Between 1999 and 2011 (in 12 years), our health expenditures increased 16 times. While the share of this expenditure covered by the public increased by 14%, the share covered by the private sector decreased by 14%. According to SAGEM (Ministry of Health, General Directorate of Health Research), citizens are very satisfied with the situation. So much so that the satisfaction rate with health services increased from 39.5% to 75.9% in the same period. . I wonder if the citizens are satisfied with the awareness that the money comes out of their own pocket indirectly? What are the satisfaction criteria?
When it was revealed that the total health expenditures, which were foreseen as 44.4 billion in the 2012 budget, would close the year by 6 billion more than the projected, the economy management sought a solution to close the budget deficit. . One of the main reasons behind the hike decisions is this budget deficit.
Why is healthcare spending increasing so much faster than anticipated?
One of the reasons for this is the increase in the frequency of our visits to the doctor. While the number of visits to a doctor in a year in Turkey was 3 in 2002, it was 7.7 in 2011. This rate is 6.5 in OECD countries. Moreover, in OECD countries, the proportion of people over the age of 65 who get sick more frequently and more severely is more than twice that in Turkey (16%) (7%). . This means that most visits to the doctor are either unnecessary or far from satisfactory!
One of the main reasons for the excessive increase in health expenditures is the excessive use of medical imaging services! For example, while in 2011, an average of 46.5 people out of a thousand people in OECD countries had MRI, 67.5 people out of a thousand people had MRIs in 2011, with fewer devices: an average of 12.2 for every 1 million people in OECD countries, and for every 1 million people in Turkey. 8.9 MRI devices per person . The situation is not limited to MR. This means that a very important part of medical imaging examinations in Turkey are done in vain!
The excessive use of medical imaging methods is not unique to us, it is a problem of other countries. In the USA, between 2000 and 2007, medical imaging services expanded faster than all other medical services, but these “high-tech” tests were useless, unnecessary and unethical by up to 50%. is emphasized [4,5].
Why is “overuse” of medical imaging a bad thing?
By excessive use, I mean useless, useless, non-healthful uses. If a medical application does not benefit health, it definitely has harm! In fact, the physical and psychological harms are even more than the economic cost. These include being insensitive to taking precautions due to an unwarranted sense of security, being exposed to unnecessary radiation, side effects of intravenous drugs, other physical and mental effects due to other useless examinations, follow-ups and surgeries, and not being able to reach the right service when it is really necessary one day due to the loss of faith in medicine. such damages.
In order to prevent the budget imbalance in health, the first remedy applied in every country is to reduce the costs of medical services. This is the reason why healthcare services, especially medical imaging, are getting cheaper in our country, despite the constant inflation. However, what triggers excessive use is actually this so-called precaution! Because “cheaperization” serves to standardize medical services from being a practice of medicine, to become ordinary, to become worthless, and thus to turn a factory (hospital) into ordinary “products” in the product line. In this way, the uniqueness, therefore identity and prestige of the physician arising from his experience, talent and art is removed. An ingenious method to reduce the cost of the “physician”, the most expensive link in health, to the system!
The devaluation of medical services leads to a tremendous increase in unnecessary and poor quality radiological applications, excessive or inadequate treatments made in hospitals with a plan to make money from the release. Health service changes meaning. It essentially replaces the traditional patient-doctor relationship. heserving the profits of private hospitals and insurance companies “packages” taking. Most radiologists, as physicians, are only required to be accountable to their patients and reject claims that may harm their patients, but cannot do this!
Ultrasonography and other tests, simply because they do not involve radiation “trustworthy”and “harmless” marketed by advertisements. Every laboratory, social association, municipality and hospital that agrees with a media figure can scan with any test they want. Consumers influenced by the well-known advertising figure, “free”It ignores questioning the benefits and harms of these tests.
Healthy people who are admitted to the hospital under the pretext of screening are scoured from head to toe until something that requires treatment (which can be profitable) is found. I mean, really, a man went to the doctor, that’s the way to go! The public monitors which test is used, when and how often, by monitoring the personal practices and advertisements of journalists..
As a result, although the citizen visits the doctor more often than necessary, he cannot find a solution to his problem and even suffers harm. When he reaches the end of his patience, in his eyes “system” grabs the collar of the representing doctor. Radiologists are lucky to be so good at being invisible! Because radiological examinations are called “examinations”, the public cannot choose the target; he thinks his damage is caused by the devices and he is looking for the most… high tech to surrender himself next time! Is it any wonder, under these circumstances, that the medical profession is constantly losing credibility?
What to do to prevent overuse of radiology?
one.The fees of radiological examinations should be increased to a level that guarantees quality.
2.Physicians who are not radiologists should be prevented from directing radiological examinations, trying to diagnose with radiological methods, and receiving premium/performance benefits from hospital administrations and financial benefits from private radiologists in return for the number of patients they send to radiology.
3.The relationship of non-radiologists with radiologists, as in other branches, “consultation”Patients should be sent to radiology for “radiological consultation”, not “examination”.
4.Patients should be able to directly apply to radiology and choose their radiologists in matters (breast) where diagnosis and screening consist of radiology.
5. Radiologists should be free to choose the appropriate radiological methods for their patients’ condition, and should be responsible for accounting for inappropriate practices. They should inform their patients about the method, use, side effects, diagnosis, etc. face to face and answer their questions.
6.Radiologists , “physician” They must remember that they are the best and that they have to look after the well-being of their patients above all else! They have no obligation to use vain or useless practice on the patient! They can refuse the requested action, no matter who it comes from, even if it is harmless, if they believe it will likely be useless!.
Who better understands the limitations of a radiological method than the radiologist?
Who knows better than the radiologist which ways and methods can be beneficial to the patient in radiology?
Who better to explain the radiological findings and diagnosis to the patient than a radiologist?
Who can decide more accurately than the radiologist on the type of radiological follow-up and in which case a biopsy will be required?
2. “The performance of the state has increased, the health of the budget has deteriorated”. News by Aysel Alp, 28 September 2012. www.hurriyet.com.tr/ekonomi
4. The overuse of diagnostic imaging and the choosing wisely initiative. Annals of Internal Medicine. Rao VM, Levin DC. www.annals.org 28 August 2012