Thursday, 23 February 2012

Health care for all

New legislation has recently been introduced here in Turkey to ensure that every member of the population has health care insurance.

It's a wonderful idea of course, but as usual when  the government introduces a scheme like this, they do not appear to think it through before implementation.  Wherever you look for the correct information, be it on websites, forums or social security offices, there is much conflicting information.   This is nothing new...the left hand very rarely knows what the right hand is doing in this country.

It would seem that everyone must belong to the government health scheme.  At least this was the message a couple of months ago, with a deadline of January 31st for registration, failure to do so resulting in a hefty fine.  

Most of the confusion has been amongst expats, some of whom already subscribed to private health insurance but were being told they had to join the government scheme regardless.  Foreign consulates got involved and meetings were held with officials and varying bıts of information were posted on embassy websites...updated within days...changed...updated...and on and on.  One minute they have to join, the next minute they don't.  If you asked me to give you the  latest correct information, I couldn't because I've lost the plot.

Basically until now there have been two types of cover (well three if you count just paying as you go for treatment).   If you are employed with a contract, your employer is obliged by law to pay your health cover.  It's called SSK.   There have been a few times in the past where Mr A was covered by SSK, which also covered me.   Interestingly, each time this was the case, the EMPLOYER's contribution was deducted from Mr A's salary at the end of each month...not what is supposed to happen but often does. 

The second type of cover is called Bağkur and this is for people who are either self-employed or unemployed.  I did a lot of research on this back in October because Mr A was convinced he wasn't eligible but I was sure he was.   Of course I was right!  Finally on 21st December he registered with the social security department.  One month later he collected his form to take to the bank to make his first payment.  We were both covered from 21st January.

The Bağkur monthly contribution is understandably much less than the SSK contribution.  Where I actually started to lose the plot was when I kept reading about everyone having to have SSK cover, because I always believed this to be an employer contribution.  I still don't get what's happening.  All I know for certain is that Mr A has health cover, and because I am his wife, and a Turkish citizen by marriage, I am also covered.

I do feel sorry for foreigners who have settled here because there is still so much confusion.  I don't think anyone objects to paying for healthcare, but they do need to know exactly how they must go about obtaining it.

I've always been very impressed with the treatment I've received here on occasions when I've needed it.  Some of the devlet (state) hospitals are in a poor state of repair but the system, although confusing at times, is relatively fast and efficient.  You can walk into a hospital without an appointment and see a doctor. If you need to have blood or urine tests, ultrasounds or ex-rays, these are done straight away and the results produced within hours.  I've had to pay on these occasions, but the costs were minimal (although with the new legislation, people without cover now have to pay considerably more).

When we lived in Side, Antalya, I had been ill for some months with what I later discovered were 2 strains of food poisoning.  I lost weight, had stomach pain constantly, and eventually collapsed.  I was taken to the private hospital where it was established that apart from the salmonella and shigella lurking in my body, I had a large stone just about to burst my gallbladder.    Within hours I had been admitted, and my gallbladder removed and then put on IV antibiotics.  I spent a day in intensive care and a further 5 days in the hospital.  I know that the rapid response from the surgeon prevented something much worse happening to me.

The biggest surprise was the bill at the end of all this.  Around 400 pounds.  And this was private treatment.

I have used the devlet hospital in Milas once, in 2010, for a urinary tract infection which was cleared up promptly with the correct medication.  Again, I had no health cover at the time, and the charge was 45 lira for doctor consultation and diagnosis, blood and urine tests and ultrasound.

Even if I still had access to the NHS in England, I would be very reluctant to use it.  I am perfectly satisfied with the care here.

And yesterday we made a further discovery.   I did know that on the odd occasion a doctor from Milas would visit the village for a couple of hours to hold a surgery.  The problem here was that you never knew when he would be coming, until an announcement was made over the public address system to announce his arrival.

Yesterday whilst Mr A was in the village teahouse he saw a notice on one of the buildings attached to the primary school which announced that a doctor's clinic was in progress.  He went to investigate and learned that we now have a regular doctor's surgery for 2 hours every Wednesday and Friday.  This is great news for those of us without transport, and particularly the elderly, as the devlet hospital is on the far side of Milas and difficult to get to.

There will undoubtedly be more teething problems with this new health care legislation before it's running smoothly...if it ever does...but it's a huge step in the right direction in my opinion.

18 comments:

  1. It does sound confusing, although as you say, if you can find your way through things, health care seems to be very good at the point of delivery, which I guess is the important thing. I know the NHS gets lots of criticism, but it is reassuring to have it, and my family and I have had astoundingly good care within the NHS. Friends in France tell me how excellent the system is there, but I still feel nervous about exactly how to access care if needed....very interesting to hear about your system.

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  2. Janice it's always nerve-wracking the first time you need medical treatment in a different country and I guess at first I assumed that Turkey's health care might be a bit "third world"..but I was pleasantly surprised at how good it is.

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  3. I signed up at our local GP last month. i was very impressed. Medical care for all is the biggest improvement in the last 10 year.

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  4. As far as I understand it, SSK and Bağ-Kur somehow became the same thing, or under the same umbrella at least, around the time SSK changed its name to SGK. I'm not 100% sure about that, but then again, probably no one is :)

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  5. hooray for a health care system that is at least trying!

