Sağlık hizmeti krizi: Reformlar ve krizi aşma yaklaşımları

1980li yılların başından itibaren gelişmiş ve gelişmekte olan pek çok ülkenin sağlık hizmetlerinde köklü reformlara giriştikleri görülmektedir. Bu reformların nedeni olarak her ne kadar sağlık hizmetlerinin kalitesini artırma ya da evrensel kapsayıcılığı sağlama olduğu iddia edilse de gerçekte amaçlanan, artan sağlık hizmetleri maliyetlerine vatandaşların ortak edilmesi ya da kamunun sunduğu sağlık hizmetlerinin özel sektöre devredilmesidir. Bu amaçla hayata geçirilen en önemli reform girişimi, merkezi otoritenin yetkilerinin daha alt kamu birimlerine ya da özel sektöre devredilmesini öngören desentralizasyondur. Diğer yandan maliyetlerde yaşanan patlamaların kamu maliyesi üzerindeki etkilerini azaltmak amacıyla, maliyet kısıtlamaları ve maliyet paylaşımı uygulamalarının da hayata geçirildiği görülmektedir. Bu reform sürecinde gelişmekte olan pek çok ülkenin, evrensel kapsayıcılığa sahip bir sağlık sistemi kurmaya giriştiği de görülmektedir.

Health care crisis: Reforms and approaches of overcome the crisis

Since the beginnig of 1980, we have seen lots of developed and developing countries going about rooted reforms on health service. Although it is claimed that the reasons for these reformsa re to increase the quality or to set universal coverage of health service, the real aim is to participate citizens to increasing health cost or to sublet public health service to private sector. Fort this reason the most important reform attendance to enliven is decentralization which foresee the sublet of central authority to lower part of public units or to private institution. Moreover to reduce the effects of cost explosion on public finance cost restriction and coast sharing applications are applications are seen. In this reform process plenty of developing countries setting up health system which has üniversal coverage are also observed.

PDF

___

Adlung, Xenio Scheil, Aboy Asfow, Frikkie Booysen, ve diğerleri. (2006), What is the Impact of Social Health Protection on Access to Health Care. A Comparative Analiysis of Three African Countries, WHO, Discussion Paper Number 2, Geneva.

Ağartan, Tuba. (2007), Sağlıkta Reform Salgını, Avrupada ve Türkiyede Sağlık Politikaları, Reformlar, Sorunlar, Tartışmalar, 1. Baskı, İletişim Yayınları, İstanbul.

Andersen, Gosta-Esping. (1994), After the Golden Age: The Future of the Welfare State in The New Global Order, UNSISD, Occasional Paper No.7 World Summmit For Social Development, Geneva.

Andersen, Gosta- Esping. (2010),Toplumsal Riskler ve Refah Devleti, Sosyal Politika Yazıları, Ayşe Buğra, Çağlar Keyder, (drl.), 4. Baskı, İletişim Yayınları, İstanbul.

Brinkerhoff, Derick ve Charlotte Leighton.(2002), Insights for Implementers: Decentralization And Health Syestem Reform, PHRplus No.1.

Bossert, Thomas J. ve Joel C. Beauvais. (2002), Decentralization of Health Systems in Ghana, Zambia, Uganda and the Philippines: A Comparative Analysis of Decision Space, Health Policy and Planning,17(1):1431,Oxford University Pres.

Bossert, Thomas J. (2006), Sağlık Sistemlerinin Desantralizasyonu, Haydar Sur (çev.), Makro Bakış, Sayı 4.

Böckmann, Roman. (2009), The Private Health Insurance: Demarketization of a Welfare Market?, German Policy Studies, Vol. 5, No. 1.

Bankauskaite, Vaida ve Richard B. Saltman. (2007), Central Issues in the Decentralization, Decentralization in Health, Richard B. Saltman, Vaida

Bankauskaite, Karsten Vrangbaek (ed.), Europen Observatory on Health Care Systems and Policies Series, First Published, Berkshire, Open University Press.

Chamchan, Chalermpol ve Guy Carrin. (2006), A Macroeconomic View of Cost Containment: Simulation Experiments for Thailand, Thammasat Economic Journal, Vol.24, No.2.

Carin, Guy. (2006), A Macroeconomik View of cost Containment: Simulation Experiments for Thailand, Thammasat Economic Journal, Vol.24, No.2.

Carin, Guy ve Piya Hanvoravongchai. (2002), Health Care Cost-Containment Policies in High Income Countries: How Successful Are Monetary Incentives? WHO Discussion Paper Number 2, Geneva.

Carin, Guy ve Chris James. (2004), Reaching Universal Coverage Via Social Health Insurance: Key Design Features in The Transition Period, WHO Discussion Paper Number 2, Geneva.

Carrin, Guy, C. James ve D. Evans. (2005), Achieving Universal Health Coverage: Developing the Health Financing System, Technical Briefs For Policy Maker, Nunber 1, WHO, Geneva.

