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Financial protection should be the principal objective of any health system. Commonly used indicators for financial protection are out-of-pocket (OOP) payments as a share of total health expenditure and the amount of households driven into poverty by catastrophic health expenditures (CHEs). In the last decade, OOP health payments consisted of approximately one-fifth of the health finance resources in Turkey. Until the year 2008, Turkish health system covered different public and private financing programmes as well as different types of service provision. After 2008, universal financial coverage became a part of the Health Transformation Programme (HTP). This study aimed to evaluate the financial protection in health in the era of health reforms in Turkey between 2003 and 2009. Household expenditures were derived from nationally representative Turkish Household Budget Surveys (HBSs), 2003, 2006 and 2009. Proportion of households facing CHE and impoverishment are calculated by using the methodology proposed by Ke Xu. Probability of incurring and volume of OOP spending were assessed across the health insurance groups by two-part model approach using logistic and OLS regression methods. Our findings showed that the probability of incurring and volume of OOP spending increased gradually in publicly insured households between 2003 and 2009. However, there was a diminishing trend in CHE in Turkey during the period under consideration. The official data showing an ∼3-fold increase in per capita health care use since 2003 and our study findings on decreasing CHE in this period can be interpreted as positive impact of HTP. On the other hand, increased household consumption as a share of OOP health payment and the deterioration in the progressivity of OOP spending in this period should be monitored closely.

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BACKGROUND: Municipalities have a crucial role in the adaptation of urban spaces, buildings, and public services for full use by persons with disabilities. OBJECTIVE: The aim of this study was to determine the attitudes toward persons with disabilities in municipal employees. METHODS: This descriptive study included 338 municipal employees of a major municipality in Ankara, Turkey. Data were collected via a questionnaire and the Attitude towards Persons with Disabilities Scale (ATPDS) (Dokmen, 2000). Descriptive statistics, the t test, ANOVA, and ordinal logistic regression were used to analyze the data. RESULTS: Among the participants, 5.1% had some type of disability, 15.0% had a family member with a disability, and 6.9% cared for a person with a disability. Pity was the most common feeling (30.6%) toward persons with disabilities. Mean ATPDS score was 115.6 ± 15.1 out of 150. The attitudes of the employees with a family member or a friend with a disability, as well as those of the employees that had cared for a person with a disability were more favorable than their counterparts (p < 0.05). CONCLUSIONS: The present findings showed that close contact and interaction with persons with disabilities were associated with more positive attitudes. Therefore, promoting positive attitudes among municipal employees and the development of a supportive organizational culture with respect to the rights of persons with disabilities may be useful. Interventions aimed at increasing awareness of and interaction with persons with disabilities may improve the attitudes of municipal employees, and consequently improve the services municipalities provide to persons with disabilities.

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BACKGROUND: The use of endocrine therapy (ET) in postmenopausal breast cancer patients may affect their cognitive status. This study aims to assess the effects of tamoxifen and aromatase inhibitors (Als) on quality of life (QoL) and cognitive functions in breast cancer patients. PATIENTS AND METHODS: The study included 101 patients receiving tamoxifen, 97 patients receiving Als, and 95 patients without any ET. All patients completed both the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Short Form-12 (SF-12) questionnaires. RESULTS: The patients' characteristics were similar between the groups. The mean duration of ET was 2.6 years for tamoxifen and 2.5 years for Als. EORTC QLQ-C30 global scores and cognitive functioning scores as well as SF-12 mental scorings (mcs) were found not significantly different between patients without any ET and those receiving tamoxifen or Als (p = 0.529, p = 0.333, and p = 0.452, respectively). SF-12 mcs correlated moderately with EORTC QLQ-C30 global scores for the 3 treatment groups (all p values < 0.001). CONCLUSION: Our study suggests that QoL and cognitive functions are similar in patients receiving Als or tamoxifen. Moreover, it appears that these parameters also do not differ in patients with respect to the use of ET.

