Vural NASUHBEYOĞLU
Istanbul

Crisis in health sector in Turkey is growing. As making an appointment with hospitals is getting harder, hundreds of medical drugs are not available; the crisis in the supply of medical supplies is also growing. Medical supply firms do not provide materials to public hospitals due to concerns of extreme rise in foreign exchange rates. Many medical operations are also postponed for that reason. A wide spread health problem is awaiting for us unless the crisis is resolved that has already reached the dimensions threatening public health.

PACEMAKER WARNS FOR MAINTENANCE, BUT NO BATTERY IS AVAILABLE

One of the citizens affected by the short-comings in medical supplies is Ali Dursun Dogan, living in Erzurum. Using a pacemaker since 2018 due to his cardiac dysfunction, Dogan had reported to Erzurum Training and Research Hospital on January 5, upon his pacemaker warned him. After examined, he was advised that his pacemaker was about to run out of charge, and that companies did not provide any batteries due to increase in foreign currency. Referring to that Doctor who said that the pacemaker battery was to be replaced in two weeks, Dogan continued “They advised me to call back on Jan 14. When I called, they told me to be at the hospital on Jan 20. I don’t know if the battery supply issue is resolved. I will find out when I get to the hospital.”

“THE SHORTAGE IS TO GET WIDENED”

The leader of the Working Group of Health Policies of Turkish Toraks Association (TTA), Assoc. Prof. Yavuz Havlucu points to the balance of payment difficulties of public and university hospitals as the reason for the shortage in medical supplies. Indicating that the payments of procured supplies by the hospitals could not be made in earlier than 18 months, Assoc. Prof. Havlucu said “In such a period when the foreign currency is so volatile and economy is so bad, even a small store does not supply goods for such long periods of payment. In such case, medical material suppliers do not provide any goods for which the payment is said to be made in 18 months after the shipment. Shortage got extended to cardiovascular surgeries in addition to orthopaedic and neuro surgery. And it seems that it will get more spread. Nobody can guarantee that the shortage will not happen in the near future in the most basic operations of general surgery. It is bound to surface in those areas as well.”

“CONSEQUENCE OF MARKETIZATION OF HEALTH SERVICES”

Warning that it is to become a huge public health issue and that the hospitals are to fall into a situation that they will not be able to provide any services, Havlucu continued “Recently, the state set aside billions of TL funding for the city hospitals instead of public and university hospitals.” Mentioning that despite this funding, the city hospitals also happen to have the supply issues, Havlucu argued “Because the main cause of that is the marketization of health services. This shortage will persist on as long as that does not end and the public health is left to the mercy of international monopolies. The issues happening in health services are the consequence of that marketization of health system. Because the hospitals were turned into companies, and the patients into customers. If you move with company operation management logic, this crisis will strike at the hospitals too.”

“PRICES NOT UPDATED FOR 10 YEARS”

Reminding that Social Insurance Institution (SII) has not updated the tariff in the Health Practices Communique  (HPC), Havlucu said “While the charge used to be 200TL for bronchoscopy 15-20 years ago when I was a resident, it is now 275TL. There is a huge difference between them. One of the main reasons of this crisis is not to have performed proper pricing by updating the HPC prices.” On the other hand, drawing attention to that the state diverts to private hospitals the funds coming from the taxes people pay for their right to health services, Havlucu elaborated on “Huge differences have been created between the public and private hospitals. It is the task of the state to provide everybody with quality health services. But, this and the view of being a social state have been forgotten.” Mentioning that the doctors have been dragged into a situation in which they are not able to help their patients because of the means that his hospital has not been able to provide for, Havlucu said “This too is causing burnouts. After having a 10 yearlong education, a doctor will not accept to perform only polyclinic services because supplies and means are not available. Because of compensation and such situations, many doctors resign from public services.”

“30% OF MEDICAL DRUGS NOT AVAILABLE”

Emphasizing that there happens a very serious shortage for medical drugs, Havlucu stated “There is specifically a problem in getting imported drugs. Of the drugs, almost 30% is not commercially available. Because they are imported. The state has fixed Euro rate at 4.70 TL and makes the reimbursements at this rate. Which company would supply them at this rate? The expected rate increase is 6.50-7.00TL and that is not sufficient.” Also reminding the announcements of Ministry of Health claiming “there is no shortage of drugs”, Havlucu added “Pharmacies say, for example, that ‘we cannot find Albuterol Syrup.’ But the Ministry says ‘it is available.’ Yes, it is available but only one bottle. Company is sending one bottle, but there is a need for hundreds of bottles of it. Here, they clearly play with quantities.” Stating that flu drugs are in no existence, and further that there are problems in cases of drugs whose raw materials are imported, in addition to those drugs imported., Havlucu said “The problems in drugs and medical supplies have happened so openly, everbody knew they would.”

ÖKTEN : NO OPERATIONS EXCEPT IN EMERGENCY SITUATIONS

Turkish Medical Association (TMA) Deputy Chair, Assoc. Prof. Ali Ihsan Ökten had said “We cannot do surgeries due to shortage of materials,” waning about medical materials crisis in the first week of December. Stating that there has been no change since that day on, Ökten said “We still cannot perform surgeries outside of emergency cases. This is very serious problem.” Taking an example of cervical disc hernia which is to be operated on without delay, Ökten continued “Because the patient gets saved from both the loss of arm strength and elevating pain. In addition, in elderly patients, in cases like hip fracture we have to put the patient on his/her feet early by operating on the hip. If this does not happen, as the patient is tied to bed, some additional illnesses will emerge.” Mentioning that the doctors operate in these cases on their patients assuming the risks, Ökten said “This should not be that way. Ministry of Health made certain payments to the companies.  But HPC has not changed for 10 years. It is urgent situation that this problem be resolved for the sake of both doctors and patients.”