Colombo, Francesca ve Nicole Tapay. (2003), Private Health Insurance in Australia: A Case Study, OECD Health Working Paper No.8, Paris.

Colombo, Francesca ve Nicole Tapay. (2004), Private Health Insurance in OECD

Countries: The Benefits and Costs for Individuals and Health Systems, OECD Health Working Papers no.15, Head of Publications Service, France.

Chunling Lu, Rİchard G. Frank ve Thomas G. Mcguire, (2009), Demand Response to Cost Sharing Under Managed Health Care, Contemporary Economic Policy, Vol. 27, No. I, January.

Criel, Bart, Mario-Pia Waelkens ve Guy Carin. (2005), Community Based Health Insurance in Developing Countries: A Study of Contributions to the Performance of Health Financing Systems, Tropical Medicine and İnternational Health, Volume 10, No.8, Blackwell Publishing.

Cavagnero, Eleonora, Guy Carrin ve Ruben Torres. (2010), A National Social Health Insurance Plan for Argentina: Simulating its Financial Feasibility, WHO Discussion Paper Number 4, Geneva.

Carin, Guy. (2002), Social Health İnsurance in Developing Countries: A Continuing Challenge, International Social Security Review, Vol. 55, 2/2002.

Doetinchem, Ole, Bernd Schramm ve Jean-Olivier Schmidt. (2006), The Benefits and Challenges of Social Health Insurance for Developing and Transitional Countries, Financing Health Care: A Dialogue Between South Eastern Europe and Germany, Laaser Ulrich; Radermacher Ralf (ed.), Series International Public Health, Vol. 18, Lage.

Evans, Timothy. (2005), Universal Coverage: From Concept to Implementation, Extending Social Protection in Health Developing Countries Experiences, Lessons, Learnt and Recommendations, İnternational Conferenge on Social Health Insurance in Developing Countries, ILO, GTZ, WHO, Berlin.

Eikemo, T.A., C.Bambra, K. Joyce ve Espen Dahl. (2008), Welfare State Regimes And Income-Related Health Inequalities: A Comprasion of 23 European Countries, European Journal of Public Health, Vol.18 No.6, Oxford University Pres.

Gericke, Christiati A., Matthias Dehn, Matthias Wistvar ve Reinhard Busse. (2009), Cost-Sharing in the German Healthcare System: Effects of Health Reforms on Efficiency and Equity, Journal of Management & Marketing in Health Care, Vol. 2 No.4.

Gottret, Pablo ve George Schieber. (2006), Health Financing Revisted: A Practioners Guide The World Bank, Washington D.C.

Haydar Sur, (2006), Türkiyede Sağlıkta Desantralizasyona İlişkin Genel Öneriler ve Değerlendirmeler. Makro Bakış, Sağlık Politikaları Gündemi, Sayı 4, Ofset Matbaacılık.

Haji, Mahjabeen, Varatharajan Durairaj, Pascal Zurn, ve diğerleri. (2010), Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems, Bulletin of the World Health Organization, 88.397399.

Işıklı, Alpaslan. (2007), Neoliberal Küreselleşme, Sosyal Devlet ve Kemalizm, Ankara Üniversitesi Üniversitesi Siyasal Bilgiler Fakültesi Yayını, No: 595, Prof. Dr. Cahit Talaş Anısına Güncel Sosyal Politika Tartışmaları, Ankara.

Intyre, Diane Mc, Bertha Garshong, Gemini Mtei, Filip Meheus ve diğerleri. (2008), Beyond Fragmentation and Towards Universal Coverage: Insights from Ghana, South Africa and the United Republic of Tanzania, Bulletin of the World Health Organization, 86, 871876.

İLO. (2008), Social Health Protection. An İLO Strategy Towards Universal Access to Health Care, Social Security Policy Briefings Paper 1, First Published, Geneva.

Litvack, Jennie ve Jessica Seddon. (2009), Decentralization Briefing Notes, World Bank İnstute Working Papers, http//siteresourse.worldbank.org/WBI/Resourse/wbi37142.pdf(19.04.2009)

Leid, R. (1998), Health Care and its Financing in the Single Europen Market, IOS Pres,Amsterdam, 1998:1-10.

Maynard, Alan ve Anna Dixon. (2002), Private Health Insurance and Medical Savings Accounts: Theory and Experience, Funding Health Care: Options for Europe, Elias Mossialos, Anna Dixon, Josep Figueras, Joe Kutzin (ed.), Open University Pres, First Published, Buckingham.

Mathauer, Inke ve Guy Carrin. (2010), The Role of Institutional Design and Organizational Practice For Health Financing Performance and Universal Coverage, WHO Discussion Paper Number 5, Geneva.

Myles, John ve Jill Quadagno. (2002), Political Theories of theWelfare State, Social Service Review, March.

