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 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 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

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Source: The World Bank.
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.

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 the World Summit Award (WSA) in 2016.

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 shown in the image below).

e-Nabız was developed to enable citizens to access their health data, collected from multiple healthcare institutions, in one place. 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 Türk PHR system allows users to use 38 different 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 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 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.

• 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. 

(Birinci, 2023)

Challenges and areas for improvement

The system lacks a symptom tracking feature.

Published outcomes - statistics

The e-Nabız platform has achieved widespread adoption, with remarkable growth. Below are some statistics about its usage and impact:

• Rapid User Growth: In 2018, e-Nabız had 11 million users. By 2022, this number had grown to 68 million active users, representing 80% of Türkiye’s population.

• Integrations: The platform collects data from 28,608 system-integrated health facilities and 39 other public institutions, including ministries.

• Cost Savings: Since its launch in 2015, e-Nabız has registered radiological images within the system, eliminating the need for patients to request duplicate copies. This innovation has resulted in a 27.5% reduction in costs, saving 750 million Türk Lira (approximately $21.87 million) in radiological imaging expenses from the platform's inception until 2023.

(Birinci, 2023)

In the research paper titled ‘A Digital Opportunity for Patients to Manage Their Health: Türkiye National Personal Health Record System (The e-Nabız)’, Birinci (2023) provides additional insights into the system's utilisation. Table 5 from the paper presents e-Nabız usage rates among Türk citizens in 2021, as shown below:

Screenshots

On the Pathology Information page, patients can download the report of the pathology procedure that they have undergone in health institutions for the diagnosis of all diseases, treatment options and determination of diseases associated with genetic syndromes.

On the ‘My Epicrisis Information’ page, patients can download epicrisis reports containing information about each of their conditions, the respective diagnosis and treatment.

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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: NCBI - WWW Error Blocked Diagnostic (accessed 13 December 2023).

• e-Nabız Has More Than 74 Million Users. (online) Available at: e-Nabız Has More Than 76 Million Users! (accessed 13 December 2023).

• User Manual e-Nabız, 2024. (pdf) Available at: https://enabiz.gov.tr/document/User_ManualEN.pdf (accessed: 2 August 2024).

• World Health Organization. (n.d.). Türkiye: Country overview. Available at: Türkiye health system information (accessed: 2 August 2024).

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