SAĞLIK TURİZMİ VE ÜNİVERSİTELER DOÇ. DR. CEM KAAN PARSAK Ç.Ü. TIP FAK. BALCALI HASTANESİ SAĞLIK TURİZMİ KOORDİNATÖRÜ 1

“The best way to predict the future is to create it.” Abraham Lincoln “Geleceği tahmin etmenin en iyi yolu onu yaratmaktır”

TÜRKİYEDE SAĞLIK TURİZMİ Türkiye‟ye gelen bir “tıp turisti” ortalama 8.000 dolar harcamaktadır. 2023 de Türkiye ilk 7 ülke arasında olacaktır. ABD’de 80 milyon sigortasızdır. AB’de 65 yaş üzeri nüfus %20’dir. Türkiye, deneyimli personel, tesis, fiyat, iklim, ulaşım vb avantajlar + vize kolaylıklarına sahip

Sağlık Turizminde Üniversitelerin Rolü

2011 Yılı Sağlık Turizmi

Neden Üniversite Hastaneleri? Mevcut hastanelere göre daha spesifik kadro (geniş yan dal ve branşlaşmış hekim sayısı) Öğretim Üyesi faktörü Zor ve komplike ameliyat tecrübesi. Branş yoğun bakım yatakları ve hizmeti.

ÜNİVERSİTE VE SAĞLIK TURİZMİ SAĞLIK TURİZMİNİN KOORDİNASYONU PAZARLAMAYA YÖNELİK BÜTÇE SORUNLARI ÜNİVERSİTE HASTANESİNDE SAĞLIK TURİZMİNİN TÜM HATLARI İLE KOORDİNASYONUN SAĞLANMASINDA EKİP OLUŞTURMADA YAŞANILAN SIKINTILAR, ÜNİVERSİTENİN BAĞLI BULUNDUĞU MEVZUATLAR ÇERÇEVESİNDE KONUNUN PROFESYONELLERİNİN SÜREÇLERE DAHİL EDİLMESİ YÖNÜNDE OLUMSUZLUKLAR İÇERMEKTEDİR. KONU SADECE SAĞLIK TURİZMİ AÇISINDAN DEĞİL ÜNİVERSİTENİN TÜM BİRİMLERİNDE VE ÖZELLİKLE YÖNETİM VE KOORDİNASYON ÇALIŞMALARINDA YAŞANILAN BİR SIKINTIDIR. HER NE KADAR İLGİLİ MEVZUATLAR ÇERÇEVESİNDEE HİZMET ALIM YÖNTEMİ İLE PERSONEL ÇALIŞTIRABİLİYOR OLSAK TA KOORDİNATÖRLÜĞÜ YÜRÜTEN KİŞİLERİN KADRO İÇERİSİNE DAHİL EDİLEMEMESİ SÜRECİ BİR ÇIKMAZA SÜRÜKLEMEKTEDİR. 2. SĞLIK TURİZMİ YURTDIŞINDA TANITIM YAPMAYI GEREKTİREN VE HATTA YURTDIŞINDA OFİS AÇMAYA GEREKTİREN ÇALIŞMALAR ZİNCİRİNİN BİR PARÇASIDIR. ANCAK FARKLI SEBEPLERDEN DOLAYI ÜNİVERSİTENİN İÇİNDE BULUNDUĞU BÜTÇESEL SIKINTILAR, SÜRECİN İLERLEYİŞİNE ENGEL OLMAKTADIR. ÜNİVERSİTELERİN BÜTÇE AÇISINDAN YATIRIMA OLANAK TANIMAMASI VEYA ZORLANMASI ÖZEL HASTANELERİN SÜREÇTEN DAHA FAZLA PAY ALMASINA VESİLE OLMAKTADIR. MARKALAŞMA MOTİVASYON EKSİKLİĞİ OTURMAMIŞ MEVZUATLAR ARACI ŞİRKET-TURİZM ACENTASI-HASTANE İLİŞKİSİ 7 7

