Suchergebnisse

The number of elderly people relying on formal long-term care services is dramatically increasing year after year, and the challenge of ensuring the quality and financial stability of care provision is one faced by governments in both the developed and developing world. This edited book is the first to provide a comprehensive international survey of long-term care provision and regulation, built around a series of case studies from Europe, North America and Asia. The analytical framework allows the different approaches that countries have adopted to be compared side by side and readers are encouraged to consider which quality assurance approaches might best meet their own country's needs. Wider issues underpinning the need to regulate the quality of long-term care are also discussed. This timely book is a valuable resource for policymakers working in the health care sector, researchers and students taking graduate courses on health policy and management

The recent introduction by the central government of recovery plans (RPs) for Italian hospitals provides useful insights into the recentralization tendencies that are being experienced within the country's decentralized, regional health system. The measure also contributes evidence to the debate on whether there is a long-term structural shift in national health strategy towards more centralized stewardship. The hospital RPs aim to improve the clinical, financial and managerial performance of public-hospitals, teaching-hospitals and research-hospitals through monitoring trends in individual hospitals' expenditure and tackling improvements in clinical care. As such they represent the central governments recognition of the weaknesses of the decentralization process in the health sector. The opponents of the reform argue that financial stability will be restored mainly through across-the-board reductions in hospital expenditure, personnel layoffs and closing of wards, with considerable negative effects on the most vulnerable groups of patients. While hospital RPs are comprehensive and complex, unresolved issues remain as to whether hospitals have the necessary managerial skills for the development of effective and achievable plans. Without also devising an overall plan to tackle the long-standing managerial weaknesses of public hospitals, the objectives of the hospital RPs will be undermined and the decentralization process in the health system will gradually reach a dead-end.

Health care reform has been given the utmost importance on Turkey's policy agenda since the late 1980s. In 1989, the SPO's Master Plan Study (SPO, 1990), which was developed through a World Bank loan, introduced new concepts to the Turkish health care system. The Plan suggested splitting the functions of purchasing and provision, developing an internal market, implementing general health insurance, formulating a family medicine system at the primary health care level and giving autonomy to state hospitals. From 1990 to 1993, intensive efforts were undertaken to reshape the health care system in a way that reflected global trends and approaches. The World Bank had an important role in developing this process. The National Health Policy (Ministry of Health, 1993) presented the first comprehensive analysis of priority health care policies and also set out future strategies. However, a decade of political and economic instability (1993–2003) led to reform proposals that remained as blueprints with no concrete steps for implementation.

This chapter outlines the principles and practice of regulation and planning in the Turkish health care system. Table 4.1 outlines the main legislative arrangements upon which the health care system is based. As can be seen from Table 4.1, some of the basic legislation used in health care is quite old; however, the dates mentioned are the acceptance dates of the laws and each has undergone several revisions over time, reflecting changes in the health care environment. In the Turkish health care system, decrees and directives also play an important role. Laws create the main legislative framework, and successive decrees and directives may be issued for the purposes of implementation.

Turkey is located in the northern hemisphere and bridges Europe and Asia. The bordering countries are Greece, Bulgaria, Georgia, Armenia, the Islamic Republic of Iran, the Syrian Arab Republic and Iraq. The country has a population of 73 million, 26% being under 14 years of age in 2010. Turkey is a parliamentary democracy with a clear separation of executive, legislative and judicial powers. The 1982 Constitution describes Turkey as a democratic, secular and social state governed by the rule of law. The Turkish Grand National Assembly (Türkiye Büyük Millet Meclisi), or parliament, is the legislative body acting on behalf of the nation. The President, elected by the people, and the Council of Ministers (Cabinet) headed by the Prime Minister, exercise executive power. Independent courts handle judicial power. Administratively, Turkey is divided into 81 provinces headed by provincial governors appointed by the central government. Provincial governors are the representatives of all ministers at the provincial level. All ministries, including the Ministry of Health, have their own local organizations in the provinces and the heads of these organizations are responsible to the provincial governor.