National health technology assessment in Turkiye after a decade: are key principles followed?

BACKGROUND: Health technology assessment (HTA) is growing in low- and middle-income countries (LMICs) to ensure optimal use of limited resources. However, the impact of HTAs on decision making in LMICs has been limited. The study aimed to provide an overview of Turkiye's progress since establishing the first HTA agency in 2012. METHODS: The web sites of three national HTA agencies in Turkiye were searched for HTA guidelines and national HTA reports. The HTA guidelines were assessed by two researchers independently against the key principles of HTA developed by Drummond et al., and the HTA reports against the national guidelines. RESULTS: The study included one HTA guideline and eight national HTA reports. The guideline included very limited technical guidance. Compliance with the principles was poor to moderate, and significant methodological limitations were identified. The reports were inconsistent regarding the scope and the HTA assessment criteria. The link between HTA findings, HTA decision making, and health policies were not clear. DISCUSSION: The inconsistencies between the reports and the methodological limitations demonstrate the need for national HTA guidelines. Improving the characteristics of the HTA might impact implementation. Among the key issues is transparency regarding priority setting, the HTA process, and decision making. CONCLUSION: Establishing and adopting national HTA guidelines at international standards is needed. Involving external scientific committees and health economists in the HTA processes might help ensure that the key principles of HTA are followed. The study findings might be helpful for countries that are developing their HTA systems.

Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey.

OBJECTIVE: To determine the prevalence of catastrophic health payments, examine the determinants of catastrophic expenditures, and assess the poverty impact of out-of-pocket (OOP) payments. METHODS: Data came from the 2004 to 2010 Household Budget Survey. Catastrophic health spending was defined by health payments as percentage of household consumption expenditures and capacity to pay at a set of thresholds. The poverty impact was evaluated by poverty head counts and poverty gaps before and after OOP health payments. RESULTS: The percentage of households that catastrophically spent their consumption expenditure and capacity to pay increased from 2004 to 2010, regardless of the threshold used. Households with a share of more than 40% health spending in both consumption expenditure and capacity to pay accounted for less than 1% across years. However, when a series of potential confounders were taken into account, the study found statistically significantly increased risk for the lowest threshold and decreased risk for the highest threshold in 2010 relative to the base year. Household income, size, education, senior and under 5-year-old members, health insurance, disabled members, payment for inpatient care and settlement were also statistically significant predictors of catastrophic health spending. Overall, poverty head counts were below 1%. Poverty gaps reached a maximum of 0.098%, with an overall increase in 2010 compared to 2004. CONCLUSIONS: Catastrophe and poverty increased from 2004 to 2010. However, given that the realization of some recent policies will affect the financial burden of OOP payments on households, the findings of this study need to be replicated.

An evaluation on levels of knowledge, attitude and behavior of people at 65 years and above about alternative medicine living in Ankara.

The aim was to determine the knowledge, attitude and behavioral levels of people at and above 65 years of age, living in Ankara (Turkey) about alternative medicine. The study was carried out between March - April 2010 through survey application of 200 participants by selective random sampling from the population. Data obtained as a result of the survey were analyzed by SPSS program. The study revealed that 83.5% of the participants believed in alternative therapy methods but 16.5% of them did not. It is concluded that herbal therapy methods are the most frequently used methods with a 63% rate among other alternative therapy methods. When status of the participants was analyzed it was found that it was found that 69% received the information about alternative medicines from their family while 53.5% received it from television This study revealed that alternative medicine is profoundly used by people above 65 years of age in Ankara.

Markets, modernisation and national interest: three faces of patient choice policy in Turkey.

This article discusses three faces of patient choice policy in a developing country, Turkey. As part of its wider health transformation programme (HTP), Turkey has created a purchaser/provider system in which a single public purchaser channels funding to a range of public and private hospitals, and patients--in theory at least--are given significant freedoms to choose their hospital and physician. At the same time, marketisation has been softened by an emphasis on the creation of 'human-centred' services, resulting in a variety of initiatives to enhance patient rights and using a similar rhetoric to that employed in modernising 'third-way' reforms in countries such as the United Kingdom. We argue that neither markets nor modernisation fully explain the specifics of Turkish choice policy, which is also driven by the strong political imperative arising from Turkey's proximity to the European Union and its accession ambitions. Europeanisation represents an approach to markets softened by social solidarity, and gives the Turkish reforms a very different profile from neo-liberal reforms implemented in other middle income countries. However, in practice, medical workforce shortages, the uneven distribution of resources across the nation, and the lack of systematic information on provider outcomes limit the scope of choice for much of the population. In this situation, a planned allocation of resources to support equity of provision has advantages over a system where resource flows to providers are determined by individual patient choices.

