Fevzi Akinci

Assessment of the Turkish health care system reforms: A stakeholder analysis

BACKGROUND The Turkish health care system has been undergoing a significant transformation with the Health Transformation Program (HTP) since 2003. The HTPs overall objective is to improve governance, efficiency, user and provider satisfaction, and long-term fiscal sustainability of the health care system in Turkey. OBJECTIVES To systematically evaluate the effects of the HTP Phase I reforms on various stakeholders, and to outline strategic options for the implementation of the second phase of health transformation in Turkey. METHODS A total of 47 formal structured stakeholder interviews, representing 29 different institutions, are conducted between December 2008 and January 2009. Five main components of the HTP were examined: strengthening of the Ministry of Health (MoH) capacity for stewardship, universal health insurance, reorganizing health service delivery, human resources development, and national health information system. RESULTS AND CONCLUSIONS There is a general agreement among stakeholders that the progress made thus far is the greatest in the national health information system and the slowest in strengthening the MoH capacity for stewardship. It appears that the HTP has the capacity to deliver cost-effective health care services and the implementation progress, so far, is in congruence with the overall economic development and growth in Turkey.

Translation, Cultural Adaptation, Initial Reliability, and Validation of Turkish 15D’s Version A Generic Health-Related Quality of Life (HRQoL) Instrument

This article describes the adaptation of the Finnish 15D standardized measure of health-related quality of life (HRQoL) instrument for use in Turkey and assesses its psychometric properties. The HRQoL is measured in a sample of 75 patients with Type 2 diabetes using both 15D and Nottingham Health Profile (NHP) instruments. The internal consistency within the domains of 15D was high, with Cronbach’s alpha values 0.89 for 15D scale and 0.89 for NHP. Significant correlations were observed between the scores of similar domains of 15D and the NHP in general health perception supporting the construct validity of the new 15D Turkish version. Overall, the results indicated that the adaptation of the 15D for use in Turkey was successful. The Turkish version was found to be a reliable and valid instrument. It is suitable and applicable to both clinical and population-based studies for the measurement of HRQoL in Turkey.

Improving the Health Status of US Working Adults with Type 2 Diabetes Mellitus: A Review

Diabetes mellitus is the seventh leading cause of death (sixth leading cause of death by disease) in the US. Approximately 5.9% of the US population has diabetes and one-third of those with diabetes are unaware that they have the condition. Diabetes is the leading cause of adult blindness, end-stage renal disease, and non-traumatic lower extremity amputation.The annual per-capita incremental cost of diabetes among employees compared with individuals without diabetes has been estimated at

The Missouri disability epidemiology and health project

US4410 (1998 values). Furthermore, more than 30% of the costs associated with diabetic employees are attributable to medically related work absences and disability, and this is estimated to cause a one-third reduction in earnings due to reduced workforce participation.The incidence of diabetes and long term medical complications could be reduced through more effective diabetes education and patient self-management. Intensive management of diabetes can help workers remain productive, decrease costs associated with complications, and reduce associated costs for overtime. Policy complications from this review encourage employers and Medicare/Medicaid to invest in diabetes education and Wellness programs.

National Performance Measures for Diabetes Mellitus Care: Implications for Health Care Providers

INTRODUCTION Estimates of disability in this country are as high as 20%. State health departments need to provide the core activities to deal with this public health problem including assessment, policy development, and assurance. A collaboration among academic institutions and the Missouri Department of Health (MDOH) is a model for providing this core. METHODS A disability workgroup was established among bureaus of the MDOH and three universities. This group selected the disability domain of mobility impairments for initial work. Existing data from the Centers for Disease Control and Preventions (CDC) Behavioral Risk Factor Surveillance System (BRFSS) in Missouri and data from the 1990 Census were analyzed. Dissemination of the findings involved community and consumer participation via an advisory group and a public health-sponsored conference on disability. In addition, new data collection efforts are underway using the BRFSS. Education and training activities include both public health students and public health practitioners in learning the content and methodology associated with disability epidemiology. RESULTS Data analyses have identified rural geographic areas of the State with high levels of disability and a trend of increasing work disability since 1993. A selected key condition, arthritis, has been confirmed as having a high prevalence (28%) in Missouri. These data also demonstrate that there is a strong risk of limitations associated with arthritis [adjusted odds ratio (OR) 3.57; 95% confidence intervals 3.0, 4.2]. These results will be applied to program planning. CONCLUSIONS The Missouri program is succeeding in providing both academic and public health practice partners with a productive experience that meets the needs of each.