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OBJECTIVE: This survey aimed to investigate the effect of medical education on the attitudes of students towards individuals with mental health problems. METHOD: The first phase of the survey was conducted in 2002 with first-year medical students (n=168) and the second phase was carried out in 2007 (n=202) with sixth-year medical students. The questionnaire we used collected the students' sociodemographic data and their responses to propositions that reflected their attitudes towards individuals with mental health problems. A composite attitude index was developed based on the questions and propositions. The chi-square test and variance analysis were used to analyze the data. RESULTS: Mean age of the first-and last-year students was 18.25 +/- 0.88 and 23.46 +/- 0.85 years, respectively. The percentage of students that had mental health problem or had a family member with mental health problem increased when they were sixth-year students (first year: 4.2% and 14.3%, p=0.187, and 7.4% and 27.7%, p=0.002, respectively). Among the first-year students, "nervousness" was the most common feeling towards people with mental health problems, versus "pity" among the sixth-year students. Compared to the first phase of the study, the frequency of the opinion, "a person with a mental health problem must be cared for by their family", was higher during the second phase (from 49.4% to 64.9%, p=0.003). The percentage of sixth-year students that thought people with mental health problems can adapt to social life was lower than that of first-year students (94.6%, and 88.6%, respectively, p=0.040). When the students became sixth-year students they developed more positive attitudes, such as "to abstain to talk"(p=0.015), and "to share a room" (p=0.008), and more negative attitudes towards "marrying an individual that had a family member with a mental health problem" (p=0.007) compared to when they were first-year students. According to the year of education, there wasn't a significant difference between the mean composite attitude index score (p=0.940). CONCLUSION: We recommended the use of new training methods to develop positive attitudes among medical students towards individuals with mental health problems.

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OBJECTIVES: This study aims to identify the level of catastrophic health expenditure (CHE) in Turkey and, to reveal household factors predicting this outcome. METHODS: CHE is calculated from a national representative data derived from TurkStat, Household Budget Survey, Consumption Expenditures, 2006. The methods introduced by Ke Xu and colleagues are employed for calculations. RESULTS: The proportion of households with CHE is 0.6%. Impoverished households consist 0.4% of total. Average out-of-pocket health payment is 7.36 USD (PPP$-2006) in lowest fifth that is approximately one tenth of the highest fifth (70.18 PPP USD-2006). In the logistic model, probability of facing CHE increases by each unit rise of per capita expenditure. Household head's health insurance is closely related with catastrophe. Rural households face 2.5 times more catastrophe than the urban area residents. Having preschool child in the household is seen as a protective factor for catastrophic expenditure. On the other hand, elderly or disabled person increases risk of catastrophe. CONCLUSIONS: Results indicate that more people in Turkey benefited from risk pooling/health insurance by 2006 and were, therefore, on average, better protected from catastrophic medical expenses, than in many other countries with comparable income levels at that time.

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Bronchial asthma is one of the most common chronic diseases of childhood. In recent years a consistent increase in the prevalence, and concomitantly, in the social and economic impact of the disease, has been reported. In order to provide data for the cost of pediatric asthma and its determinants in Turkish children, a study was performed in a single outpatient clinic, which encompasses a questionnaire-guided interview and retrospective evaluation of the last year files. From the 183 patients enrolled, most were males (65.6%) and atopics (63.5%), with a disease severity of mild intermittent (67.7%). Mean annual total costs per patient was US $991.7 +/- 73.2 (median = 688.8) and the largest proportion of the direct costs was due to outpatient clinic costs (48.5%). Mean cost of any hospitalization per patient was US $955.5 +/- 16.5. In multivariate analysis, the disease severity, current use of preventive drugs and current use of emergency sevice and/or current hospitalization appeared to be the main determinants of direct costs. Adequate control of the disease plays a key role in decreasing the total direct costs of pediatric asthma although it increases the medication and outpatient costs.

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In health care today, scientific and technological frontiers are expanding at unprecedented rates, even as economic and financial pressures shrink profit margins, intensify competition, and constrain the funds available for investment. Therefore, the world today has more economic, and social opportunities for people than 10 or 100 years since globalization has created a new ground somewhat characterized by rapid economic transformation, deregulation of national markets by new trade regimes, amazing transport, electronic communication possibilities and high turnover of foreign investment and capital flow as well as skilled labor. These trends can easily mask great inequalities in developing countries such as importation and spreading of infectious and non-communicable diseases; miniaturization of movement of medical technology; health sector trades management driven by economics without consideration to the social and health aspects and its effects, increasing health inequalities and their economic and social burden creation; multinational companies' cheap labor employment promotion in widening income differentials; and others. As a matter of fact, all these factors are major determinants of ill health. Health authorities of developing countries have to strengthen their regulatory framework in order to ensure that national health systems derive maximum benefit in terms of equity, quality and efficiency, while reducing potential social cost to a minimum generated risky side of globalization.

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The basic aim of the activities concerning health is to implement the initiatives for people to attain the best health status and sustain it. That's why these initiatives have to be chosen from the ones that consume minimum resource and affect life quality and duration in most beneficial way. Asthma is one of the most prevalent chronic disorders. Asthma brings significant direct and indirect costs to societies. To decrease the burden of asthma, it is necessary to emphasize its effects related to morbidity, mortality and material losses. Therefore, countries should give priority to cost of illness studies.

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