ULAŞIM VE BÖLGESEL FARKLILIKLAR MEVZUAT VE SORUNLAR FİYATLANDIRMA ULAŞIM VE BÖLGESEL FARKLILIKLAR BU KANUN 3359 SAYILI SAĞLIK HİZMETLERİ TEMEL KANUNUN 3. MADDESİ DAYANAKLI OLARAK HAZIRLANMIŞTIR. DAYANAK ALDIĞI KANUNUN İLGİLİ MADDESİ,KAMU KURUM VE KURULUŞLARINA AİT SAĞLIK KURULUŞLARINDA SUNULAN HİZMETLERİN FİYATLARININ İLGİLİ BAKANLIK TARAFINDAN BELİRLENECEĞİNİ BELİRTMİŞ ANCAK ÖZEL HASTANELER ÜZERİNDE SADECE GEREK GÖRDÜĞÜ TAKDİRDE FİYATLARIN DÜZENLENECEĞİ BELİRTİLMİŞTİR. YÖNERGENİN 12. MADDESİNİN 2. FIKRASI DEVLET ÜNİVERSİTELERİNİN BELİRLENEN FİYAT TARİFESİNİ UYGULAMAK ZORUNDA OLDUĞUNU BİLDİRİRKEN, AYNI YÖNERGENİN 12. MADDESİNİN 3. FIKRASINDA KAMU HASTANELER BİRLİĞİNE BAĞLI OLAN HASTANELERE GEREKTİĞİNDE REVİZYON YETKİSİ TANIMIŞTIR. KANUN VE YÖNERGE ANAYASA DA GÜVENCE ALTINA ALINMIŞ EŞİTLİK İLKESİNİ İHLAL ETMİŞTİR. FARKLI BÖLGELERDE HİZMET SUNAN TÜM ÜNİVERSİTE HASTANELERİ AYNI ÇERÇEVE İÇERİSİNDE DEĞERLENDİRİLMİŞTİR. BU DA HASTALARIN AYNI FİYATLARDA DAHA BÜYÜK İLLERE GİTMESİNE VESİLE OLMAKTADIR. HER NE KADAR GEÇTİĞİMİZ AY İÇERİSİNDE EKLENMİŞ OLAN 12. MADDESİNİN 7. FIKRASI, ÖĞRETİM ÜYELERİNİN HAKEDİŞLERİNİ DÜZENLEMİŞ OLSA DE YÖNERGE, ARACI KURUMLAR VE YURTDIŞINDAN REFERANS EDEN DOKTOR İLE İŞBİRLİĞİ MODELİNİ VE HAKEDİŞLERİNİN NASIL ÖDENECEĞİNİ BELİRLEMEMİŞTİR. HAKEDİŞLER 8 8

HASTALAR NASIL GELİYOR? MASRAF : 1000 TL HASTA UHB BÖLÜM TEDAVİ Background How is the U.S. health care dollar spent? What is driving health care costs? What are the major proposals to contain costs? Discussion Questions Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1] In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 4.4 percent in 2008, a slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs are likely to continue to rise in the foreseeable future.  Many analysts have cited controlling health care costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts under way. Although Americans benefit from many of the investments in health care, the recent rapid cost growth, coupled with an overall economic slowdown and rising federal deficit, is placing great strains on the systems used to finance health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have increased by 131 percent, placing increasing cost burdens on employers and workers.  [2] With workers’ wages growing at a much slower pace than health care costs, many face difficulty in affording out-of-pocket spending. Government programs, such as Medicare and Medicaid, account for a significant share of health care spending, but they have increased at a slower rate than private insurance.  Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. [3] Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may result in increased Medicaid spending figures soon. [4] As shown in the figure below, hospital care and physician/clinical services combined account for half (51%) of the nation’s health expenditures. National Health Expenditures, 2008  Total = $2.3 Trillion Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. Controlling health care expenditures requires a solid understanding of the factors that are driving the growth in spending.  While there is disagreement on exactly what those are, some of the major factors to consider are: Technology and Prescription drugs – For several years, spending on new medical technology and prescription drugs has been cited as a leading contributor to the increase in overall health spending; however, in recent years, the rate of spending on prescription drugs has decelerated.  Some analysts state that the availability of more expensive, state-of-the-art technological services and new drugs fuel health care spending not only because the development costs of these products must be recouped by industry but also because they generate consumer demand for more intense, costly services even if they are not necessarily cost-effective. [5] Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [6] Aging of the population – Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector.  However, experts agree that aging of the population contributes minimally to the high growth rate of health care spending. [7] Administrative costs – It is estimated that at least 7% of health care expenditures are for administrative costs (e.g., marketing, billing) and this portion is much lower in the Medicare program (<2%), which is operated by the federal government. [8] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending. DOĞRU YÖNTEM 9