Examining the health care payment reforms in Abu Dhabi

When considering the trends in disease management, the focus of healthcare in the US has shifted from communicable diseases, which can most often be managed successfully, to chronic diseases, which are currently not managed very well. Chronic diseases, such as diabetes mellitus, become a lifelong health problem for the individual, the family, and in the workplace. Currently, there is no vaccine to prevent diabetes and no cure for diabetes once acquired. In order to improve the quality of care for diabetes, national performance measures have been developed to provide a unified set of diabetes-specific performance and outcome measures.The Diabetes Quality Improvement Project (DQIP) founded in 1997 through a partnership between the Center for Medicare and Medicaid Services, the National Committee for Quality Assurance, and the American Diabetes Association, established a single, standardized set of performance measures for diabetes care quality improvement and accountability in the US, which were published in 1998. The DQIP measures are noteworthy as a model for many other chronic diseases. Indeed, the DQIP represents the first widely adopted comprehensive performance measurement standards, not just for diabetes but for any single chronic disease. This is of further significance since it was developed by a coalition of public and private entities in the US.In order to prevent long-term complications from diabetes, there needs to be a physician-coordinated treatment plan involving a team approach to the problem. When such a physician-coordinated treatment plan is developed in conformance with the comprehensive performance measures, the prospects for a greater impact on diabetes might be enhanced.Overall, national performance measures for diabetes care have been widely adopted into health plan quality initiatives and have resulted in increased efforts to promote preventative screening and testing. Better compliance has lead to more stringent glucose control and helped to educate the public on the utility of the glycosylated hemoglobin level test for finding those at risk for microvascular and neuropathic complications. While more Americans with diabetes are receiving the recommended standards of care as a result of the implementation of national performance measures, diabetes management remains suboptimal but achievable.The authors concluded from this review that national performance measures have provided health plans and providers with objective tools to measure quality; however, these measures now need to move to prevention standards and initiatives. Policy development for diabetes care must continue to move from managing chronic illness to preventative screening of pre-diabetes through to identification and modification of lifestyle risk factors.

Examining the Association Between Preventive Screenings and Subsequent Health Services Utilization by Patients with Type 2 Diabetes Mellitus

OBJECTIVE The purpose of this paper is to provide an overview of the current health care payment reforms in Abu Dhabi and discuss the potential impact of these reforms on health care consumers and providers as we all as long-term sustainability of the mandatory health care insurance system. METHODS A focused literature review was conducted to systematically identify and summarize relevant literature published on the recent payments reforms in Abu Dhabi along with a secondary review and analysis of existing related government documents, technical reports, and press releases by the Health Authority-Abu Dhabi (HAAD) and other relevant research groups. RESULTS The implementation of the mandatory health insurance system allowed all UAE nationals and foreign workings in Abu Dhabi to have access to medical care insurance and access to care. Prospective payment reforms represent critical sustainability interventions for health care funding in Abu Dhabi. The full impact of payment reforms on affordability, system efficiency, and patient outcomes is yet to be documented. CONCLUSION Given the Government of Abu Dhabi has identified the sustainability of healthcare funding as a key governmental policy, more research is needed to systematically examine the impact of the current payment reforms on multiple stakeholders.

Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey

IntroductionIn recent years, health plans have turned to disease management programs as a means of reducing inpatient utilization while promoting preventive outpatient services provided for patients with type 2 diabetes mellitus.AimThe purpose of this study was to assess the association between four preventive diabetes screenings (retinal eye exams, glycosylated hemoglobin [HbA1c] testing, lipid testing, and albumin testing) in the base study period, and health services utilization patterns during a 24-month follow-up study period for 2641 patients with type 2 diabetes.MethodsClaims data from Regence BlueShield of Idaho for the three periods of 2000 (base period), 2001, and 2002 (results period) have provided the basis for this empirical analysis. Based on our review of the relevant literature and results from disease management and health plan management programs, the central hypothesis of this study was that the four preventive diabetes screenings in the base study period would be associated with lower inpatient utilization and greater preventive outpatient utilization during a 24-month follow-up study period. Simple linear association analysis was used to measure the relationship between the utilization of preventive diabetes screenings and subsequent utilization of emergency room, inpatient, and preventive outpatient services.ResultsThe study results show that for patients who comply with recommended lipid screening services, health plans can expect to see a significant reduction in the number of inpatient admissions over the subsequent 2 years, while marginal inpatient reductions might be expected following HbA1c testing. Furthermore, for patients who comply with recommended screenings of either retinal eye exams or albumin testing, health plans can expect to see these patients utilizing preventive outpatient services more frequently in the subsequent 2 years.ConclusionsPursuing a state- or federal-supported screening program for patients with type 2 diabetes could reduce frequent utilization of inpatient services. Furthermore, in support of the goal of disease management programs to reduce inpatient utilization and increase preventive outpatient service utilization among the increasing proportion of members with type 2 diabetes, health plans are encouraged to provide education about and monitor their patients’ compliance with recommended screenings in the future. Further studies should examine the role of lipid testing in reducing the risk of microvascular diseases. Future research should also pursue an understanding of how a reduction in inpatient utilization is associated with an increased emphasis on lipid screening.