenmesi, jenerik ürünler için ihaleler açılması, ve rasyonel ilaç kullanımının teşvik edilmesi bu hedeflere ulaşmada katkı sağlayacaktır

An Analysis of Public Pharmaceutical Policy, Pricing and Spending in Turkey

Turkey has undergone significant changes on its pharmaceutical policy with Health Transformation Program launched in 2003. For instance, Turkey moved from cost-based pricing system to external reference pricing system, reimbursement commission was fırst established, and positive list was introduced. Then Universal Health Insurance nearly covering whole population was put into practice. From 2003 to 2009, public pharmaceutical spending grew drastically, rising more than 7% annually on average in real terms. As a consequence, Turkish government announced a 3-year global budget on late 2009 along with new copayments for hospital outpatient visits and for prescriptions to reduce excessive utilization and additional rebates to lower drug prices. Those policies were quite successful in curbing overall expenditure, dropping by 28% in real terms in three-year time, as well as roughly 14 billion TL saving. In addition, spending in 2009 hiked to 1.7% of gross domestic product and then dropped to 1% in 2012 and stayed close to 1% in 2013 and 2014. However, Turkey faces new challenges to stabilize spending and increase credibility, transparency, and consistency of its reimbursement decisions. Designing clear methodology on reimbursement decision, revising positive list, developing alternative reimbursement methods such as risk sharing agreements, introducing jumbo pricing, lauching new generic pricing policy and tendering, and incentives for rational drug use will help reach those targets

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