Predicting the Resilience of the Health Care System to New Arrivals: The Case of the Public Health System of Turkey

Purpose/Objectives: Since the start of the Syrian war, a significant population has moved out of the Syrian Republic into its neighborhood environs. Turkey has had a significant effect on its health system and society, as a significant new number has entered the Turkish society, increasingly using the Turkish healthcare system. Our aim is not only to numerically identify the size of the effect to the Turkish system, but to identify the domestic resources that allow the Turkish healthcare system and society to build up resilience against the significant health demand shock. The main objectives of this study is 1) To understand whether there is a complementarity between the earlier efforts in the Turkish health system and the current capabilities that is necessary to meet the Syrian Populations Health Needs. 2) To understand if the newly revamped Turkish Primary Healthcare System Provide a crucial buffer for the negative congestion effects that could have been caused by such a significant and relatively unhealthy refugee population being integrated into the health system, at a relatively rapid pace. Research method: The main two outcomes that the analysis plans to predict are the changing efficiency and the changing user satisfaction of the Turkish health system. Using multi-level regression models (MLO) we (i) Start by looking at the effect of the Syrian effect on the crucial Turkish health parameters, following this by (ii) Looking at the factors of family health program introduction, and family health system utilization to look at how the functionality of the health system, and the satisfaction that it brings to the Turkish population is being affected. We used fixed effect model to remove unobserved heterogeneity in each province (model specification in Appendix 1). We have controlled for health system variables (public primary physicians per 10,000; public hospital specialists per 10,000; public hospitals per 10,000; public PHC centres per 10,000; and the presence of a university hospital in the province) as well as population characteristics (rural population (%); population aged 65 and over (%); population aged 14 and under (%); and the province population). Because demographic data was available only for the years 2007-12, it was linearly extrapolated for the years 2002-6 and 13. The penetration of family medicine model in each province was measured by an indicator variable (0,1) for whether the MLO model was introduced, and the number of years since the introduction of the MLO model. The Syrian effect was measured through the proportion of Syrians under temporary protection status to the domestic province population. Main results: The health system status of the Turkish population is unaffected in the large period from 2011-2016. The significant effect in the initial period was significantly alleviated in the intervening years. The main sources of resilience were found to be the changing importance of the alternative primary health system that allowed Turks to receive a new option to the secondary part of the Turkish health system that was increasingly congested. Increasing use of the immunization for the same goal is also substantiated for the Turkish population. Recommendations: Turkey’s experience is instructive for a lot of the middle income countries, which can face similar refugee and migrant pressure in the next 50 years. The health systems priority to UHC and to (relative) open access that it offered to its citizen population and its outside populations alike, has served its efficacy in good stead. The health system must create enough elasticity to limit a drop in health system satisfaction and health system utilization in either of these critical populations.
Journal of Epidemiology and Public Health Reviews


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Citation Formats
İ. C. Özen, “Predicting the Resilience of the Health Care System to New Arrivals: The Case of the Public Health System of Turkey,” Journal of Epidemiology and Public Health Reviews, pp. 1–13, 2021, Accessed: 00, 2021. [Online]. Available: