Sustainability Of Value-Based Healthcare Reform In Turkey Essay.

Write a report that maps and critically evaluates the sustainability of healthcare system that has adopted a value-based healthcare reform and that reflects on the implications of such a model on health outcomes, experience of care and efficient and effective care in relation to costs.

Guiding Principles for Healthcare Reforms in Turkey

This essay is an expression of opinion that offers an explanation based on the health transformation from traditional based health care to value-based healthcare specifically that took place in the country of Turkey. The report also discusses the challenges in the leadership and all that is related to this transformation. Currently, a great large number of countries have had the desire to do the transformation on their health systems (Ferlie et al, 2016). The factor behind all these motivations being the desire to satisfy their citizens needs related to health care and more so through the provision of high-quality and equitable services without causing any hardship financially. In another way, the main idea has been aiming to reach the Universal Health Coverage (UHC) that is measured in terms of its value to the citizens.  The main important question is that why does a country or nation we aim to achieve this? The answer to this question is just a simple and obvious one. Healthcare in a nation is a fundamental right to every citizen in the country, and its sustainability depends on its operational condition. The purpose of writing this report is to shed some light on how Turkey has been successful in their transformation from traditional healthcare to the new advance value-added health care system. The report is also made to learn from Turkey’s actions on how to aggressively move on so that one may achieve value-based health care system that is measured in terms of the value it offers to the common citizen (Baumhauer & Bozic, 2016). The structure of the essay has been divided into the following various sections. The first section discusses guiding principles based on the healthcare reforms, under this section; discussion about the guiding principles that were used by the nation of Turkey in the realization of transformation from a traditional healthcare system to a value-based healthcare system are discussed. The second section discusses on the findings based on the sustainability of the value-based healthcare model putting into consideration the aging population, the increased chronic diseases, demand on the entire healthcare and finally the ever increasing cost of technological advancement. The final section discusses the recommendations that should be made based on the future performance of the current healthcare system. Here the emphasis is made addressing the aging population, increased chronic diseases, the rising demand on the entire health care system and finally the increasing costs of technological advancement (Nordin, Kork&Koskela, 2017).

The experience in Turkey teaches us a lot concerning the leadership of transformation and the overcoming of challenges of change. Below are the nine guiding principles in the process of Turkey struggle for transformation from traditional to value-based healthcare.

The leading principle is that transformation leadership needs internal motivation and steady and resolute ability to decide on bringing revolution in the public favor. The importance of this principle is that you find it difficult to address abuses of the system abuses without making difficult decisions and also lobby groups wrath risking that are more powerful (Aspry&Salmoirago-Blotcher, 2016). You can’t put a strong resistance that will lead to your failure. Therefore, you ought to act fast enough to repel the attacks. In the absence, your readiness for you to face opposition and real conflicts, you together with your teams can’t build leadership that is transformational and finally ends up fighting with severe chaos and problems of coordination. Now, this is the situation that is called the fibrillation state, and it looks like the uncoordinated rapid twitching of the heart movements when circulation and pulse stops.

Findings based on Sustainability of Value-Based Healthcare Model

The second principle has two-prolonged transformation approach. It is the first and the decisive change that builds political support immediately along with gradual and deep change aiming at revolutionizing the system. For example, one of the executed quickly changes that lead to public support production that was strong is a decree that was issued against the patient holding practices; whereas the implementation of the family medicine application was made for more than five years gradually in the system (Howell, Conway & Rajkumar, 2015). Our effort in solving the dual-practice problem also illustrates the two-prolonged approach. What we did is that at first, we made the doctors to abandon their tasks by incentivizing them and when critical doctors were on board, the practice was banned. By using these two-prolonged interventions, our transformation power extended.

The third principle is the gaining of public support and trust. Sometimes the support becomes the protector even against some friends, cabinet and also your very own party.  Therefore you should never act against the citizens and resist attempts of austerity (Vetter et al, 2014). The provision and the changes on a demand side have a close relation. When you set public health insurance that is a single-payer, you have to make sure the facilities required are available for providing emergency transport when they arise, hospital care, and primary care. When these needs are not met, some incremental changes will limit the achievements that you make.

The fourth principle is the making of a comprehensive transformation, and this is one of Turkey's reasons for success. All the health insurance schemes that are fragmented of Turkey were under one shed which leads to the formation of a public insurance system that was single. Our certainty was that the UHC was not only about the universal insurance but also that our focus was on both sides too. Therefore we harmonized and brought together all the services through accountability and delegation an allowed their equal usage by all the citizens. A generous and a package of equal benefit was made that applied to all the people with the inclusion of even the poor. The benefits package contains all the primary care, hospital care, and the entire emergency and the extensive care. That package also contains the cares that are most expensive like the surgery of the heart, transplant organs and treatment for cancer.

