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Country’s healthcare system in a nutshell
Türkiye provides universal public health insurance through the Social Security Institution (SSI), allowing all registered residents access to free healthcare. However, equitable access remains a challenge, partly due to a nationwide shortage of doctors. As a result, many people opt for additional private insurance to cover treatments in private hospitals.
The Republic of Türkiye, Ministry of Health (MoH) is responsible for setting health policy and owns more than half of the country's hospitals. The SSI handles collecting and pooling social security premiums, contracts with healthcare providers, and sets tariffs for services. Other government agencies manage workforce planning and the regulation of drugs and medical devices.
Funding for social insurance premiums comes from both employer and employee contributions, with exemptions for those on low incomes. The MoH Ministry of Health contracts with family physicians for preventative and primary care, who are paid according to the number of patients under their care. Patients are required to make co-payments at varying levels for primary, secondary, and tertiary care services (World Health Organization, n.d.).
According to the most recent data from 2011, health insurance covered 86% of the population in Türkiye. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).
Public vs private
The national PHR
History
In 2008, the Republic of Türkiye, Ministry of Health, began efforts to coordinate stakeholders nationwide to centralise and process personal health records, along with administrative and financial data, from all healthcare providers. This initiative started with the development of the first version of the National Health Data Dictionary (NHDD), which has since served as a reference for information systems used by all healthcare facilities, significantly contributing to terminology standardisation. Subsequent steps toward digitalisation were built upon this common terminology and system architecture outlined in the NHDD.
The NHDD laid the foundations for the http://Sağlık.Net V1 system, introduced in 2009; the http://Sağlık.Net V2 system, launched in 2011, and most recently, the e-Nabız system.
e-Nabız, the Türk Personal Health Record, was put into service in Türkiye in 2015 as an application of the Republic of Türkiye, Ministry of Health, and was awarded "The Best Health Application" in WSA (the World Summit Award (WSA) in 2016. The platform, which is an application of the Türk Ministry of Health, was developed by Tiga Healthcare, the same that has contracts with the Türk Ministry of Health
The development of the e-Nabız system is the result of the Ministry of Health’s extensive experience in health informatics over the years and has been adapted to meet evolving citizen needs and technological advancements. The Ministry engages third-party organisations, such as contractors, for professional services related to the maintenance and technical support of the system.
One of the Ministry’s main contractors for this project has been Tiga Healthcare, the same health tech company which, in addition to its work on the Personal Health Record system, holds contracts with the Ministry for the Pharmaceutical Track & Trace System and E-prescription (as per shown in the image below).
Ee-Nabız was developed for citizens to enable them citizens to access their health data, collected from multiple different health healthcare institutions, in one place. Patients can authorize Through the platform, patients can also authorise their healthcare professionals to access their records.
(PKB interviews, 2024; Tiga Healthcare Technologies, 2023)
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Features
The Turkish Türk PHR system allows users to use 38 different services features for treatment, prevention, health promotion, and health-related and interrelated areas. Data sources include both public and private healthcare providers.
In the appointment section, patients can see their future scheduled hospital appointments and information on past ones, and they can also can book new ones. Patients can see details of past visits, including:
prescriptions,
diagnosis,
written reports,
tests performed,
radiological images.
In the notifications section, patients can see their recent activities, such as the latest login and hospital visits.
Patients have multiple options when it comes to sharing: "No physician can see my information" “Family physicians can see my information", "The physician who performed the examination can see my information", " Every physician in the health facility where I had my examination can see my health information", " All physicians can see my information".
Patients can also share a piece of selected health information with persons of their choice, for a period of their choice (they can also share permanently), after entering their email address and phone number to confirm.Patients can see their disease history, and personal information such as blood type, age, and smoking status.
Patients can see their measurements, such as weight, height and body mass index.
Patients can evaluate a health facility visit in terms of service quality and comment on the visit.
They can also track and manage their blood and bone marrow donation choices.
They can make organ donation choices.
They can see their allergies.
They can see intensive care hospitalisation information.
They can let their insurance companies access the data.
Patients can add ‘emergency notes’ to a section so that healthcare professionals can read them in case of emergency.
Patients can upload files files.
They can see their vaccine calendar.
They can see an access log to check who has accessed their record.
Patients can add measurements. E-Nabiz will also retrieve data from OS or Google Fit.
Covid-19 features: view the vaccine information and appointments, get the vaccine certification.
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Challenges and areas for improvement
The system lacks a symptom tracking feature.
Published outcomes - statistics
In 2018, 11 million citizens used e-Nabız. In 2022, the platform counted 68 million active users. This accounts for 80.0% of the population.
