Effect of health system reforms in Turkey on user satisfaction

Abstract

In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01–3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82–4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

An Analysis of Good Governance in the Health System

“…Good health systems around the world are looking for ways to make patients and society more responsive. In the health system, responsiveness includes a common set of eight dimensions, including: Quick attention, respect to people's dignity, clarity of communication, autonomy, confidentiality of personal information, choice of provider, quality of basic services and access to family and social support (19). In this regard, in recent years, changes have been made in the health system of many countries which have led to the satisfaction of patients.…”

Iranian Health Reform Advantages in Health Care System: A Qualitative Study

“…Client satisfaction of available services is one of the key goals of the health system, which means the fulfillment of expectations and needs of the clients. Different factors could impact people's satisfaction including the health system pattern, the manner of providing care, and personal characteristics (15). We could not find any study that has evaluated people's satisfaction with health care service.…”

Universal health care in middle-income countries: Lessons from four countries

“…Expansion of family health teams led to a 3-fold increase in utilization of PHC services per person between 2003 and 2013, immunization coverage, antenatal visits and births attended by trained health staff rose significantly with reductions in infant mortality and under-five mortality. The health systems transformation which enabled the expansion of UHC helped to increase access and utilization of health care services and satisfaction of citizens with primary health care services, which further encouraged the use of primary health care services [ 30 ]. Out-of-pocket expenditures and catastrophic expenditures more than halved [ 31 ].…”