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  6. Thank you Ayak for this reassuring news. We can't afford to join the SGK system at the moment as at the moment we don't have regular enough income to guarantee being able to cover 212,76 TL x 2 per month going up to 250TL pp (x 2) in July and a rise again in Jan 2013. So we are keeping on the pay-as-you-go scheme. We have had little use of the system at the moment but I have been impressed with what we had. One sprained wrist for Mr P in 2009 with consulation, 4 or 5 X-rays and prescription cost him 25TL and a visit to the gynecologist with a small surgical intervention to remove an implant for me just cost me the entry ticket of 15,50TL.
    You say "although with the new legislation, people without cover now have to pay considerably more)".
    I haven't actually seen anything official about this but as you the say the whole thing has been handled so badly that nobody knows what you pay nor what is covered - what about dental or optical treatment for example? One positive thing is that private insurance companies are now lowering their monthly premiums to below the level of SGK contributions to attract foreigners who haven't taken out SGK cover. Even now nobody is really sure whether you really have to pay a fine if you join now or whether if you join in a year's time they will actually make you pay back-payments from 31st Jan 2012 onwards. What a mess! And such a shame that the Govt lost an marketing opportunity to show the positive side of the scheme instead of just communicating about the compulsory bit and the heavy fine. It certainly is a step in the right direction, though, and I'm glad you and Mr A have the comfort and reassurance that you are covered.
    Vicky

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  7. BtoB. We have previously lived in towns where there were these small "GP" clinics available and they seem to be very good. However they don't seem to be everywhere.

    Stranger; You may be right but I really wouldn't bet on it either!

    Theanne; Hopefully it will get there eventually.

    Vicky: It is all a huge mess at the moment and I think people who are adopting a "wait and see" attitude for the time being are probably wisest. We all know how the goalposts move here without reason or warning
    Have a wade through this thread on Kusadasi.biz http://forum.kusadasi.biz/threads/important-changes-to-turkish-health-insurance-regulations.28750/
    Ignore the comments but focus on those bits of info from the govt sites that have been posted there. See what you think.

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  8. It sounds welcome news....once the muddles are sorted out!
    In Costa Rica we've found the NHS - the Caja - to be excellent, though it might vary according to where you live. There's a good basic clinic, a new hospital ten minutes away and first class care in San Jose for specialist care.

    And yet American expats run down this service and prefer to pay through the nose for private U.S. style hospitals...must be bonkers!

    We weren't allowed to join the French system we we moved, so had private insurance. By the time we left the cost of that insurance was less than would have been the case if we'd joined the system and had to pay the top up insurance!
    French health care? Very much the curate's egg!

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  9. Glad that you have the reassurance of being covered....to me that would be a load off my mind.
    I can't believe how cheap the fees are over there.
    What cost you 40 L. would be over a thousand bucks here.....when my Mother/in/Law was in the hospital where she lived in Izmir the hospital was like a luxury hotel. My Dr. here told me that Turkey's medicare is all updated and not to worry about going there.But then my husband's family lives in a big city. I always felt better b/c my MIL's neighbours were Dr.'s so when I got food poisoning....I got care from them.

    Too bad all these 'political'issues go around and around till things get settled for the people....
    This sure makes me feel better b/c here in Canada...all medical care is free....and equal for all and no limits.

    I'm glad about your posts about medicare and visa's that I get all this info about Turkey. In a few years my husband wants to move back for 4 to 6 months a year. He said that he can't handle more..... he is used to living here now.

    I was sorry to hear of your food poisoning illness that you had to endure before....but happy all is well.

    .....have a great day!!!!

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  10. Fly. I expect you were pleasantly surprised to discover such good health care in CR, perhaps for much the same reasons as I was in Turkey. It's wonderful when it works well.

    Erica: I'm hoping that all the problems can be sorted out without any more confusion. As far as cost is concerned, this will be a big issue for the Turks as the majority will find it hard to pay the monthly fees. I hope this particular problem will be addressed by the government instead of imposing fines for non-payment.

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  11. Thank you for the link - nothing new so we'll just see what hapens. Unsurprisingly when Mr P called the French embassy last month they hadn't heard anything about it and said they would look it up on the UK Embassy site!!!
    Vicky

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  12. Vicky, I'm sure the reason why the embassies don't have accurate information is simply because the Turkish government still don't know what they're doing. It doesn't inspire confidence does it?

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  13. That does sound like a big improvement, Ayak, even if the details are very confusing at the moment. it certainly sounds like the standard of care is good and the costs affordable.

    Like Janice I've always had wonderful care from the NHS. My only experience of medical care abroad was when I was working in Germany as a student and had to have my appendix out. All covered, thank goodness. an

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  14. I've been quite impressed so far Perpetua. Once this new system has ironed out the problems it should work well.
    I guess we all have different experiences of the NHS. In my family we've had both good and bad treatment, but I suppose that's inevitable.

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  15. I signed up with the Turkish system this week having had a letter a three weeks previously while I was visiting the UK, my wife told be to return by the 27th or health care would be expensive if I needed it.

    I have had to make use of the Turkish health system when I had a severe chest infection, I found them to be very good and not expensive.
    I was struck by the incongruity on leaving the well equipped modern hospital to see a street vendor selling leaches from a tank of murky water for 5TL each.

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    1. Oh my goodness Peter...leaches for sale outside the hospital? I've never seen that before. I wonder if its a common occurrence here?

      I agree with you about the Turkish health system. I've had very good treatment.

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  16. Apparently the leeches are a traditional treatment for varicose veins, a google search came up with several Turkish companies like this http://www.leechesturkey.com/index.html offering leeches for export. They are used to prevent blood clots in re-constructive surgery.

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    1. Peter I did know that leeches were still used in medicine today, but I was just surprised that you saw them for sale outside the hospital. Ah well, we shouldn't really be surprised about anything in Turkey I suppose!

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