Published on February 25, 2014
M.Said YILDIZ, Prof.Mahmud KHAN (Presented in Florida, February 23th 2014)
Content • • • • • • • Turkey and health status indicators Turkey Health System and reforms Increase in health expenditure CRMS (Centralized Resource Management System) Case Study : Two problems, solutions and effects Contribution of IT system to implementation Conclusion
Turkey at a glance Population 2013: 75,627,384 Population Growth Rate: 1.3% Area total: 302,535 sq mi Density: 239.8/sq mi GDP(PPP) per capita: $15,001 HDI(2013): 0.722 (high) Growth Rate (2010): 9.5% Inflation Rate: 7.4% Unemployment Rate: (2012) 9.2%
The Health Transformation Program • Started (2003), • Health reforms by Ministry of Health (MoH) • Objectives: to increase access to healthcare services and to improve efficiency. • Triggered administrative and financial reforms.
Life expectancy at birth Predicted by WHO for Turkey by 2025 (WHO report of 1998) Average 75 Achieved by Turkey 2011 Female 76.8, Male 71.8. Maternal Mortality Rate a decline by 75% Infant Mortality Rate (per 100,000 live births) a decline by 79% 2003 61 47 2011 14.5 9.9 Per 100,000 live births
Some quotes on success • Health Transformation Program seems to represent “good practice” in the development and implementation of major health system reforms and preliminary indications are that it has been successful. (OECD report, 2010) • “Based on the overall information available from the latest national health accounts and Household Budget Surveys, it appears that the Turkish health system performs quite well in terms of equity and financial protection, both in absolute terms and relative to other countries.” (OECD Review of Health Systems Report) The lessons from Turkey are that with political commitment and a flexible, results oriented approach, Health Systems Strengthening interventions can be successfully implemented to have an important impact on the performance of the health sector. (World Bank Report, Sarbani Chakraborty Lessons from the Turkish Experience, Dec 2009, Volume 12)
• Turkey and health status indicators • Turkey Health System and reforms • • • • • Increase in health expenditure CRMS (Centralized Resource Management System) Case Study : Two problems, solutions and effects Contribution of IT system to implementation Conclusion
Before Reforms Dispersed and fragmented Social Security and Hospital Systems Bag-Kur (1971) Social Insurance Agency of Self- Self-employed employed - SISE SSK (1946) Social Security Association – SSA Blue Collar workers Emekli Sandigi (1950) Pension Fund for Civil Servants – PCS Civil Servants Yesil Kart (1992) Green-Card (uninsured people)
Before Reforms Dispersed and fragmented social security and hospital system SSA Hospitals SSA Hospitals SISE patient SSA patients PCS PCS patients patients Military patients Limited number of patient MoH Hospitals MoH Hospitals University Hospitals Military Hospitals Private Hospitals
Unification of dispersed and fragmented social security system All social security institutions united under SSI (2005), General Health Insurance could be created. Green Card as an instrument of Social Policy covered needy and uninsured people from catastrophic health expenditures. GC
Unification of Public Hospitals Ownership of all SSA’s hospitals were transferred to the MoH. Hence, with this final step unification process of the reform has been completed. (law: 5502)
After Reforms All patient groups that are covered by General Health Insurance could get service from either MoH, university or private hospitals Civil servants are allowed to benefit from private health institutions. (Protocol signed between MoH and the Ministry of Finance, (April 2003) A protocol signed that enables Members of SISE, PCS and GC to benefit from SSA hospitals, and members of SSA to benefit from MoH (public) hospitals. (July 2003) General Health Insurance could be implemented for all citizens by January 2012 MoH MoH Hospitals Hospitals All patient groups with General Health Insurance University Hospitals witit wh hcco o-pp - aa yym mee nnt t Military Hospitals Private Hospitals
• Turkey and health status indicators • Turkey Health System and reforms • Increase in health expenditure • • • • CRMS (Centralized Resource Management System) Case Study : Two problems, solutions and effects Contribution of IT system to implementation Conclusion
Total health expenditure (% of) GDP 6.1 7 6 5 4 3 2.4 2.4 2 1 0 1980 1985 1990 1995 2000 2005 2007 2008
Health Expenditure in Turkey Investments Investments %9 %9 Other Other %51 %51 Turkey Statistics Institute Bulletin, Number: 34, February 18, 2011, Hospitals Hospitals %40 %40
Ownership status by hospital beds 2011 Private % 17 2004 University % 19 MoH % 64
Number of beds (2011) Private Private %17 %17 University University % 19 % 19 MoH MoH %64 %64
• Turkey and health status indicators • Turkey Health System and reforms • Increase in health expenditure • CRMS (Centralized Resource Man. System) • Case Study : Two problems, solutions and effects • Contribution of IT system to implementation • Conclusion
Increased health expenditure cost containment policies Unification of public hospitals interconnected IT systems CRMS Improvements in Hospital IT Systems HRMS SAS
Interconnected IT systems (Stocks-Accounting-Human Resources) CRMS is a resource management system which operates in conjunction with 2 other IT systems: SAS - Uniform Accounting System HRMS -Human Resources Management System)
Reasons for initiating the CRMS •• To transfer hospital records from manual to To transfer hospital records from manual to digital digital •• To build a central inventory management system To build a central inventory management system •• To standardize data entry for all hospitals To standardize data entry for all hospitals To assure To assure more reliable -more reliable transparent transparent system system
CRMS Centralized Resource Management System • • • • • • • web based, Integrates hospital IT systems; centralized monitoring and control policy making in more than 1000 health facilities by more than 7000 users since 2009.