The fifth principle is the creation of the engagement with the private sector and ensuring that the public sector has the strength for the protection of both the low income and also the middle-income groups. The balance established between the private and public sector is challenging (Hunter, 2016). The challenge was because of excessive privatization, and under-control private healthcare.

Maintenance of focus and carefulness in the protection of people from hardship is the sixth principle. The reason behind this is that laissez –fair markets don’t consider health as one of its parts. The Turkish citizens now are being protected well by the systems that are in place, and are cheaper where the expenditure per capita was 5.6 percent of the Gross Domestic Product back in the year 2012.

Recommendations for Future Performance

The seventh principle is the admitting and correcting the wrongdoing before you risk blame. Different strategies have experience in the provision of health services that are equitable across the regions that are economically unequal in Turkey makes a good illustration of this point. Sometime back there was a service in Turkey that was compulsory, and this made doctors sometimes spend in undeveloped regions. This policy was unpopular, and thus we tried changing it. We desired that the same doctors start working in those regions instead of them serving there. Luckily, our policy did not work because the rewards didn’t encourage a good number of doctors (Berwick, Bauchner & Fontanarosa, 2015).This became a crucial lesson for us .Therefore, the previous policy of the doctors was restored that were compulsory.

Principle number eight is avoiding being blinded by the success. Always, there will always be something that needs change or improvement. For instance, a period of ten years is long enough to make preparations for a health transformation plan (Sen&DeLeire, 2018).They believe that there is that the health transformation system that Turkey has consisted of overlapping of small circles of changes and thus every policy that is great needs to be followed by another one, because of varying in the needs, context, expectations, and the resources.

Principle number nine is outcome oriented rather than input oriented as a sign of expressing the literature on health reform. Turkey made use of a wide array of tools for assessment reforms and monitoring as well as channels for feedback to strengthen the outcome-orientation reforms. We began by a helpline that was operating 24 hours for seven days a week and it responded to 6,000 calls daily in approximation. We created the rights of the patients in every hospital; an annual satisfaction and expenditure was conducted using the Turkish statistical institute and used the international universities and organizations(Yip & Hsiao, 2015). The learning and monitoring require the top level executives in the understanding events at all levels of policy implementations.

With current health progress and the findings that we have, the aging population that continues to grow. According to the report on aging that was presented by WHO and the Global health,the people's population aged 65 and above is expected to rise from an estimate of 524 million to almost 1.5 billion by the year 2050, with the most increase in the developed countries.Also, by the year 2050, the population of the aged people is expected to outnumber the population of children that are younger than five years of age.

The attribution made by WHO is that the increased number of the elderly population is attributed to change in the leading cause of death, i.e. from the infection of chronic diseases that are non-communicable and also with the increase in the life expectancy. These chronic diseases consist of hypertension, arthritis, diabetes, diseases of the heart, high cholesterol, cancer, cognitive heart failure and dementia (Tan & Tan, 2017). Cancer and heart diseases have been the leading chronic conditions that have had the greatest impact on the aging population, and more especially the more-income countries. To add on that, obesity incidences and falls are also on the increase too.

These observations lead us to the question: what are the effects of old age in the health care of a population? All of us have come across or heard about the word “Baby Boomer.” According to the office of health promotion and disease prevention, the first Baby Boomer (those babies born between 1946 and 1964) turned 65 in the year 2011, and by the year 2030, the expectations are that more than 60% of this generation will be managing more than one chronic condition. The management of the chronic conditions together with the increased level of the disability of the patients will lead to increased financial demands in the systems of our health care. The cost of treatment increases simultaneously with a number of chronic conditions that are treated, considering the expected number to be twice as many hospital admissions and visits for Baby Boomers by the year 2030.

According to the report given by WHO, some people believe that as the peoples life expectancy increases, the probability of the disability decreasing id high because of the progress that is made in medicine has a likelihood of slowing down the progression of chronic diseases to disability (Adler-Milstein et al, 2017). Therefore what is expected to be the result is that there will be an increase in milder chronic disease. Some other researchers in some other place believe that with the increase in life expectancy, the disability prevalence increases as well.

With the increase in the number of aging population, there are certain health conditions in our healthcare systems that are expected to be a challenge. Some of these conditions include dementia, obesity, and an increased number of falls, diabetes, and cancer.

Because of the increase in the aging population, the expectations are that the numbers of cancer infections are expected to rise to 18 million by the year 2020 and 27 million by the year 2030.

Dementia expects that it will increase as well as the increase in the aging population. Alzheimer’s Disease international makes projections that the number of individuals that will be living with Alzheimer Disease will be 116 million all over the world by the year 2050 (Hooff et al, 2015). The proportions of the organization are that among them 115m million people will be from the developed countries.

