Işıl Ergin

The change in capacity and service delivery at public and private hospitals in Turkey: A closer look at regional differences

BackgroundSubstantial regional health inequalities have been shown to exist in Turkey for major health indicators. Turkish data on hospitals deserves a closer examination with a special emphasis on the regional differences in the context of the rapid privatization of the secondary or tertiary level health services.This study aims to evaluate the change in capacity and service delivery at public and private hospitals in Turkey between 2001-2006 and to determine the regional differences.MethodsData for this retrospective study was provided from Statistical Almanacs of Inpatient Services (2001-2006). Hospitals in each of the 81 provinces were grouped into two categories: public and private. Provinces were grouped into six regions according to a development index composed by the State Planning Organisation. The number of facilities, hospital beds, outpatient admissions, inpatient admissions (per 100 000), number of deliveries and surgical operations (per 10 000) were calculated for public and private hospitals in each province and region. Regional comparisons were based on calculation of ratios for Region 1(R1) to Region 6(R6).ResultsPublic facilities had a fundamental role in service delivery. However, private sector grew rapidly in Turkey between 2001-2006 in capacity and service delivery. In public sector, there were 2.3 fold increase in the number of beds in R1 to R6 in 2001. This ratio was 69.9 fold for private sector. The substantial regional inequalities in public and private sector decreased for the private sector enormously while a little decrease was observed for the public sector. In 2001 in R1, big surgical operations were performed six times more than R6 at the public sector whereas the difference was 117.7 fold for the same operations in the same regions for the private sector. These ratios decreased to 3.6 for the public sector and 13.9 for the private sector in 2006.ConclusionsThe private health sector has grown enormously between 2001-2006 in Turkey including the less developed regions of the country. Given the fact that majority of people living in these underdeveloped regions are uninsured, the expansion of the private sector may not contribute in reducing the inequalities in access to health care. In fact, it may widen the existing gap for access to health between high and low income earners in these underdeveloped regions.

Socio-economic inequalities in overweight among adults in Turkey: a regional evaluation

OBJECTIVE Patterns of socio-economic inequalities in obesity and overweight have not been documented for Turkey. The present study aimed to describe educational and wealth-related inequalities for overweight in Turkey, taking a regional perspective. DESIGN Cross-sectional self-reported data of the World Health Survey 2002 for Turkey were used. BMI ≥ 25·00 kg/m2 was considered as overweight. Respondents were classified according to education years and a wealth score derived from the availability of household assets. Logistic regression analysis was applied to assess the relationship between overweight and socio-economic factors. Analyses were stratified by sex and region (West, Mediterranean, Middle, Black Sea and East). SETTING Turkey. SUBJECTS Among the respondents 20 years and older, 3790 women and 4057 men had data on self-reported height and weight. RESULTS Age-adjusted overweight prevalence was 48·4 % for women and 46·1 % for men. For men, education was not systematically related to overweight while overweight was significantly increased among the highest wealth groups. For women, the prevalence of overweight was highest for low-educated and middle-wealth groups. The size of the inequalities in overweight showed only small regional variations. In the East, however, overweight prevalence was more related to higher socio-economic position than in the other regions. CONCLUSIONS Socio-economic inequalities for overweight in Turkey are at a similar level as in most European countries, and especially comparable to Southern Europe. The smaller inequalities in the East correspond to the low level of socio-economic development in this part of the country. Prevention of overweight should focus on lower educational groups throughout the entire country and especially on low-educated women.

Public health education in Ege University Medical Faculty: Developing a community-oriented model

Background: Ege University Medical Faculty (EUMF) introduced a community-oriented curriculum in 2001. Aims: To evaluate the new public health education program in EUMF curriculum. Method: The study adopted triangulated methods. Quantitatively, a comparison of the students who were exposed to a community-oriented curriculum (Year 4 in 2007) was made with the students who were exposed to the traditional curriculum (Year 4 in 2005) in terms of their assessment of their achievement of our learning objectives. A total of 255 students in 2005 (80.7%) and 243 students in 2007 (81.5%) were surveyed using a questionnaire. Qualitatively, five focus group- and five individual interviews were performed with the 2007 cohort. Results: Except the one related to teamwork (p > 0.05) all learning objectives yielded significantly higher scores in the 2007 cohort than in the 2005 cohort (p < 0.05). The qualitative analysis supported the achievement of objectives in the 2007 cohort. The students appreciated the relevance of public health education with clinical subjects and interactive methods, but criticized didactic lectures and written assignments. Conclusions: A community-oriented approach is more effective in achieving a holistic approach to health problems. Improving community-based activities and assessment methods would be more successful in integrating population health into medical training.

Demographic and socioeconomic inequalities for self-rated health and happiness in elderly: the situation for Turkey regarding World Values Survey between 1990 and 2013.

PURPOSE To define the socioeconomic and demographic determinants for self-rated health and happiness for Turkish elderly (≥60) using the World Values Survey (WVS) database. METHODS WVS data for Turkey covering 23 years (1990-2013) with five separate cross-sections (1990, 1996, 2001, 2007, 2013) were pooled for analysis (n=870). Dependent variables were self-rated health (SRH) and perception of happiness.Their relation with age, sex, number of children, marital status, income, education, employment status and class perception were evaluated. Chi-square and logistic regression analysis were used. Regression coefficients and their standard errors were derived to calculate odds ratios. RESULTS Mean age was 66.96±5.78 (60-91), 58.16% were male and 76.32% were married. The majority (61.10%) was at lowest income level and 80.60% had education attainment at primary level or below. Very happy/quite happy were 81.77% while only 46.59% perceived their health as very good/good. The crisis year (2001) increased the risk of bad self-rated health 4.4 times, being a women 2.0 times, while being a widow had a 2.3-fold, low-income 3.0-fold effect. The odds for unhappy status was increased 4.3 times at low-income levels and 8.4 times for the divorced/separate living partners. Happiness state improved after crisis period. CONCLUSION SRH and happiness of Turkish elderly bare demographic and socioeconomic inequalities. The inexistence of a partner, being a women, low-income level and major threats for it, like economic crisis, are important drivers for elderly health and happiness. To improve well-being of elderly, better social policies for income is essential and at economic crisis times, support policies should be prioritized for vulnerable groups, including elderly.

Sociodemographic aspects of consanguineous marriage in an urban slum of a metropolitan area in İzmir, Turkey.

Background: Consanguineous marriage is a common practice in Turkey. Sociodemographic and cultural factors associated with it are still unclear. Aim: The purpose of this study was to investigate the association between sociodemographic and fertility factors and consanguineous marriages in an urban slum of a metropolitan area in Turkey. Methods: This community-based case-control study was conducted in Bayrakli Municipality health centres. Of the 1243 married women, 85 consanguineously married were included in the case group. A control group in non-consanguineous marriages consisted of 85 women matched to cases according to age and neighbourhood. Information about the subjects’ sociodemographic features, fertility history and opinions about consanguineous marriage was collected. Results: Factors that were associated with consanguinity included; having a low level of education (OR = 2.7, CI = 1.1–6.7), a brief duration time in Izmir after migration (OR = 4.7, CI = 1.9–11.6) and consanguineous parents (OR = 3.8, CI = 1.5–9.7). Despite the increased numbers in fertility features and higher perinatal mortality for first cousin marriages, there was no significant difference in the mean numbers of pregnancies, births, stillbirths and living children. Conclusion: Time after migration and educational background of women were the main factors associated with consanguineous marriages. Public health interventions to reduce consanguineous marriage in urban areas should target socioeconomically disadvantaged populations in cities.