Advanced functions of CRMS system • Hospitals could make price inquiries before purchasing, could learn about purchasing prices of other hospitals and their providers • MoH and hospitals had opportunity of making macro analysis for hospital inventories, • MoH and hospitals could plan inventories more accurately. • MoH could implement macro policies more conveniently.
• • • • Turkey and health status indicators Turkey Health System and reforms Increase in health expenditure CRMS (Centralized Resource Management System) • Case Study : Two problems, solutions and effects • Contribution of IT system to implementation • Conclusion
INVENTORY PROBLEM-1 SOLUTIONS High stock levels in the hospital system in general 1. Controlling and managing stock levels 2. Transferring to other hospitals
INVENTORY PROBLEM-2 SOLUTION Waste of unused materials Transferring to other hospitals before they are wasted
Solution: Controlling Intakes and Stock level
Excess stock transfer process Hospitals which MoH regulation: MoH regulation: has excess stock “Maximum stock in “Maximum stock in made hospitals limited to the hospitals limited to the declaration by need over three months” need over three months” system Hospitals made inquiry before purchasing Hospitals could access each other’s “excess stock” information Transfer between hospitals started
Stock level reached maximum. Implementation started 1200 Initial results Stabilization of stock level 1000 800 600 million TL 400 First months. Sharp decrease in stock level 200 0 Feb-08 May-08 Aug-08 Nov-08 Feb-09 May-09
Amount of medical supplies (purchased vs stocked - million TL)
Amount of medicines (purchased vs stocked - million TL)
Result #1: Amount of materials transferred within system Transfers of materials which exceeded maximum stock limit 2009 44,024,213 US $ 2010 42,067,765 US $ 2011 29,516,233 US $ 2012 27,623,826 US $ 2013 (first 9 months) 48,750,505 US $ Total 191,982,542 US $
Solution: Using unneeded stock before it goes to waste
Unneeded stock transfer process MoH wanted health MoH wanted health facilities to share facilities to share information about their information about their supplies that are not supplies that are not needed needed Hospitals which has unneeded stock recorded information to system Other Hospitals made inquiry before purchasing Hospitals could access each other’s “exceeding stock” information Transfer between hospitals started
Result #2: Amount of materials transferred Transfer of materials which are no more needed 2009 64,035,219 US $ 2010 22,939,795 US $ 2011 35,519,535 US $ 2012 36,664,240 US $ 2013 first 9 months 27,684,419 US $ Total 186,843,208 US $
• • • • • Turkey and health status indicators Turkey Health System and reforms Increase in health expenditure CRMS (Centralized Resource Management System) Case Study : Two problems, solutions and effects • Contribution of IT system to implementation • Conclusion
How CRMS works? Hospital records information about their unneeded or exceeded stocks Hospital which receives the demand for its materials call back in 5 days Hospital which needs material sends request to other hospitals which has exceeded or unneeded stock,
Hospitals record their stocks’ price, amount and other details to web based system
Unneeded and over stock materials can be monitored by hospital and MoH
Hospital that needs material has to make an inquiry for unneeded or over stock materials from other hospitals before purchasing
Conclusions • A reliable, standardized and central inventory system is generated with integration of separate hospital systems. • System enabled inventory planning, making analysis for hospital inventories, implementing macro policies. • Transferring unneeded and exceeded stocks between hospitals was a macro policy implementation which became possible with CRMS. • This policy implementation reached its targets with efficient use of system.
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