Minister Koca’s achievements: Great for himself, difficult to compensate for the health system

The debate regarding the resignation, dismissal, or—as it is attempted to be phrased in our language—the "request for relief from duty" of Minister of Health Fahrettin Koca has been ongoing for days. As I write these lines, breaking news is reporting that he has been dismissed and will be replaced by Istanbul Provincial Health Director Kemal Memişoğlu. 

Fahrettin Koca, who served as Minister of Health since 2018 and whose star shone brightest during the Covid-19 pandemic, was presented to the public as a sincere and reliable figure; however, this image did not last long. By disclosing data months later that they had not shared transparently—and had even distorted—during the pandemic, they achieved a first not only in the country but in the scientific world!

Many things can certainly be said to commemorate Fahrettin Koca, who will now be referred to as the former Minister of Health. But how do you think our doctors and healthcare workers will remember Fahrettin Koca? 

It is certain that the hand gesture he used to imply that doctors who were forced to continue their professions abroad were "leaving just to make more money" will not be easily forgotten. 

Furthermore, when his actions are listed one after another, it is a fact that Fahrettin Koca will go down in history as the minister of the years when the health system experienced its worst period. In the 6 years he remained in office, while he took great steps for himself, the country's health deteriorated more than ever before.

İYİ Party Op. Dr. Turhan Çömez, who participated in a Halk TV broadcast in recent days, said of Fahrettin Koca, "Ask for relief from the President, but do not ask for forgiveness from this nation; this nation will not forgive you." 

In the program, Çömez explained that a report was presented to Erdoğan at the Kızılcahamam camp regarding Koca, whom he described as "someone who has worked only to enrich his own hospitals since the day he came to the ministry." He argued that this report contained the information: "The biggest problem leading to the results in the last elections is the economic crisis, and then the dire situation in the health system. Therefore, the Minister of Health must be dismissed." 

Claiming that AKP figures are also complaining about the rent-seeking in the Ministry of Health, Çömez said, "The Ministry of Health is involved in terrible rent-seeking. When the AKP came to power, Minister of Health Fahrettin Koca did not own the Medipol hospital group. There was no such hospital in Turkey. This chain of hospitals grew during the AKP era and became a massive trust. And the Minister of Health is still not satisfied. Most recently, he set his sights on the 6 hospitals in the hands of the Red Crescent. What lands he acquired in Beykoz..." he said.

While listening to Çömez, the change over the last 20 years passed before my eyes like a film strip. It is worth reminding here as well. 

Turhan Çömez explained the balance sheet of Fahrettin Koca's ministerial term as follows: 

Hospital licenses in the Ministry of Health are currently changing hands like taxi plates. No new hospital licenses are being issued. Licenses are being sold on the black market. 

Since the AKP came to power, the number of surgeries in private hospitals has increased 7-fold, while in state hospitals it has increased 2-fold. Why? Because this system was supported in a planned manner. 

Tekel had a massive building in Unkapanı worth billions of liras. This building was given to the Minister of Health. He also seized Tekel's lands in Beykoz. 

The magnificent buildings at the Ankara Train Station were seized. 555 thousand square meters of land at the Atatürk Forest Farm were allocated to the Minister of Health. 

Years ago, he received 5 billion liras in incentives. 60 million dollars in incentives were given to his own hospital. There are 26 thousand diabetic children in this country. We begged the ministries. If an insulin pump were given to all of these children, it would cost 20 million dollars. But they did not do it. 

During the Covid pandemic, 70 million doses of vaccine were imported to Turkey. The Sinovac vaccine that came from China. The version of the same vaccine produced by AstraZeneca was 3 dollars. The Sinovac vaccine was purchased for 12 dollars. There is a 9-dollar difference. They set up an intermediary company. The Ministry of Health did not import it itself. 630 million dollars were poured into someone's pockets.

15 thousand of our doctors emigrated abroad. Dozens of our medical school graduates are still preparing for exams to become doctors abroad. He implied that doctors go abroad for money. 

The cost of medicines consumed in Turkey every year is 175 billion liras. 40 percent of this is imported. 60 percent is produced in Turkey, but 95 percent of the raw materials and active ingredients come from abroad. 

58 pharmacy faculties were opened, but 30 percent of the graduates are unemployed. We have so many pharmacy faculties, but 80 percent of the pharmaceutical sector is dependent on imports. 

FROM WHERE TO WHERE IN HEALTH?

While Turhan Çömez was trying to reflect the general framework regarding what was and was not done in the health system, it is also necessary to convey the point that the long-standing problems have finally reached. 

When we talked to Istanbul Medical Chamber President Prof. Dr. Osman Küçükosmanoğlu about the state of the health system and healthcare workers and "from where to where" it has come, he summarized the point reached as: "We are experiencing a system change where health has turned into a commercial activity. There is a large budget from which profit is made from health." 