Data is flowing from the 28,608 system-integrated health facilities and other 39 e-Nabız-integrated public institutions (ministries, etc).
registering radiological images in the system prevented patients from needing to request them again. This led to a significant cost savings of 27.5%, equivalent to 750 million Türk Lira (approximately equivalent to $21.87 million), in the domain of radiological images.
In a research paper titled ‘A Digital Opportunity for Patients to Manage Their Health: Türkiye National Personal Health Record System (The e-Nabız)’, Birinci (2023) includes a table (Table 5) displaying e-Nabız usage rates among Türk citizens in 2021. The table is shown below:
Age interval | e-Nabiz users | Total population | Ratio of e-Nabiz users in total population |
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0-4 | 4,940,318 | 5,913,609 | 84% (kids' parents) |
5-9 | 5,656,183 | 6,624,202 | 85% (kids' parents) |
10-14 | 5,395,513 | 6,438,152 | 84% (kids' parents) |
15-19 | 5,372,255 | 6,229,709 | 86% |
20-24 | 5,712,808 | 6,741,580 | 85% |
25-29 | 5,605,692 | 6,476,899 | 87% |
30-34 | 5,233,845 | 6,341,787 | 83% |
35-39 | 5,075,415 | 6,386,208 | 79% |
40-44 | 5,188,475 | 6,547,162 | 79% |
45-49 | 4,407,263 | 5,662,261 | 78% |
50-54 | 3,686,493 | 4,754,484 | 78% |
55-59 | 3,201,477 | 4,707,180 | 68% |
60-64 | 2,471,722 | 3,611,916 | 68% |
65-69 | 1,933,364 | 3,156,448 | 61% |
70-74 | 1,274,086 | 2,175,024 | 59% |
75-79 | 729,507 | 1,392,718 | 52% |
80-84 | 393,509 | 861,409 | 46% |
85-89 | 171,028 | 456,548 | 37% |
90+ | 67,521 | 202,977 | 33% |
Screenshots
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In the "Smart Assistant", which you can access from the menu, you can view all your disease history, and personal information such as blood type, weight, height, age, body mass index and smoking status. The diseases you have had are marked on a human body diagram and the diagnoses are shown in the fields indicated with dots.
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You can list all tests you have had, their results and their reference values by the date and description, and you can access the details by clicking on the test you want. You can filter by date range and procedure name.
On the Pathology Information : You page, patients can download the report of the pathology procedure that you they have undergone in health institutions for the diagnosis of all diseases, treatment options and determination of diseases associated with genetic syndromes from this page.
My Epicrisis Information: You can download the report containing all the information that determines your navigational status in health institutions. Your epicrisis report contains information about the disease, its diagnosis and treatment. You can access your epicrisis information from the listing screen and download it as pdf and view it.
Blood Donation: You can view the address and date information of blood donation teams and track your blood donation historyOn the ‘My Epicrisis Information’ page, patients can download epicrisis reports containing information about each of their conditions, the respective diagnosis and treatment.
My Insurance Activities: You can create an insurance code on the "My Insurance Activities" page so that insurance companies can access your health data. Insurance companies can only access your health data sent to e-Nabız System with the insurance code. You can enter the informations about the insurance companies with which the insurance code will be shared. You can create a separate insurance code for each insurance or share one code with multiple insurance companies.
My Documents You can upload photos related to your health that you want your physician to see (instant wounds, rashes, etc.) to this section.By clicking on the "Upload Document" button, you can upload photos, edit the documents you have added or delete them if you wish.
Vaccine Calendar: You can view the vaccines included in the childhood vaccine calendar of the Ministry of Health of the Republic of Türkiye and their status on the Vaccine calendar. If you would like to obtain the vaccine calendar document, you can download the Electronic Vaccine Card in the PDF format. In the Vaccines section, you can view the list and details of all vaccines administered.
In the percentile section, you can see percentile charts for head circumference, height and weight.
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Bibliography
Birinci, Ş., 2023. A digital opportunity for patients to manage their health: Turkey national personal health record system (The e-Nabız). Balkan Medical Journal, 40(3), p.215. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175887/ (
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accessed 13 December 2023).
e-Nabız Has More Than 74 Million Users.
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(online
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) Available at: https://www.tigahealth.com/e-nabiz-has-more-than-74-million-users/#:~:text=e%2DNab%C4%B1z%2C%20which%20was%20put,more%20than%2071%20million%20users (
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accessed 13 December 2023).
User Manual e-Nabız, 2024.
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(pdf
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) Available at: https://enabiz.gov.tr/document/User_ManualEN.pdf (
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accessed: 2 August 2024).
World Health Organization. (n.d.). Türkiye: Country overview. Available at: https://eurohealthobservatory.who.int/countries/turkiye (
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accessed: 2 August 2024).