HASTALAR NASIL GELİYOR? HASTA : 3000 TL Y. DOKTOR SİMSAR SİMSAR : 1000 TL Background How is the U.S. health care dollar spent? What is driving health care costs? What are the major proposals to contain costs? Discussion Questions Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1] In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 4.4 percent in 2008, a slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs are likely to continue to rise in the foreseeable future.  Many analysts have cited controlling health care costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts under way. Although Americans benefit from many of the investments in health care, the recent rapid cost growth, coupled with an overall economic slowdown and rising federal deficit, is placing great strains on the systems used to finance health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have increased by 131 percent, placing increasing cost burdens on employers and workers.  [2] With workers’ wages growing at a much slower pace than health care costs, many face difficulty in affording out-of-pocket spending. Government programs, such as Medicare and Medicaid, account for a significant share of health care spending, but they have increased at a slower rate than private insurance.  Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. [3] Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may result in increased Medicaid spending figures soon. [4] As shown in the figure below, hospital care and physician/clinical services combined account for half (51%) of the nation’s health expenditures. National Health Expenditures, 2008  Total = $2.3 Trillion Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. Controlling health care expenditures requires a solid understanding of the factors that are driving the growth in spending.  While there is disagreement on exactly what those are, some of the major factors to consider are: Technology and Prescription drugs – For several years, spending on new medical technology and prescription drugs has been cited as a leading contributor to the increase in overall health spending; however, in recent years, the rate of spending on prescription drugs has decelerated.  Some analysts state that the availability of more expensive, state-of-the-art technological services and new drugs fuel health care spending not only because the development costs of these products must be recouped by industry but also because they generate consumer demand for more intense, costly services even if they are not necessarily cost-effective. [5] Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [6] Aging of the population – Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector.  However, experts agree that aging of the population contributes minimally to the high growth rate of health care spending. [7] Administrative costs – It is estimated that at least 7% of health care expenditures are for administrative costs (e.g., marketing, billing) and this portion is much lower in the Medicare program (<2%), which is operated by the federal government. [8] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending. DOKTOR DOKTOR : 1000 TL HASTANE AM.+ HST: 1000 TL ARACI KURUM YÖNTEMİ 10

Sabit fiyatlandırma ne derece doğru?

PRATİK HAYATTA SORUNLAR Özel hastane yada 2 ve 3 basamak hastanelerde cerrahi yada dahili komplikasyon gelişiminde karşılaşılacak sorunlar; Sevk zinciri ??? Ödeme sorunu ???

07.2013 tarihli yönetmelikte neler yok? * Üniversite hastaneleri yönetmeliğin neresinde? * Tanıtım ve pazarlama giderleri döner sermaye kaynaklarından hangi alt ve üst limitlerle karşılanabilir? Başarısızlık durumu?? *Aracı kurumlarla çalışma koşulları? İhale? Finansman? Hakediş? *Direkt hasta transferinde yasal statü? *Turizm boyutunda var mıyız? *Tükenmiş hastada zorunlu sevk durumunda hangi statü? Hastaneler arası ilişki? *

FİYATLANDIRMA ÜNİVERSİTE YÖNETİMİNE BIRAKILMALI ÇÖZÜM ÖNERİLERİ FİYATLANDIRMA ÜNİVERSİTE YÖNETİMİNE BIRAKILMALI EŞİTSİZLİKLER ORTADAN KALDIRILMALI DOKTOR HAKEDİŞLERİ ÜNİVERSİTE YÖNETİMİNE BIRAKILMALI PAZARLAMA ÇALIŞMALARINA ÖZEL BÜTÇE DESTEĞİ OLMALI ARACI KURUMLARLA ÇALIŞABİLME REEL GERÇEKLERE UYGUN OLMALI 14 14

Bize düşen görevler... Acil Eylem Planı –Bilgilendirme Sağlık turizminde insan kaynağı çok önemlidir. Doktor, sağlık çalışanı, turizm acentaları ve yatırımcılarda farkındalık yaratacak ve bilgilenmelerini sağlayacak toplantı, konferans, kongreler düzenlemek. Bu kongrelerde daha çok kalite, markalaşma, destinasyon ve pazarlamaya yönelik olmalı

Kısa-Orta Vade Sertifikasyon Sağlık Turizmi sertifika programları düzenlenmek (tanıtım ofislerinde, hastane içinde, dış ofislerde, havaalanlarında görevlendirilecek personel için)

Uzun Vade SMYO (Sağlık Meslek Yüksek Okulları) Sağlık Turizminde görevlendirilecek yardımcı sağlık personeli yetiştirmeli.

Dil Eğitimi İngilizce ve Arapça başta olmak üzere dil eğitimi Tıp alanında, turizm ofislerinde, havaalanında, karşılama noktalarındaki görevlilere yönelik, hızlandırılmış kurslar vb.

