Transformation in health and the current dilemma

Let me remind you. The Health Transformation Program is a state policy initiated in 2003 by the then-Minister of Health, Dr. Recep Akdağ, whose main axis aimed to make it easier for our citizens to access physicians. It is indisputable that being able to access a physician when necessary is a leading individual right. For this reason, the Health Transformation initiative has also been a very important source of votes for the AK Party for years, just as it was planned. This is quite natural, and at first glance, as long as it is implemented truly and honestly for the purpose of serving the public, there is no aspect to condemn.

What is truly condemnable is our almost social ignorance. It is the fact that we cannot or do not want to learn that health services and medical services are not synonymous. Medical services are only a part of health services. In a society's ability to remain healthy, the contributions of very diverse professional groups, primarily politicians, and among them definitely environmental and traffic experts, as well as engineers, architects, merchants, industrialists, traffic experts, businessmen, etc., come to the fore. The physician's duty, on the other hand, is medical services, which consist of diagnosing the disease, trying to cure it, and comforting the patient when they cannot do so. Ensuring protection from diseases is also naturally among the physician's duties. However, this duty does not go beyond warning patients on an individual basis, prescribing preventive medication in some cases, and occasionally making suggestions and warnings to those primarily responsible for public health. In their education, which lasts at least 6 years, the physician mainly learns to recognize and cure disease. In summary, medicine is an individual endeavor—both for the physician and the patient—while health is a public one.

On the other hand, throughout history, there have been those who wanted to give physicians health service-intensive tasks, partly out of ignorance and partly for the sake of gaining political power. Mao's barefoot doctors or the 1980 coup's assignment of physicians to compulsory service are two examples of this.

The extent to which health services and medical services are two separate functions can still be seen in the USA. The USA is perhaps the most advanced country in the world in terms of medical services, but it is quite behind in terms of health services. For example, let's say the life expectancy of a US citizen who has been able to have a liver transplant is longer compared to other developed countries. However, the average life expectancy in the USA is still significantly behind similar countries, for example, 5 years behind England. By the way, do not get confused; what is happening in the USA is not physician malpractice, but rather that significant segments of society are deprived of the most basic health services due to the very poor income distribution in the same country. The reason for this is wrong political choices. Furthermore, there is no widespread, at least cheap and effective health insurance—by the way, the correct term should be physician and hospital services insurance—system in the same country.

Let's return to the Health Transformation. The Health Transformation was once quite popular, taking advantage of the fact that this society, just like its administrators, did not understand/know the distinction between health and medical services, but this popularity has gradually exhausted itself and has turned into a nightmare for both society and physicians. Look, in the first 10-15 years of the AKP government, there was indeed a significant improvement in newborn life expectancy, which is one of the most basic health services. However, it does not even come to mind, or if it does, it is not admitted out of cunning, that the main reason for this may not be the health transformation, but rather the enrichment of the country's people through the influx of money into our country—yes, even by those hateful foreign powers—and their access to better roads, cleaner water, and better nutrition. I remember well. In the same years, when I researched what the rate of access to chronic dialysis for kidney patients was, which is a medical service indicator, I could not find any data and discussed the issue with leading physician friends who were supporters of the health transformation at the time.

In summary, the Health Transformation is essentially a program for access to a physician. It is neither known nor thought of that physician (medical) services are only a part of health services. In our country, there are still major problems in both health services (in my opinion, much more dominant) and medical services, partly due to the very bad economic conditions we are in and partly due to refugees. However, there is also a truly tragicomic dimension to the matter. A very clear indicator of this is a circular published by the former Minister of Health, Dr. Fahrettin Koca, just before he left, which he even called good news to family physicians last month. In this circular, the honorable minister stated that family physicians could receive an additional 5000 TL bonus if they see 70 patients a day. If a 1-hour lunch break is deducted from the daily working hours of physicians working in the public sector, the total is 6 hours, or 360 minutes. This means that what the minister suggests to our family physicians is that they allocate 360/70 = 5 minutes per patient they see per day. I understand with regret that those who govern my country still have only one obsession regarding health services, and that is to send the patient to the physician.

Let us never forget Socrates' saying: "There is only one good, knowledge; and there is only one evil, ignorance." Let me remind this to those who govern, and perhaps even more so, to those who are governed.