Türkiye’de trans yağ tüketiminin ve sağlığa olumsuz etkilerinin azaltılması: EVIPNet Europe Politika için kanıt özeti, Sayı 7

Trans yağ asitleri (TYA), veya trans yağlar, insan sağlığı için birçok olumsuz sonuçları bulunan önemli bir halk sağlığı sorunudur ve çözümü için çok paydaşlı sağlık politikası müdahaleleri gerektirir. TÜSEB Türkiye Sağlık Politikaları Enstitüsü, Türkiye Cumhuriyeti Sağlık Bakanlığı ve DSÖ Türkiye Ülke Ofi si bir araya gelerek DSÖ Avrupa Kanıta Dayalı Politika Ağı bünyesinde yayınlamak ve Türkiye’de TYA tüketiminin azaltılması sorununu çözecek politika belirleyiciler için kanıta dayalı seçenekler sunmak amacıyla bu politika için kanıt özetini geliştirmişlerdir. Bu çalışma, TÜSEB Türkiye Sağlık Politikaları Enstitüsü ve DSÖ arasında işbirliği çerçevesinde gerçekleştirilmiş olup Türkiye Cumhuriyeti Sağlık Bakanlığı, üst düzey ulusal politika kurumları ve ulusal uzmanları kapsamaktadır ve DSÖ Avrupa Bölge Ofi sinin teknik uzmanları tarafından desteklenmiştir. TÜSEB Türkiye Sağlık Politikaları Enstitüsü, sahadan, Sağlık Bakanlığı ve Tarım ve Orman Bakanlığından temsilcilerden oluşan bir çalışma grubu kurmuştur. Grup, sorun hakkındaki araştırmalardan elde edilen kanıtları tespit etmiş, seçmiş, değerlendirmiş ve sentezlemiş, çözüme dair üç seçenek geliştirmiş ve her bir seçeneğin uygulanmasında göz önünde bulundurulacakları değerlendirmiştir. Bu üç seçenek şunlardır: (1) TYA’lar için zorunlu sınırlar getirilmesi; (2) TYA’sız gıdaların etiketlenmesi ve TYA’ların sağlığa etkileri hakkında halkın bilinçlendirilmesi ve (3) endüstriyel olarak üretilmiş TYA’ların yerini daha sağlıklı katı ve sıvı yağların alması için teşvikler getirilmesi.

Reducing the consumption of trans-fats and their negative impacts on health in Turkey: EVIPNet evidence brief for policy, number 7

Trans-fatty acids (TFAs), or trans-fats, are an important public health problem that has many negative consequences for human health and requires multi-stakeholder health policy interventions for its solution. TÜSEB Turkish Institute for Health Policies, the Ministry of Health of Turkey and the WHO Country Office in Turkey came together to develop this evidence brief for policy, to be published under the aegis of the WHO European Evidence-informed Policy Network, to provide evidence-informed options for policy-makers to tackle the problem of reducing the consumption of TFAs in Turkey. The work was carried out within the framework of the collaboration between TÜSEB Turkish Institute for Health Policies and WHO; it involved the Ministry of Health of Turkey, high-level national policy institutions and national experts, and was supported by technical experts from the WHO Regional Office for Europe. TÜSEB Turkish Institute for Health Policies convened a working group comprising representatives from the clinical field, the Ministry of Health and the Ministry of Agriculture and Forestry. The group identified, selected, appraised and synthesized relevant research evidence on the problem; devised three options for tackling it; and weighed up considerations in implementing each option. The three options are: (1) Establishing mandatory limits on TFAs; (2) Labelling TFA-free foods and raising awareness of the health effects associated with TFAs; and (3) Introducing incentives to replace industrially produced TFAs with healthier oils and fats.