Üniversite sağlık ofisi-şirketi Teknokent = Sağlıkkent Üniversite Hastanesi içinde Sağlık Turizmi ofisleri İnönü Üniversitesi Tıp Fakültesi, Malatya (5 Aralık 2012) İstanbul Aydın Üniversitesi, Dentaydın Yakın Doğu ÜTF

ADANA VERİLERİ 10. KALKINMA PLANI TOPLAM 4500 HASTA ( KAYITLI) 30.000.000 $ CİRO (2013) SAĞLIK TURİZMİ ALANINDA HÜKÜMETİMİZ ÖNCÜLÜĞÜNDE ÇOK CİDDİ ÇALIŞMALAR BAŞLAMIŞTIR. ÖNCELERİ PAYDAŞ SEKTÖRLERİN İLGİLİ BAKANLIKLARI TARAFINDAN YAPILAN ÇALIŞMALARDA SAĞLIK TURİZMİ BELİRLİ SEVİYELERE ULAŞMIŞTIR. 2013 YILI İÇİNDE KANUN HALİNE GETİRİLEN VE 10. KALKINMA PLANI ÇERÇEVESİNDE YERİNİ BULAN SEKTÖR, KALKINMA BAKANLIĞININ ÖNCÜLÜĞÜNDE, SEKTÖREL BİRLİKTELİKLE İLERLEMESİNE HIZLI VE KOORDİNELİ ADIMLAR İLE DEVAM EDECEKTİR. SEKTÖR PAYDAŞLARININ VE ÖZELLİKLE ÖZEL SEKTÖR ÇALIŞMALARI İLE RENKLENEN VE SAYISI İLE CİROSU HIZLA ARTAN SEKTÖRÜN SAĞLIK TURİZMİ VERİSİ, NET RAKAMLAR TAM OLARAK GİRİLMEMİŞ OLMASINA RAĞMEN 4500HASTA RESMİ OLARAK İLİMİZDE TEDAVİ EDİLMİŞTİR. BURADA ANADA YAKLAŞIK OLARAK 30 MİLYON DOLAR CİRO ELDE ETMİŞTİR. 20 20

12.000.000 $ 2.000.000 $ CİRO CİRO HEDEF 2014 YILI ORTALAMA TOPLAM 250 HASTA 2015 YILI ORTALAMA TOPLAM 1500 HASTA Background How is the U.S. health care dollar spent? What is driving health care costs? What are the major proposals to contain costs? Discussion Questions Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1] In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 4.4 percent in 2008, a slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs are likely to continue to rise in the foreseeable future.  Many analysts have cited controlling health care costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts under way. Although Americans benefit from many of the investments in health care, the recent rapid cost growth, coupled with an overall economic slowdown and rising federal deficit, is placing great strains on the systems used to finance health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have increased by 131 percent, placing increasing cost burdens on employers and workers.  [2] With workers’ wages growing at a much slower pace than health care costs, many face difficulty in affording out-of-pocket spending. Government programs, such as Medicare and Medicaid, account for a significant share of health care spending, but they have increased at a slower rate than private insurance.  Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. [3] Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may result in increased Medicaid spending figures soon. [4] As shown in the figure below, hospital care and physician/clinical services combined account for half (51%) of the nation’s health expenditures. National Health Expenditures, 2008  Total = $2.3 Trillion Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. Controlling health care expenditures requires a solid understanding of the factors that are driving the growth in spending.  While there is disagreement on exactly what those are, some of the major factors to consider are: Technology and Prescription drugs – For several years, spending on new medical technology and prescription drugs has been cited as a leading contributor to the increase in overall health spending; however, in recent years, the rate of spending on prescription drugs has decelerated.  Some analysts state that the availability of more expensive, state-of-the-art technological services and new drugs fuel health care spending not only because the development costs of these products must be recouped by industry but also because they generate consumer demand for more intense, costly services even if they are not necessarily cost-effective. [5] Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [6] Aging of the population – Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector.  However, experts agree that aging of the population contributes minimally to the high growth rate of health care spending. [7] Administrative costs – It is estimated that at least 7% of health care expenditures are for administrative costs (e.g., marketing, billing) and this portion is much lower in the Medicare program (<2%), which is operated by the federal government. [8] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending. 12.000.000 $ CİRO 2.000.000 $ CİRO 21 21

“You can and should shape your own future; because if you don’t someone else surely will” Joel Barker, US futurist “Kendi geleceğinizi şekillendirebilirsiniz ve şekillendirmelisiniz; eğer siz yapmazsanız emin olun başkası yerinize bunu yapacaktır”

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