Class 2, 13.09.2012 Atatürk University Medical Faculty

1. Access to Health Care Class 2, 13.09.2012 Atatürk University Medical Faculty Zekeriya Aktürk, Prof. Dr. zekeriya.akturk@gmail.com http://aile.atauni.edu.tr

2. John Q (2002) • John Quincy Archibald's son Michael collapses while playing baseball as a result of heart failure. • John rushes Michael to a hospital emergency room where he is informed that Michael's only hope is a transplant. • Unfortunately, John's insurance won't cover his son's transplant. • Out of options, John Q. takes the emergency room staff and patients hostage until hospital doctors agree to do the transplant.

3. John Q (2002) http://www.imdb.com/video/screenplay/vi1502806297/

4. Aims – Objectives • The participants will learn about the principles about access to health • At the end of this course participants will be able to; • Explain the difference between «access to health services» and «access to health care» • Understand the components of access to healthcare services • List the standards for access to health care • List factors affecting access to health services

5. Access to care/Access to health

6. Definition • Being able to receive health care when needed. • Has different components • Economical = Ability to pay • Other = Health service; • Close to settlement • Accessable road • Culturally accessible • Timely, appropriate, and understandable

7. Access to which service? • Preventive health care • Chronic problems • Primary health care (GOBI-FFF) • Growth monitoring • Oral rehydration therapy • Breastfeeding • Immunization • Family planning • Female education • Food supplementation • Emergency heatlh care • Hospital services

8. Service Standards for Primary Care • Receiving care within 4 weeks for routine problems • Receiving care within 4 weeks for emergency problems • Access to telephone consultation all 24 h • Receiving standard preventive services according to the guidelines • Receiving immunizations according to national schedule • Receiving consultation for non urgent problems within 4 weeks • Receiving consultation for urgent problems within 24 hours Saultz JW. Textbook of Family Medicine. McGraw Hill 2000

9. Factors effecting the decision to take health care • Seriousness of the problem • The amount of anxiety the problem arises • Views of family authorities • Personal or family experience with the same problem • Difficulties in accessing health • Consequences of not attending to work or job • The value an indvidual or family gives to continuity of care • Experiences with the health care • Health costs

10. Barriers • Education • Sex • Family • Komorbidities • Healthsystem • Language • Race • Economical • Geographical • Distance • Cultural and social

11. Number of uninsured in the USA Escalating Cost & Recessionary Cycles Economic Recession Good Economy

13. http://blog.milliyet.com.tr/genel-saglik-sigortasi-basladi-1-ay-icinde-milyonlarin-muracaati-gerekecek-/Blog/?BlogNo=343157http://blog.milliyet.com.tr/genel-saglik-sigortasi-basladi-1-ay-icinde-milyonlarin-muracaati-gerekecek-/Blog/?BlogNo=343157

14. Who are uninsured? • 2002, USA • %32 Latin • %20 African • %18 Asian • %11 White

15. How can we measure service utilization? • Health expenditure • Mean number of yearly visits • 2001: 1,6 – 2010: 7 • Hospitalization • Preventive services

16. Immunization rates http://www.istanbulsaglik.gov.tr/w/sb/bh/asilarbulasici2.asp

17. Population per health professional

18. Buerocracy decreased number of patients increased http://www.medimagazin.com.tr/ana-sayfa/kategorisiz/tr-burokrasi-azaldi-hasta-sayisi-katlandi-1-666-15868.html

19. Summary • What do you understand from «Access to health care»? • What is the difference between “access to health” and “access to care”? • What are the standards for access to health care? • What can be the barriers for access to health care?

20. The Cost-Access-Quality Triangle

21. Access to Health Care