Health Care Services and the Elderly: Utilization and Satisfaction in the Aftermath of the Turkish Health Transformation Program

With the implementation of the health transformation program, Turkey has gone through substantial changes in its health system in the last decade. This study relies on two nationally representative data sets to investigate health service utilization and satisfaction of the elderly. In particular, it examines the share of elderly who have an unmet need for medical care and who could not afford a medical examination or treatment over the years 2006 to 2015, using data from the Turkish Survey of Income and Living Conditions. It also examines the utilization of health services and satisfaction from these services by the elderly in years 2004 to 2015 using data from the Turkish Life Satisfaction Survey. This study finds that utilization has increased and, coinciding with the introduction of the family medicine system, the percentage of patients choosing primary care facilities has increased. The share of the elderly with unmet need and those who could not afford health care have declined. Notwithstanding, overall satisfaction increased only until 2011-2012. Understanding the utilization and satisfaction of the elderly is important, because along with many other countries, the population is aging in Turkey. In the near future, health care needs of the elderly will have a higher priority on the agenda of policy makers

How to defend mandatory immunization against vaccine hesitancy and vaccine refusal? An ethical assessment

One of the basic ethical principles in medical practice is to respect personal autonomy. However, it is a widely accepted view that when it comes to health problems that concern not only the individual but also the society, especially in epidemics of infectious diseases, individual autonomy can be violated by prioritizing the benefit of the community. This view is based on the scientific fact that epidemics can only be controlled by immunizing all susceptible individuals. However, whether all susceptible individuals can be compelled to be immunized remains a matter of debate around the world. Especially in the last three years, during the worldwide Coronavirus disease-2019 (COVID-19) pandemic, a significant part of the society has been hesitant about being vaccinated, and some have argued that vaccines should be rejected altogether. In the face of the situation outlined above, the question of "should immunization be mandatory?" has become more important than ever to be able to answer the question in a way that will ensure as broad consensus as possible. In this review article; it was discussed under which conditions mandatory immunization could be justified in terms of ethics and thus, it was aimed to contribute to the solution of the vital problem created by the phenomenon of vaccine hesitancy and rejection in terms of public health. To this aim, first of all, the need to clarify some concepts was mentioned. Afterwards, the arguments "must be compulsory", "should be optional", and "should not be done to anyone" were evaluated with their justifications and it was determined that the argument that immunization should be mandatory could be justified in terms of ethics. In the article, it was argued that the conflicts of "individual freedom X community benefit" and "personal autonomy X community benefit" did not exist in today's actual conditions, but it was stated that an individual with the knowledge of reality experiences a tension in the face of not putting this knowledge into practice. It was emphasized that in order to overcome this tension, consolidation of the theoretical background and also consideration of the macro determinants of vaccine hesitancy and rejection in practice were necessary. What needs to be done to re-establish trust in the medical institution was listed, and it was argued that the question of how to implement mandatory immunization could only be answered in a healthy way through a transformation process that will be implemented through a social dialogue

A follow-up study on the effects of an educational intervention against pharmaceutical promotion.

BackgroundThe promotion strategies of pharmaceutical companies create many problems including irrational prescribing, diminished trust in the patient-physician relationship and unnecessary increases in pharmaceutical costs. Educating prescribers is known to be one of the few potentially effective measures to counteract those impacts. However such educational programs are limited in the literature, and their effectiveness against the effects of hidden curriculum in the long term is unknown. This study aims to evaluate the effectiveness of an education program both in the short term and the long term after the students have been exposed to informal and hidden curriculum and various pharmaceutical promotion methods.MethodsA longitudinal and controlled study was carried out in a school of medicine in Turkey where there are no restrictive policies for pharmaceutical promotion. A survey was applied to 123 students who attended the class throughout the terms of 2011-12, 2012-13, and 2013-14, evaluating the pre-educational status of students' opinions of promotion and any post-educational changes. A follow-up study four years later asked those three cohorts to fill out the same survey to see the possible effects of the clinical environment and various promotion methods. Also, the opinions of all 518 sixth-year students who had not taken the class in those three terms were compared to the educated students.ResultsThe program was significantly effective in the short term in changing students' opinions and attitudes positively towards recognizing companies' discourse and promotion strategies. But in the long term, the education lost its ability to convince students of the importance of not getting financial support for scientific activities from pharmaceutical companies (p:0.006) and carrying out research (pConclusionsThe education program could be used for creating awareness of, increasing skepticism towards, and inculcating disapproval about pharmaceutical promotion practices. However, the effectiveness of the educational intervention is susceptible to erosion after exposure to the informal and hidden curriculum together with exposure to promotion. The impact of role-models, organizational culture, and institutional policies could be important aspects to be addressed for sustaining the effectiveness of such education programs