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Sağlık hizmetlerinde krizlerin şekli ve yapısı: Bir derleme

Construction and contours of crises in health care: A review

Journal Name:

  • Sağlık Akademisyenleri Dergisi

Publication Year:

  • 2016
DOI: 
10.5455/sad.13-1457435935

Key Words:

Keywords (Original Language):

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Abstract (2. Language): 
There may be a number of crises which plague the health services across the world, multi-level in nature; but there are also ideological differences in the way in which this crisis is posed in literature. The crises may be broadly reflected as unavailability of services, of human resources or financial resources. This review of literature, comparing and contrasting crises depiction in the pre- globalization era and post- globalization era, also tries to compare the crises between countries falling onto the categories of high-income group vis-a-vis the rest Increasing cost of care, poor medical supplies, shortage of staffs, lack of insurance coverage leading onto denial of health care, high burden of communicable diseases in developing countries are the commonly mentioned health crises. The review shows that crises in health care cannot be seen in isolation but is largely influenced by societal crisis. The evidence that emerge, points to neo-liberal reforms as a predictor of deterioration of quality of services reflected as crises, through dis-investment in health care. The reforms paved way for withdrawal of governments from welfare schemes, impacting the poor households in terms of decreased access to health care. Homogenizing the crisis just in terms of availability of health human resources will be over-simplification of the issue, since poverty among people indicating a large societal crisis is closely linked to health crisis as well. Any policy initiatives towards universalization of health need to understand these broad linkages and socio-political processes underlying the crises in health care.
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Abstract (Original Language): 
Krizler çoğunlukla hizmetlerin, insan kaynakları veya finansal kaynakların elverişsizliğini aksettirir. Dünya genelinde birçok düzeyde sağlık hizmetlerinin başına bela olan birçok kriz bulunabilir. Fakat literatürde krizlerle ilgili ideolojik farklılıklar da vardır. Bu literatür derlemesi, küreselleşme öncesi ve küreselleşme sonrası çağları karşılaştırmalı olarak tanımlamaktadır. Ayrıca derleme, yüksek gelir grubuna sahip ülkelerle karşılaştırıldığında geriye kalan gelişmekte olan ülkelerde sıklıkla bahsedilen, yüksek maliyetli sağlık bakımı, kötü tıbbi malzeme, yetersiz sağlık çalışanı, sağlık sigortası eksikliğinin yol açtığı sağlık bakımının reddedilmesi ve yüksek hastalık yükünü karşılaştırmaya çalışmaktadır. Derleme, sağlık alanındaki krizlerin izole olarak görülemeyeceğini ve toplumsal krizlerden büyük oranda etkilendiğini göstermektedir. Elde edilen bulgular, sağlık alanında yatırım yapılmaması yoluyla kriz olarak yansıyan sağlık hizmetlerinin kalitesinin bozulmasını tahmin eden neo-liberal reformları işaret ediyor. Reformlar, azalan sağlık hizmetlerine erişim açısından yoksul haneleri etkileyerek hükümetlerin refah/sosyal yardımlaşmadan çekilmesinin ortamını hazırlamıştır. İnsanlar arasında yoksulluk, büyük bir toplumsal krizi gösterdiği ve bu aynı zamanda sağlıkla ilgili krizle de ilişkili olduğu için, sağlık insan kaynakları açısından krizin homojenize edilmesi aşırı basitleştirme olacaktır. Sağlığın evrenselleşmesi yolunda herhangi bir politika girişiminin sağlık hizmetlerindeki krizlerin altında yatan geniş bağlantılı sosyo-politik süreçlerin bilinmesine iht iyaç duymaktadır.
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