Family Medicine

Development of Family Medicine in Turkey

The development and organization of medical services in our country has been gradually increased and accelerated particularly considering the provision of preventive and curative health services to patients since the proclamation of the Turkish Republic. Since then, modern medical services and the relevant organizations have been established. The network of treatment was desired to be expanded in the early Republic Period, and many developments have been experienced in the preventive health services, as well. Immediately after the proclamation of Turkish Republic, Dr. Refik Saydam, (the first Minister of Health in Turkish Republic) contributed to the establishment and development of health services in our country. The implementation and organization of relevant health policies laid down in the Turkish Public Health Law (dated 1930) consisted of the implementation of preventive and curative medicine, the prevention of epidemic diseases, and the principles concerning the increase of interests in the schools of medicine throughout the country. The implementation of these health services was carried out in line with these principles with “single aimed in a large region”/“vertical organization model”. Examination and treatment centers began to be established especially in the regions where the population was large and the physicians of preventive medicine were supported, and the current transformation of health program has been initiated since then.

The basic objective of Transformation of Health Program is to increase the institutional status of fundamental health services to a position over all the other service levels. To improve the conditions of citizens and health workers is the primary point of further improvements in that field. The most remarkable feature of Health Transformation Program are to provide the citizens with healthy life standards, to reduce the mother–child mortality rates, to prioritize the epidemic diseases control as well as the risk factors of chronic diseases, and to provide the citizens with the capability of self–control of health conditions, and to place the preventive medicine approach into the core of health services.

The major objectives of Health Transformation Program include the facts that the implementation to be applied will increase the health level of our citizens, more services will be provided by using the resources in an appropriate pattern, all the citizens will benefit from available health services by considering equitability, and the differences between rural and urban regions as well as between the Western and Eastern part of the Country in terms of health services will be reduced. To this end, primary health care is to arrange and appoint health workers using a contemporary approach and to provide a preferable health service to all the society. The fact that family physicians should be selectively, easily and preferably provided to all the citizens is the one of the major phases of this approach. As Prof. Dr. Nusret Fisek, M.D. states: “Outpatient and in-house health care should be integrated. This integrated health care model is contemporary family medicine.”

With the contemporary family medicine, we intend to provide all the citizens residing throughout our country with equitable health services, to hold the contributions of the society to these health services, and to present preventive, diagnostic, and rehabilitant treatment procedures to all the society. In this delivery of health services, the main principles are to improve and develop health care with continual training activities, to attract the physicians on duty and other health staff, to focus on preventive health system, and to apply an acceptable transfer system. These principles will hinder the accumulation of challenges at the secondary level, thereby allocating and providing satisfactory time for patients. Considering family medicine as a multidisciplinary-based medical approach, a uniform health service is established. In addition, this approach establishes reliability based on communication and deals with the challenges and problems taking into account of physical, psychological, and social sides. Besides being individual centered, family medicine is of great importance due to its uniformity, continuity at familial and social level. The gradually increasing health needs of older population will be met by family physicians the patients know well.

Providing primary health care in an effective way will enable a decrease in the disease burden of the society as well as providing a better and more quality health service and health trainings to the secondary and tertiary treatment centers.

Among the goals of World Health Organization (WHO) are to make family- and society-based health services widespread throughout the world until 2010, enable the continuation of the resolutions of Alma Ata Congress, and include these resolutions in the 21st century concept of “Health for Everybody”. Health Transformation Program, which intends to reach these aims, suggests primary family health care to be provided by the health staff with required training and equipment in an integrated method. Family medicine has successfully been carried out in most countries of the world, and relevant studies continue in our country.

In our country Family Medicine Pilot Implementation Act no. 5258 was published in the Official Gazette no. 25650 of 24.11.2004, and respectively the next Directive about Family Medicine pilot implementation was published in the Official Gazette no. 25867 of 06.07.2005, and the Directive concerning the conditions of contract and reimbursement to the personnel of the Ministry of Health in the context of Family Medicine pilot implementation was published in the Official Gazette no. 25904 of 12.08.2005. In this regard, on 15.09.2005, Family Medicine pilot implementation was launched in the province of Düzce. Currently, Family Medicine model is implemented in the primary care in 81 provinces. Family medicine implementation directive was published in the Official Gazette no. 27591 of 25.05.2010 and this directive abrogated Directive no. 25867 of 06.07.2005 concerning the Family Medicine Pilot Implementation.

"Legislation On Contract and Payment Principles and Procedures to be Made to the Personnel Who Were Employed by The Ministry of Health Within the Scope of the Family Medicine Implementation” issued on the Official Journal no. 27801 of 30.12.2010. In the light of the contentment of patient-physician relationship and successful studies within the cities which have passed on family medicine so far, family medicine implementation became nationwide at the end of 2010.