1. Class 2, 13.09.2012 Atatürk University Medical Faculty Access to Health Care Zekeriya Aktürk, Prof. Dr. zekeriya.akturk@gmail.com http://aile.atauni.edu.tr

2. John Q (2002) John Quincy Archibald's son Michael collapses while playing baseball as a result of heart failure. John rushes Michael to a hospital emergency room where he is informed that Michael's only hope is a transplant. Unfortunately, John's insurance won't cover his son's transplant. Out of options, John Q. takes the emergency room staff and patients hostage until hospital doctors agree to do the transplant.

3. 3 John Q (2002) http://www.imdb.com/video/screenplay/vi1502806297/

4. Aims – Objectives The participants will learn about the principles about access to health At the end of this course participants will be able to; –Explain the difference between «access to health services» and «access to health care» –Understand the components of access to healthcare services –List the standards for access to health care –List factors affecting access to health services

5. Access to care / Access to health

6. Definition Being able to receive health care when needed. Has different components –Economical = Ability to pay –Other = Health service; Close to settlement Accessable road Culturally accessible Timely, appropriate, and understandable

7. Access to which service? Preventive health care Chronic problems Primary health care (GOBI-FFF) Growth monitoring Oral rehydration therapy Breastfeeding Immunization Family planning Female education Food supplementation Emergency heatlh care Hospital services

8. Service Standards for Primary Care Receiving care within 4 weeks for routine problems Receiving care within 4 weeks for emergency problems Access to telephone consultation all 24 h Receiving standard preventive services according to the guidelines Receiving immunizations according to national schedule Receiving consultation for non urgent problems within 4 weeks Receiving consultation for urgent problems within 24 hours Saultz JW. Textbook of Family Medicine. McGraw Hill 2000

9. Factors effecting the decision to take health care Seriousness of the problem The amount of anxiety the problem arises Views of family authorities Personal or family experience with the same problem Difficulties in accessing health Consequences of not attending to work or job The value an indvidual or family gives to continuity of care Experiences with the health care Health costs

10. Barriers Language Race Economical Geographical Distance Cultural and social Education Sex Family Komorbidities Health system

11. Number of uninsured in the USA Good Economy Economic Recession Escalating Cost & Recessionary Cycles

12. 12

13. 13 http://blog.milliyet.com.tr/genel-saglik-sigortasi-basladi-1-ay-icinde-milyonlarin-muracaati-gerekecek- /Blog/?BlogNo=343157

14. Who are uninsured? 2002, USA –%32 Latin –%20 African –%18 Asian –%11 White

15. How can we measure service utilization? Health expenditure Mean number of yearly visits –2001: 1,6 – 2010: 7 Hospitalization Preventive services

16. Immunization rates http://www.istanbulsaglik.gov.tr/w/sb/bh/asilarbulasici2.asp

17. Population per health professional

18. Buerocracy decreased number of patients increased http://www.medimagazin.com.tr/ana-sayfa/kategorisiz/tr-burokrasi-azaldi-hasta-sayisi-katlandi-1-666-15868.html

19. Summary What do you understand from «Access to health care»? What is the difference between “access to health” and “access to care”? What are the standards for access to health care? What can be the barriers for access to health care?

20. The Cost-Access-Quality Triangle

21. Access to Health Care