Normand, Charles ve Reinhard Buse. (2002), Social Health Insurance Financing, Funding Health Care: Options for Europe, Elias Mossialos, Anna Dixon, Josep Figueras, Joe Kutzin (ed.), Open University Pres, First Published, Buckingham.

Or, Zeynep, Chantal Cases, Melanie Lisac, ve diğerleri, (2010), Gwyn Bevan. Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismark Systems, Health Economics, Policy and Law, 5, 269293, Cambridge University Press.

Oxley, Horward ve Maitland Macfarlan. (1994), Health Care Reform Controlling Spending on increasing Efficiency, OECD Economik Departman Working Paper NO.149.OECD Publishing, Paris.

Park, M., T. Braun, G.Corrin ve D. Evans. (2007), Payments and Cost-Containment Lesson from OECD Countries, WHO Technical Briefs For Policy Makers, Number 2,Geneva.

Roberts, Marc J., William Hsiao, Peter Berman ve Michael R. Reich. (2009), Sağlık Reformunun Doğru Yapılması Performans ve Hakkaniyetin Geliştirilmesi İçin Bir Kılavuz, Sağlık Bakanlığı Yayın No: 784, Onur Matbaacılık, Ankara.

Remler, Dahila K. ve Jessica Grence. (2009), Cost Sharing: A Blunt Instrument, Annual Review of Public Health, Volume 39.

Saltman, R.B. J.Figüeras. (1998), Avrupa Sağlık Reformu: Mevcut Stratejilerin Analizi,Sağlık Bakanlığı Sağlık Projesi Genel Koordinatörlüğü Ankara.

Saltman, Richard B. (2004), Social Health Insurance in Perspective: the Challenge of Sustaining Stability, Social Health İnsurance Systems in Western Europe, Richard B. Saltman, Reinhard Busse, Josep Figueras (ed.), Open University Pres, First Published, New York.

Schneider, Pia, George Schieber ve Jack Langenbrunner. (2009), Evidence on Cost-Sharing in Health Care: Applications to Hungary, http://siteresources.worldbank.org/INTHSD/Resources/376278-1202320704235/SchneiderCoPaymentsHealthHungaryFeb152008.pdf

Saltman, Richard B. (2004), Social Health Insurance in Perspective: the Challenge of Sustaining Stability, Social Health İnsurance Systems in Western Europe, Richard B. Saltman, Reinhard Busse, Josep Figueras (ed.), Open University Pres, First Published, New York.

Saltman, R.B. J.Figüeras. (1999), Avrupa ülkelerindeki Sağlık Reform Stratejilerinin Değerlendirilmesi, Toplum Ve Hekim, Cilt 14,Sayı 5.

Sur, Haydar. (2006), Sağlık Politikası Gündemi, Makro Bakış, Sağlık Politikaları Gündemi, Sayı 4, Ofset Matbaacılık.

Savedoff, William.(2004), Tax Based Financing for Health Systems: Options and Experience, Discussion Paper Number 4,WHO, Geneva.

Sekhri, Nealam, William Savedoff ve Shivani Tihripathi. (2005), Regulation Private Health Insurance to Serve The Public Intirest, Policy Issues for Developing Countries, WHO Discussion Paper, Department Health System Financing, Geneva.

Sekeri, Neelam ve William Savedoff. (2004), Private Health Insurance: Implicatıons for Developing Countries, Discussion Paper Number 3, WHO. Geneva, 2004.

TÜSİAD. (2004), Sağlıklı Bir Gelecek: Sağlık Reformu Yolunda Uygulanabilir Çözüm Önerileri, Yayın No.TÜSİAD9/200409/380, Lebib Yalkım Yayınları, İstanbul.

Üzmez, Onur. (2006) Küreselleşmenin Türkiyede Sağlık Sektörü Ve Sağlık Harcamaları Üzerine Etkisi, Yayınlanmamış Yüksek Lisans Tezi, Kocaeli Üniversitesi Sosyal Bilimler Enstitüsü.

Vrangbaek, Karsten. (2007), Towards a Typology for Decentralization in Health Care, Richard B. Saltman, Vaida Bankauskaite, Karsten Vrangbaek (ed.), Decentralization in Health Care, Europen Observatory on Health Systems and Policies Series, First Published, Berkshire, Open University Press.

WHO. (2009), The European Health Report, Health and Health Systems, Publications WHO Regional Office for Europe, Copenhagen.

WHO. (2008), World Health Report 2008: Primary Health Care Now More Than Ever, Switzerland.

WHO. (2004), Regional Overview of Social Health Insurance in South-East Asia, Regional Office for South-East Asia, New Delhi, July 2004.

http://whqlibdoc.who.int/searo/2004/SEA_HSD_274_eng.pdf (Erişim:25.09.2009

WHO. (2000), Health Systems İmproving Performas, Health Report 2000, Geneva.

World Bank. (1993), World Development Report, İnvesting İn Health, First Published, Oxford Universty Pres, New York.