13th Health Technical Report

The outcomes of this report, which gives the first results obtained at the end of the “Health Accounts System” implementation conducted by the Health Policy Department/OECD and the experts from thirteen member states, have been presented in the comparative studies form and as a part of the OECD Health Technical Annexes which were prepared through the individual efforts by the states. This is the thirteenth volume in the series which represents the health accounts based on Turkey Health Accounts System.

NBD-CE Study has been carried out in our country for the first time and no other study of a similar nature has been carried out before.

Turkish Ministry of Health started the Study in March 1, 2002 subsequent to the agreement signed with a consortium consisting of;

•  Başkent University

•  INTRAH (USA) (The University of North Caroline at Chapel Hall, School of Medicine, School of Public Health, Sheps Center for Health Services Research),

•  John Hopkins University , School of Hygiene and Public Health ( USA )

•  Tulane University-School of Public Health and Tropical Medicine ( USA ).

Within the framework of this Study, a “Monitoring Committee” consisting of the representatives of the Directorates General of the Ministry of Health, an “Executive Committee” consisting of the representatives of the State Institute of Statistics (SIS/DİE), SSK (Social Security Authority), Turkish Pension Fund, State Planning Organization (SPO/DPT), Ministry of Finance, Interior Ministry and Treasury Undersecretariat and a “Scientific Committee” consisting of the representatives of the related departments at the Universities and faculties was set up and these committees monitored the Study on behalf of the Ministry.

“Evaluation Meetings”, in which the activities conducted within the scope of this Study were shared with the members of these committees, were held, as well.

In 18-19 September 2002 : 1 st Evaluation Meeting

25 December 2002 : 2 nd Evaluation Meeting

22 April 2003 : 3 rd Evaluation Meeting was held.

Following activities were carried out so that the Calculations for the Burden of Disease and the Cost Effectiveness Analysis, which were the final outcomes in the Study, could be made:

•  The Household Survey , the latest sampling plan of which was made by SIS and covered 12.000 households, was conducted in January–April 2003. The World Health Survey Questionnaire of the World Health Organization (WHO) was harmonized with the requirements of the activity and was used in this Study.

•  A Verbal Autopsy Survey , which covered 60.000 households, was conducted (April-May 2003) to find out the causes of mortality, calculate the age-specific mortality rates and set the urban/rural area and regions-based lifetime tables in our country depending on the age and gender groups.

•  In addition to these surveys, all scientific studies regardless of being published or not, and all statistical information on diseases and mortality which SIS, Interior Ministry and the Ministry of Health had, was gathered as “ secondary data ”. Then, using the “Reference Manager” program the secondary data were computerized and a catalogue was made.

•  The Burden of Disease accounts (DALY), which covered the whole country on the scale of urban/rural areas and regions depending on age and gender, were calculated.

•  The Causes of Mortality in Turkey was identified on the scale of urban/rural areas and regions depending on age and gender; Approximate Mortality Rate, Infant Mortality Rate and Mortality Rate under the Age of 5 were estimated and lifetime tables were set.

•  The figures regarding the Burden of Recovered Disease, which represent the results of the eradication of risk factors identified by the Risk Factors Analysis, were measured and projections were made for the years 2010, 2020 and 2030.

•  Data required for the Cost Analysis to be performed within the scope of the Cost Effectiveness Study were collected in 29 health agencies including 15 State-owned hospitals, 2 University hospitals, 2 SSK hospitals, 1 Private hospital, 6 Health Centers ( 2 in provinces, 2 in towns and 2 in villages), 1 (MCH/FP) Mother & Child Health / Family Planning Center, 1 Malaria Control Dispensary.

•  Within the framework of the Cost Effectiveness Analysis, the intervention costs of the diseases, which were stated in the specification, at hospitals and the Primary Health Care facilities were calculated and cost effectiveness analysis was made.

•  Basic Service Packages were prepared.

1. Health Management and Training Department

2. Health Services Development Department

3. Health Economics and Financing Department

4. Public Health Development Department

5. Coordination Department

The staff are from various disciplines; such as medicine, pharmacy, dentistry, health management, law, economics, education and communication. The studies carried out within this frame, department by department are as follows: