Effect of primary health care reforms in Turkey on health service utilisation and user satisfaction
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilisation and user satisfaction.
The effect of health system reforms that introduced family medicine on utilisation was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services were explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs. secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.
Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (p<0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30 respectively a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8% respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (p<0.001) in PHC settings, but remained higher among urban, low-income and working-age populations.
The effect of health system reforms that introduced family medicine on utilisation was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services were explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs. secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.
Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (p<0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30 respectively a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8% respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (p<0.001) in PHC settings, but remained higher among urban, low-income and working-age populations.
Date Issued
2016-08-10
Date Acceptance
2016-06-28
Citation
Health Policy and Planning, 2016, 32 (1), pp.57-67
ISSN
1460-2237
Publisher
Oxford University Press (OUP)
Start Page
57
End Page
67
Journal / Book Title
Health Policy and Planning
Volume
32
Issue
1
Copyright Statement
© The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Sponsor
National Institute for Health Research
Grant Number
RP_2014-04-032
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Health care reform
health policy
primary health care
patient satisfaction
utilization
Turkey
SYSTEMS
BRAZIL
IMPACT
ORGANIZATION
PERSPECTIVE
COUNTRIES
MORTALITY
ESTONIA
PROGRAM
Female
Health Care Reform
Humans
Male
Personal Satisfaction
Primary Health Care
Secondary Care
Surveys and Questionnaires
1605 Policy And Administration
1117 Public Health And Health Services
Publication Status
Published