1. NATIONAL HEALTH ACCOUNTS IN TURKEY (1999-2000)
School of Public Health
The Ministry of Health, Turkey
Salih MOLLAHALILOGLU MD, MSc
Mehtap KARTAL, MD
Results of Final Draft Report
*Results of Draft Final Report

2. *Results of Draft Final Report
TURKEY*;
Health financing highly fragmented
Difficult to ascertain spending across different functions by different agents
Different funding sources have different incentive implications affecting provider and consumer behavior differently
Difficult to ensure efficiency and equity in public spending
Fragmentation increases administrative costs
*Mukesh CHAWLA, World Bank, Presentation of NHA Training, Turkey
*Results of Draft Final Report

3. *Results of Draft Final Report
TURKEY;
Data existing within the system is only in gross terms
Data needed for comparison is in detail so that must be collected in different ways
Especially it is hard to have the data for different functions by different financing agents and health-care providers
Different funding sources, health-care providers have different legal and administrative structure leading to different data basis with different problem for collection.
*Results of Draft Final Report

4. Health Financing Flows
Sources
Financing Agents
Health Providers
Taxes
Public Institutions
Public
Public
Public Payments
Social Security Funds
Liabilities
Private
Private Sector /
Private Insurance Enterprices
Credits
Loans
Employers
Private
Aids
Private Household Out-of Pocket
Out-of-Pocket Expenditures
Employers
*Results of Draft Final Report

5. Health Financing Flows
*Results of Draft Final Report

6. *Results of Draft Final Report
NATIONAL HEALTH ACCOUNTS IN TURKEY
It was done as a World Bank Project by the School of Public Health, Ministry of Health of Turkey between 2002 and The study was carried out by a partnership between the International Health Systems Program, Department of Population and International Health, Harvard School of Public Health and the School of Health Administration, Hacettepe University.
The study used advantage of more recent methodological developments, particularly the development by the OECD of the System of Health Accounts framework (SHA) and the International Classification of Health Accounts (ICHA) in It also incorporated additional methodological advances from the Guide to Producing National Health Accounts with Special Applications for Low-income and Middle-income Countries of the World Bank, World Health Organization, and U.S. Agency for International Development, published in 2003.
*Results of Draft Final Report

7. *Results of Draft Final Report
TURKISH NHA FRAMEWORK
A sub-committee of the Steering Committee to work on the development of a Turkish NHA framework. The committee concluded that “Turkey should be able to report health expenditure data to the OECD using the SHA framework, but that for domestic policy purposes greater detail and some departures from certain SHA recommendations were needed”. The Turkey NHA;
uses a broader definition of health expenditure than that proposed in SHA but retains additional health expenditure items in separate classifications so that these can easily be removed to create SHA-compatible tables.
includes some elements of “health-related” functions in the totals reported for domestic use.
have been added additional classifications beyond the basic levels to capture specific institutional conditions in Turkey that are relevant for policy.
*Results of Draft Final Report

8. NATIONAL HEALTH ACCOUNTS IN TURKEY
Prepared Data Collection Tools;
Associations (Sample prepared for 3704 associations related with health )
Foundations (Questionnaires sent to all 256 foundations related with health which were given by General Directorate of Foundations)
Private Hospitals (via Association of Private Health Institutions)
Private Health Insurance (via Turkey Insurance and Reassurance Companies Associations)
Private Business Enterprise (Addresses provided from Ministry of Labor)
*Results of Draft Final Report

9. NATIONAL HEALTH ACCOUNTS IN TURKEY
Prepared Data Collection Tools;
State-owned economic Enterprise (provided through the agency of the Treasury, only 1 is missing)
Privatization Administration (The information has been partly reached)
Social Security Units under the provisional article of 20 of Social Insurance Organization Law (Provided through Ministry of Labor)
Municipalities (Questionnaires sent to all 3200 municipalities by Ministry of Internal Affairs)
Private Provincial Administrations (Questionnaires answered by all 81 provinces)
*Results of Draft Final Report

10. NATIONAL HEALTH ACCOUNTS IN TURKEY
Hospital Survey;
Determining how payments are provided for Service Providers/hospitals and how these financial resources including general budget are spent and used for which services by service providers. Data base depends on, hospitals’ curative care division by;
Inpatient curative care
Outpatient curative care
Dental care
Services of Rehabilitative care and
Education-Training of Health personnel
according their ratio within the hospitals.
*Results of Draft Final Report

11. NATIONAL HEALTH ACCOUNTS IN TURKEY
Household Survey ( );
The general goal of the Household Survey is to estimate out-of pocket expenditures on all levels of health care for a representative sample of 10,675 households in 2 rounds.
First round is done between September-November 2002, while the second round March-April 2003.
The answering rate is generally 91.85%.
*Results of Draft Final Report

12. NATIONAL HEALTH ACCOUNTS RESULTS
Household Survey ( );
The insurance coverage is 67.20%.
Annual Utilization Rate per Person
Out-patient visits 4.23
Hospital admissions 0.077
Annual per capita out-of-pocket health spending estimated after reimbursement
Total out-patient expenditures 58,7$
Total hospitalization expenditures 10,3 $
*Results of Draft Final Report

13. *Results of Draft Final Report
Shares of Total Current Health Expenditure Flowing from Different Financing Agents – Turkey, 2000
Financing Agent
Percentage of Total Current Health Expenditure
Central Government
24.2
MoH Health Programs
Green Card
Annexed budget institutions
Civil servants health benefits
Other
10.2
2.3
2.8
7.1
1.8
Local Government
4.0
Social Security Funds
35.0
SSK
GERF
Bag-Kur
18.8
7.5
8.7
Total Public
63,2
Private social insurance .7
Private insurance enterprises
3.6
Household out of pocket spending
27.5
Corporations direct expenditure
1.4
Total Private
36,8
Total
100.0
*Results of Draft Final Report

14. NATIONAL HEALTH ACCOUNTS RESULTS
*Results of Draft Final Report

15. NATIONAL HEALTH ACCOUNTS RESULTS
*Results of Draft Final Report

16. NATIONAL HEALTH ACCOUNTS RESULTS
Turkey
*Results of Draft Final Report

17. NATIONAL HEALTH ACCOUNTS
Main Challenges of the Study;
Institutionalization: Important as it will support the solutions of system’s problems especially for reliable data. SPO take NHA as a project to be done by SIS and its budget given to SIS.
Regular, standard data collection: It’s hard as the health system is fragmented (each financing agents, health-care providers by different laws).
Use of data by Policy-makers: All data not used for policy-makers are not useful for the society.
*Results of Draft Final Report

18. NATIONAL HEALTH ACCOUNTS IN TURKEY (1999-2000)
School of Public Health
The Ministry of Health, Turkey
Salih MOLLAHALILOGLU MD, MSc
Mehtap KARTAL, MD
Results of Final Draft Report
THANKS TO ALL PARTIES TAKE PLACE IN THIS STUDY
*Results of Draft Final Report