The TTB's 'Another Health System' proposal on March 14 Medicine Day

For years, I have been unable to agree with the Turkish Medical Association (TTB), the leading organization of my profession—a profession I have pursued by learning, trying to teach, and experiencing both great sorrow and great joy and pride—on certain fundamental issues that I consider important, even vital. The latest incident I cannot agree with is a press release issued by the TTB as part of its March 14 Medicine Day events. The statement can be accessed under the title Another Health System Is Possible (https://www.ttb.org.com). Let me emphasize this clearly: I do not have many disagreements with the TTB regarding the problems themselves. Where I disagree is on the causes of these problems and the ways to solve them.

 Among the points in the statement that I do not agree with, the most prominent are as follows:

Our country's health system is now dysfunctional and collapsed, as made visible by the Newborn Scandal and many examples that emerged afterward. The policies that caused the collapse of the health system are those known as the Health Transformation Program (HTP), which began preparations and implementation in the mid-1980s and entered comprehensive implementation starting in 2012.

I agree with this opening sentence of the press release, but I do not agree with the one that immediately follows it. I believe we need to get rid of the convenience of always blaming the recent years for the numerous and, unfortunately, long-standing, fundamental flaws we observe in various areas of life, including our judicial system and universities, alongside health and medical services.

I have explained this many times before. The main architect of the Higher Education Council (YÖK) system, which was implemented in 1981, was not the September 12 regime. In 1978, the Minister of National Education of the Ecevit government, Necdet Uğur, had sent a draft that overlapped significantly with the YÖK implementation to universities to receive their opinions. The Cerrahpaşa Faculty of Medicine faculty board had put the issue on its agenda. As a young, fresh associate professor, I was expressing my views, especially regarding what they proposed about how the revolving fund that would be formed in medical faculties would be shared, and also, as a father of two children. What I said must have angered him, because a senior surgery professor took the floor and, referring to me, stated that the faculty board should not pay much attention to the words of a novice like me. I was about to jump out of my seat to respond, but the dean did not give me the floor and ended the meeting. Just as I was leaving the meeting hall, I heard my late obstetrics professor, Prof. Yusuf Keçecioğlu, shouting so that everyone could hear: “Hasan, the person who just called you a novice, was performing an illegal splenectomy at a private hospital over the weekend.” You guessed it right; the professor who could not tolerate my views was a staunch advocate of full-time work and strictly against opening a private practice. By the way, you are right. The moral dimensions of the Newborn Scandal and performing an illegal splenectomy are quite different. What I am trying to express is that our general moral problems are not exactly new. In other words, we went from bad to worse. If you ask where to start fixing things, I think it should be, first and foremost, our judicial system.

While talking about financial matters, let's take a look at the Aims and Basic Elements of the Another Health System announced by the TTB. The introductory paragraph of the Basic Elements says:

“Health Financing: In our country, a premium-based financing model is currently applied where individuals also pay out-of-pocket co-payments. This model causes serious obstacles for the unemployed and the poor in accessing health services. All services of the Another Health System will be financed from the central budget.”

Dear and esteemed friends, look, you cannot call me a novice at this age. Please tell me, with which central budget will you be able to implement this truly extraordinarily humane practice you are proposing? Aside from our budget, how many countries can you name that are much wealthier than us and have managed to achieve what you are saying?

In the Another Health System Is Possible statement, I am including two quotes below that are very confusing, especially in light of the design that all health services will be financed from the central budget:

“……The personal rights of health workers will be improved, job security will be provided, and there will be no contract-based employment. Health workers will work full-time and will not have to work extra jobs…….”

“In private hospitals, physicians will work with employment contracts and job security in a way that provides the income they deserve and will not be subjected to turnover pressure. Physicians' right to free practice will not be restricted, and no obstacles will be placed in the way of physicians working in private practices treating their patients in private hospitals. Mechanisms will be developed where health workers are the subjects and have a say in the production of health services.”

Pay attention to the parts I have specifically highlighted in the quotes. Honestly, I cannot interpret them. It seems like a mixed, but completely muddled, working system is being proposed.

The TTB announces that additional explanations will also come from the specialized boards established and having completed their work regarding the proposed Another Health System. I am waiting with curiosity.

While waiting, I cannot help but think. Why is it that it is never understood that health services and medical services are different things, that medical services only constitute a part of health services, and that the main pursuit of the medical profession is directed toward the individual, not society? And I cannot help but ask why an organization whose main duty and fundamental reason for existence is to protect and look after the medical profession has for years perceived its reason for existence as improving public health in a society where the judicial system and especially the economy are far from what is desired.

How happy I am to celebrate the March 14 Medicine Day of all physicians, including a considerable number of my students among them, and I remember most of my professors with mercy.