As a result of the declarations published by the World Health Organization in the 1960s stating that health is a right and should be provided free of charge to everyone, studies were carried out in our country in this direction and health centers were implemented. However, this system was terminated during the AKP era and family medicine was introduced instead. 

RESULTS OF THE PERFORMANCE SYSTEM  

Explaining that the "Health Transformation Program" introduced during the AKP era was previously presented as a World Bank project, Prof. Dr. Osman Küçükosmanoğlu said: 

"Actually, the executor of this project was the AKP government. In the system introduced, something like this emerged; hospitals that we call public hospitals turned into businesses operating with revolving funds. There are hospitals that make a profit from the revolving fund and cover some of their expenses with this, and a system that revolves around this. 

Especially the performance system became the breaking point. That is, a system was introduced where you receive an additional premium in return for the procedure performed. These practices introduced after the AKP gradually developed and became significant money for physicians' incomes and other healthcare workers within hospital revenues. As such, public resources are already limitedly transferred, and hospitals have turned into commercial enterprises."

THEY DO NOT WANT TO SPEND MONEY ON FAMILY MEDICINE

We are in the 15th year of the family medicine system introduced during the AKP era. However, it is stated that the number of patients registered to a family physician is 4 thousand and this places a heavy burden. 

Stating that no progress has been made over the years to reduce this number, Prof. Dr. Küçükosmanoğlu said, "There was a system working at the primary level, and they ruined that too. In the system we call tiered health services, where we say 70-80 percent of patients should be handled at the primary level, there is no need to queue at a university hospital or chase appointments on MHRS. The primary level is what we call family medicine. 

First, you go to the family physician, and they handle your minor ailments and perform your health screenings. Which is important for preventive medicine. It is not just a place you go when you are sick. For example, they recommend vaccinations for your child, provide information when you are about to enter menopause, etc.; these are the foundations of health services. 

But there is also a partial performance system there, and the burden on family physicians is very heavy. 4 thousand patients is too many. They also pay their own rent and bills. When they need staff, they spend money on that too. The number of family physicians in Turkey needs to increase, but they do not want to spend money on it. 

There are approximately 1500 family health centers in Istanbul. Most of them serve in earthquake-vulnerable places and old buildings. The buildings should be provided by the state, and services such as cleaning, lighting, and parking should be provided, and the team should be complete."

PARTICIPATION FEES HAVE TURNED INTO VERY LARGE SUMS

Stating that private hospitals benefit from the fact that the system in the public sector does not work well, Prof. Dr. Küçükosmanoğlu continues his words as follows: 

"People are tired of waiting in line, being examined in two minutes, and going to the hospital or emergency room repeatedly, so those who have money apply to private hospitals. When this business first started, something like this was said: 'You can pay a small difference and go to a private hospital.' This difference, called a contribution fee, has turned into such a thing that it has become very large sums. 

Again, the President had a saying: 'If they go, let them go; we will continue our way with the assistants.' Our assistant friends are receiving training; they are not in a position to provide service. They have no obligation to provide service. Our friends will receive training first. They can touch the patient under the supervision of an educator, perform procedures, and help; of course, they can see patients when they are close to finishing. But now, even a newly started assistant appears before the patient like a specialist. Assistants are the ones most crushed under the workload. Normally, they should be happy that they are receiving training while doing this work, but the children are unhappy."

DEFENSIVE MEDICINE IS AT THE FOREFRONT 

Commenting on the TUS (Medical Specialty Education Entrance Exam) results in recent years, Prof. Dr. Küçükosmanoğlu said that doctors now act with a defensive medicine approach, which can be defined as protecting themselves against the risk of a potential lawsuit. 

Prof. Dr. Küçükosmanoğlu's assessment is as follows: 

"Due to reasons such as problems in the appointment system and the time allocated to the patient, an escape has begun from departments that are in direct contact with the patient. We call this defensive medicine. There is a tendency towards departments where they do not touch the patient and can be more comfortable. We can give obstetrics as an example of this. For example, you see the patient, and later, major lawsuits are filed saying, 'He did not request this test for my child, he did not do this, he did not see the anomaly.' 

The scores of departments such as pharmacology, biochemistry, pathology, and public health, which had low scores in our time, have increased. 

Currently, the biggest shortage in Istanbul is experienced in dermatology and plastic surgery appointments. These doctors resign from the public sector because there are opportunities to earn money outside. They switch to private hospitals or see patients in their own clinics. The state is also focusing on opening more positions and training more specialists to fill the vacancies. But the results of this will be even worse in 3-4 years. Because this is something done without planning or programming. Within a few years, medical education will also deteriorate. 

Again, migration abroad will continue. In the past, young graduates would study for TUS; now they are studying German to go to Germany."