Publication: Türkiye’de sağlık hizmetlerinin yerelleştirilmesi
Abstract
Desantralizasyon, kamu planlamasında, yönetimde ve karar almada otoritenin ve yönetim yetkisinin ulusal düzeyden, daha alt düzeylere yada daha genel bir deyişle, yüksek düzey hükümet organlarından daha aşağıdaki hükümet organlarına aktarılması demektir. Uygulamada sağlık sistemi desantralizasyonu çok değişik şekillerde görülmektedir. Bu hem devletin genel olarak politik ve idari yapısı ve amaçlarına hem de ülkede bulunan sağlık sistemi örgütlenmesine bağlıdır. Desantralizasyonda iki tür sınıflama yapılabilir. Birinci sınıflama bölgesel ve fonksiyonel sınıflandırma, ikinci sınıflama desantralizasyonun derecesine göre, 1-Dekonsantrasyon 2-Devolüsyon 3-Delegasyon 4-Özelleştirme Ülkemizde birinci sınıflamaya göre bölgesel desantralizasyon uygulanmaktadır. Ikinci sınıflamaya göre ise ülkenin idari bölünüşü ve valilik makamı dekonsantrasyona uymaktadir. Sosyal Sigortalar kurumunun universite hastanelerinin varlıgı delegasyona uymaktadır. Turkiye’de yerel yönetimlerin sağlık alanında yasal sorumlulukları vardır. Ancak bu kurumların gelirleri kendilerine verilen görevleri karşılayacak durumda değildir. Bu da devolüsyona uymakdatır. Ülkemizde ki sağlık sistemini desantralizasyonun çeşitlerinden birinin içerisine sokmak mümkün değildir, İç içe geçmis bir görüntü vardır. Sağlık Bakanlığı, sağlık sektöründeki aşırı merkeziyetçi ve yetkilerin üst seviyelerde toplandığı yönetim yapısı en önemli sorun olarak belirlemektedir. Sağlık Bakanlığına göre bu sorunun çözümü desantralizasyondur. Ülkemizde, sağlık hizmetleri ile ilgili yapılan reform çalışmalarında, desantralizasyon ile başlayan süreç sonuçta özelleştirmeye götürülmek istenmektedir. Yeniden yapılanma yapılırken, sağlık hizmetlerinin kamusal olma özelliği gözününde bulundurulmalı, ülke gerçekleriyle uyumlu reform yapılmalıdır.
Decentralization is either transferring the government authority’s to lower levels for public planning, administration and making decision or generally speaking transferring high level authority to lower level authority. Decentralization is that giving the responsibility of making decision to the most possible lower level in the organization. Health system decentralization can be seen differently in practice. This generally depends on government’s politics and administrative structure and its targets and also depends on country’s health system structure. Decentralization has two types. First of them is regional and functional and second type of decentralization is as follows, 1-Deconcentration 2-Devolution 3-Delegation 4-Privatization Regional decentralization is applied in our country according to first type. Turkey’s administrative division and governorship office are applied according to second type of deconcentration. Social security and university hospitals are applied according to delegation. In Turkey, regional governments have responsibility in health. But these institutions earning are not in good conditions to provide these needs. And this suits devolusyon. It is not possible in our country to suit all the health system in one type of decentralization. They conflict with each other. Health department thinks that the biggest problem in health sector is extreme centralism and authorities gathers in high level in government. According to health department, solution for this is decentralization. In our country, reforms that is made in health system and process that starts with decentralization wants to be taken to privatization at the end. During the new structuring, health service’s public character needs to be taken in concentration and reforms that are made has to be made with country’s realities.
Decentralization is either transferring the government authority’s to lower levels for public planning, administration and making decision or generally speaking transferring high level authority to lower level authority. Decentralization is that giving the responsibility of making decision to the most possible lower level in the organization. Health system decentralization can be seen differently in practice. This generally depends on government’s politics and administrative structure and its targets and also depends on country’s health system structure. Decentralization has two types. First of them is regional and functional and second type of decentralization is as follows, 1-Deconcentration 2-Devolution 3-Delegation 4-Privatization Regional decentralization is applied in our country according to first type. Turkey’s administrative division and governorship office are applied according to second type of deconcentration. Social security and university hospitals are applied according to delegation. In Turkey, regional governments have responsibility in health. But these institutions earning are not in good conditions to provide these needs. And this suits devolusyon. It is not possible in our country to suit all the health system in one type of decentralization. They conflict with each other. Health department thinks that the biggest problem in health sector is extreme centralism and authorities gathers in high level in government. According to health department, solution for this is decentralization. In our country, reforms that is made in health system and process that starts with decentralization wants to be taken to privatization at the end. During the new structuring, health service’s public character needs to be taken in concentration and reforms that are made has to be made with country’s realities.