You cannot check if your MR test was done and examined properly when you get the report

Last year, a friend of mine who runs a hospital told me this. You have to pay 1 TL to use a public toilet. If you went to a laboratory instead, you could both use the toilet and get a urinary test for about 2 TL. Aiming to privatize health services, the Ministry of Health was supporting private health institutions recklessly back then. But this was not based on a plan. Everyone was burning with the desire to provide services. The Ministry was spending without taking into account the budget constraints. In the end, health expenditures escalated and the number of doctors in university hospitals went downhill, after which the Ministry started to block the way of private health institutions the opening of which it had supported. This was when the senseless pricing practices emerged. The health budget was constrained under a global budgeting scheme. The Ministry failed to distribute the budget resources properly among services as the costs were not acknowledged. Both public and private health institutions became unable to pay their way. The Ministry and the Minister suddenly switched to statism due to the earlier extravagant spending behavior. I think the last decade for Turkey’s health system was dominated by 1930s statism and that the people will have to pay the burden for at least two decades more. Unplanned acts have always been a pain in the neck.

After the introduction, let me switch to today’s issue: when I was reading a story in Hürriyet about institutions that do a MR test for 100 TL, I recalled the quotation in the title. How can a facility do and evaluate an MR test for just 100 TL? If you buy cheaply, you pay dearly. Either the test will be done perfunctorily or the practitioner will just take a cursory look while evaluating the results. In both cases, the loser will be the people who do not have access to private health insurance. The situation will become even graver. At the end of the day, those who were content with the new health system will regretfully acknowledge that the system has died.

In fact, the issue the Ministry has been trying to solve is being debated throughout the world. From this perspective, we have to give the devil its due. The other day, the National Institute of Health of the UK was discussing how to control unplanned health spending. It is impossible to solve this problem overnight. Let me tell you why it is difficult to solve health system’s problems.

To continue with the MR example: Magnetic Resonance Imaging (MRI) as a superior imaging technique in radiology emerged in the 1990s. Now it has become widespread. Lately there are a number of private organizations that offer services to public hospitals. The Ministry of Health has been opening auctions for these organizations on behalf of public hospitals. The story in Hürriyet suggests that the auctions are done by tender, under which the quality as well as the price of the service is set. There exists a multidimensional auction process. But the process does not seem to serve the purpose, if you ask me.

Second, concerning health services, there is a profound information gap between the service provider and beneficiary. You can check the quality of the product if you are buying apples or a chair, but you cannot check if your MR test has been done and examined properly when you get the report. And it might be too late when you eventually find out.

I see thoughtless and unplanned health sector action in Turkey. We will all pay the price.

This commentary was published in Radikal daily on 08.03.2013