One of the common causes of injury to the aging population is caused by falling and the expectations are that it might be one of the challenges in the healthcare systems that we have. This is because Baby Boomers have a characteristic of living, being active and probably remaining on medication that might lead them to falls. The American Hospital Association released a report which stated that more than half of people greater than 65 years of age or older fall every year. Among all those falls, 20% to 30 % have moderate or serious injuries such as the hip fractures, which results in decreased mobility. Research shows that at least 350,000 bone fractures of the hip occurred in the year 2000 and the expectations are that the same value will double by 2050 (Ying, Feeley & Porter, 2016).

Research shows that the number of people that are overweight is likely to continue increasing in number and this will negatively impact the health care system. Obesity is not only costly but also is a risk factor to a lot of health conditions: the cost of Medicare for people suffering from obesity is 34 percent higher than for normal people (Apouey & Clark, 2015).

The number of diabetics in America is expected to rise from the current 36 million to 46 million by the year 2030. This is according to a research that was carried out by AHA (Dolan, Gudex, Kind & Williams, 2016). Every 4 Boomer, 14 million people will be living with chronic diseases

Challenges that the health care system is expected to experience are as seen below. For instance, the resource needs are expected to continue increasing across all the healthcare settings. We also get to see that the incidences of obesity will go on increasing. Also, the shortages of professionals in health care are expected to occur (Abrahams, Balch, Goldsmith, Kean, Miller, Omenn &Westrich, 2017). There is also a challenge in that care has been focused on addressing comorbidity and a single disease. It is also a challenge that the sustainability and the structure of federal programs about the increasing relations are a concern (Phelps, 2016). Another challenge is the change in the structure of the family, and this may lead to a reduction in the number of caregivers. The adaptations of adjusting to the affordable care act pose challenges.

One of the lessons learned from successful healthcare reforms in Turkey is that Health Systems Strengthening (HSS) is now at the top of the World Bank’s health agenda and this makes it critical for the countries to achieve good outcomes in health. The process of implementing HSS is complex, and thus it requires a balance of operational and technical details. The country’s evidence of how HSS works and affects the performance of the health system is now weak. Since the year 2003, Turkey has been making efforts to implement HSS reforms through the support from the World Bank through a lending program and dialogue policy. Through these efforts, the government has seen expansion in the health care system for the people especially the poor, improvement of citizen’s insurance coverage as well as building institutional capacity for sustaining these reforms.

The lessons learned from Turkey’s success in the transformation from traditional healthcare to value-based healthcare system are that the political flexibility and commitment, results-oriented approach, the implementation of Turkey’s Health Systems Strengthening is possible has to impact on the health sector performance.

Although Turkey’s transformation reform was a success, we can learn that the unsuccessful health transformation results from the lack of political flexibility, lack of commitment by the government in implementing value-based health system, the failure of the government to focus on the results that they want to achieve and also lack financial support that is the major driving factor for healthcare reformation programme.

In addressing this issue of an aging population, the system of health care also needs to take on the above-listed challenges. Preparations by the health care system are necessary for the new technology especially because of the increased costs (Devlin et al, 2018). This can be achieved by increasing healthcare workers, training them and the examination of the impact that technology will have on the hospital infrastructure. There need to be preparations because of the increasing chronic conditions within the aging populations by the health care system as well as the development of strategies to prevent the aging from falling. For instance, providing walking crutches and sticks to the aging population so that they can use them to support themselves when walking around. This can reduce falls by a large percentage. There is another important challenge, and that is for the purpose of addressing the health status of the aging population, implementing new systems in health care centers can be done. Also with the rising levels of chronic conditions in the aging population, the complication of their health increases. Concentrating on one sickness can lead to lack of focus on other present medical conditions. Avoiding patients that have fewer complications from using the hospital beds and offering those beds to the people with more complications can be used so that the aging population that requires these beds most can be offered to them as they undergo medication. This will also help cut costs for the patients, coverage plans and the health system as a whole.

What the healthcare systems should do is that they should prepare themselves by implementing a diverse approach in ensuring that the patients get better care management. The focus should be made on the provision of reactive care against preventive care. Some of the strategies that can be implemented are like the inclusion of a comprehensive care plan before patient discharge. This system can help identify patients who require follow-up. A patient monitoring program can also be implemented. Many hospitals nowadays are partnering with fitness centers for the purposes of offering exercises and wellness programs for the elderly. There are other hospitals that provide the same on their wellness centers. This also can be adopted so that the aging population can be helped in doing exercises to maintain fitness.

Most of the elderly patients have skin that is vulnerable to bed sores. The staffs attending these patients should use extra cushioning when positioning these patients in order to protect their skin which is vulnerable to damage. Hot air should be supplied to the elderly patient’s room to keep them warm. The elderly should be provided with insurance coverage from the government so that they can be covered in case they suffer from any illness. This is because they are aging and are unable to finance themselves for the rising medical cost due to technological advancement.

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