Publication: Neoliberal politikalar çerçevesinde hasta tedavi meliyetlerinin değerlendirilmesi: 2000-2007 yılları arasında kamu eğitim ve araştırma hastaneleri üzerine bir araştırma
Abstract
Neoliberal Politikalar, Küresellesme, Saglık Politikaları, Hastane Harcamaları, Hasta Tedavi Maliyetleri. ÖZET Tüm dünyada uygulaması yaygınlasan neoliberal politikalar, ülkemizde de etkisini 1980’li yıllardan sonra göstermeye baslamıstır. Neoliberal düsüncenin hakim ekonomi politikaları; özellestirme, deregülasyon veya kuralsızlastırma, ticaretin serbestlesmesi, bagımsız denetleyici kurumların olusturulması, sermaye hareketlerinin serbest bırakılması, “siskin rezerv politikası” ve “faiz dısı fazla verilmesi” politikalarıdır. Neoliberal politikalar, ülkemizde basta hizmetler sektörü olmak üzere tüm sektörlerle birlikte saglık sektörünü de etkiledigi gözlemlenmektedir. Ülkemizde Saglık Bakanlıgı tarafından 2000’li yıllardan sonra saglık sektöründe reform sayılabilecek önemli uygulamalar baslatılmıstır. Neoliberal politikalar, saglık sektöründe özellikle “özellestirme”, “özerklesme”, “desantralizasyon”, “aile hekimligi” ve “genel saglık sigortası” uygulamaları ile etkisini göstermektedir. Türkiye’de uygulanan neoliberal politikaların, Türkiye’deki hastanelerin %60’ından fazlasını olusturan kamu hastanelerinde yatarak tedavi gören hastaların tedavi maliyetlerini ne sekilde etkilediginin kesfedilmesi amacıyla çalısmaya baslanmıstır. Bu çerçevede kamu hastanelerindeki tedavi edici hizmetlerin, harcama kalemlerine göre ve kendi içlerindeki degisimleri; Dr. Lütfi Kırdar Kartal Egitim ve Arastırma Hastanesi ile Sisli Etfal Egitim ve Arastırma Hastanesi’nde 2000 yılı ile 2007 yılları arasında tedavi görmüs 7253 adet yatan hasta faturasında incelenmistir. Bu amaçla yatan hasta faturaları; yatak, laboratuar, ilaç, tıbbi malzeme, radyolojik tetkik ve genel hizmet olarak harcama kalemlerine ayrılarak fiyat, islem adedi, islem bası maliyeti ve toplam fatura içindeki oranının tek tek yıllar bazında ve 2000- 2003 yılları bir dönem, 2004-2007 yılları bir dönem olarak kabul edilerek yine aynı harcama kalemlerine sınıflanmıs yıllara göre ayrılarak fiyat, islem adedi, islem bası maliyeti ve toplam fatura içindeki oranı dönemlere göre karsılastırılmıstır. Neoliberal politikaların saglık sektöründe her ne kadar saglık harcamalarını artırdıgı yönünde görüsler varsa da bu çalısmada genel olarak fiyatlarda meydana gelen artıstan ziyade hizmet üretimi için gerekli ilaç malzeme ve istenen tetkik sayısında artıs görülmüstür. Arastırmada sınıflanmıs yıllara göre harcama kalemleri degerlendirildiginde; tüm harcama kalemlerinde, 2004-2007 yıllarındaki islem bası maliyetlerin 2000-2003 yıllarına göre artıs gösterdigi görülmüstür. Bu artıs genel hizmet islem bası maliyetinde yaklasık %300 oranında ve fatura basına islem bası maliyetinde %400’den fazla oranda gerçeklesmistir. Name and Surname : Nursen AYDIN Field : Management Programme : International Management Supervisor : Doç. Dr. Refika BAKOGLU DELORMAN Degree Awarded and Date : Master Degree – 2008 Neoliberal Politics, Globalization, Health Policies, Hospital Expenses, Patient Treatment Expenses
The application of neoliberal politics that began to spread all over the world, started showing its effect in our country after the 1980s. The economical policies that guide the neoliberal way of thinking are; privatization, deregulation and the lack of rules, the liberalization of commerce, the formation of independent supervisory institutes, the exempt of capital movements, the “inflated reserves policy” and the “giving over the interest rate” policy. It has been noticed so far that neoliberal policies, mainly affected the service sector and especially the health sector. After 2000, important reforms started to be applied by the Ministry of Health in our country. Neoliberal policies are applied especially in “privatization”, “autonomy”, “decentralization”, “family medicine” and “general health insurance”. The neoliberal policies applied in Turkey, started to be applied in order to find out the treatment costs of the patients in public hospitals, which represent 60% of the hospitals in Turkey. In these conditions, the treatment services given in public hospitals and the changes in these services and in treatment expenses were analyzed from the 7253 invoices of the patients that were treated at Lütfi Kırdar Educational and Research Hospital and Sisli Etfal Educational and Research Hospital between years 2000 and 2007. The invoices of the patients were separated into: bed, laboratory, medicines, medical materials, radiologic studies and general services and respectively into: price, procedure numbers, costs per procedure, and the percentage of each costs in the invoices, the years analyzed being 2000- 2003 for one period and 2004-2007 as a second period. The expenses were separated into: price, procedure numbers, costs per procedure, and the percentage of each costs in the invoices between the two periods were compared. Even though there are opinions on the fact that the neoliberal policy has increased the expenses in the health sector, in this case study the increase has been more visual in the medicines and materials used and in the number of investigations, more than the increase of the prices. Evaluating the expense items that were analyzed in the case study by years, the costs per procedure between 2004-2007 increased compared to the other period 2000-2003. The percentage of this rise was of 300% per procedure and of 400% per procedure for each invoice.
The application of neoliberal politics that began to spread all over the world, started showing its effect in our country after the 1980s. The economical policies that guide the neoliberal way of thinking are; privatization, deregulation and the lack of rules, the liberalization of commerce, the formation of independent supervisory institutes, the exempt of capital movements, the “inflated reserves policy” and the “giving over the interest rate” policy. It has been noticed so far that neoliberal policies, mainly affected the service sector and especially the health sector. After 2000, important reforms started to be applied by the Ministry of Health in our country. Neoliberal policies are applied especially in “privatization”, “autonomy”, “decentralization”, “family medicine” and “general health insurance”. The neoliberal policies applied in Turkey, started to be applied in order to find out the treatment costs of the patients in public hospitals, which represent 60% of the hospitals in Turkey. In these conditions, the treatment services given in public hospitals and the changes in these services and in treatment expenses were analyzed from the 7253 invoices of the patients that were treated at Lütfi Kırdar Educational and Research Hospital and Sisli Etfal Educational and Research Hospital between years 2000 and 2007. The invoices of the patients were separated into: bed, laboratory, medicines, medical materials, radiologic studies and general services and respectively into: price, procedure numbers, costs per procedure, and the percentage of each costs in the invoices, the years analyzed being 2000- 2003 for one period and 2004-2007 as a second period. The expenses were separated into: price, procedure numbers, costs per procedure, and the percentage of each costs in the invoices between the two periods were compared. Even though there are opinions on the fact that the neoliberal policy has increased the expenses in the health sector, in this case study the increase has been more visual in the medicines and materials used and in the number of investigations, more than the increase of the prices. Evaluating the expense items that were analyzed in the case study by years, the costs per procedure between 2004-2007 increased compared to the other period 2000-2003. The percentage of this rise was of 300% per procedure and of 400% per procedure for each invoice.