Report by Prof. Dilek Ural and Prof. Meral Kayikçioglu National CVD Prevention Coordinators for Turkey:
Dilek UralMD, Professor
1. Head, Department of Cardiology, Kocaeli University, School of Medicine, Kocaeli, Turkey2. Director, Clinical Research Centre, Kocaeli University, Kocaeli, Turkeycontact: emailmobile number: +90-532-2368975
Meral KayıkçıoğluMD, Professor
Ege University, School of Medicine, Department of Cardiology, İzmir, Turkeycontact: emailmobile number: +90-532-4123489
Health care | Risk factors | Main actors & prevention methods | Cardiac Rehab. | Prevention activities | Future
The state provides health services through 5 different governmental health insurance schemes that operate under a common General Health Insurance scheme. Governmental insurance covers the majority of Turkish citizens. The number of private insurance companies is increasing but most of their customers have also governmental coverage. The majority of the citizens are followed by a family practitioner, but they are also free to attend to hospitals or specialist. Prevention is the main target of the government and every regulatory effort is taken to promote healthy lifestyle habits. Implementation actions may also be taken by local municipalities. Cardiac rehabilitation is recently covered by general health insurance scheme with a small reimbursement, but needs considerable improvement in the following years.
Turkey is among the countries with highest CV mortality in Europe. Total mortality rate is 5‰ and mainly due to CV Disease (37.9%). The prevalence of major CV risk factors in recent surveys are as follows:
Standard risk factors, especially high cholesterol level, fail to identify a large proportion of individuals at high coronary heart disease risk, whereas inflammatory markers and type-2 diabetes are far more pertinent in this regard, particularly in Turkish women, than in Western populations. Risk factors related to unhealthy life style habits are on the rise in children and youth.
Ministry of Health controls Social Security Institution and General Health Insurance scheme, coordinates the main preventive projects according to the National Heart Health Policy. Social Security Institution provides all healthcare mainly through family practitioners, state and university hospitals. Nurse-based programmes and cardiac rehabilitation centres are lacking in Turkey.Turkish Society of Cardiology (TSC) is heading the preventive activities by arranging campaigns and endorsing ESC guidelines.Other national medical societies are also very effective in providing education and research in specific cardiovascular risk factors.
The concept of cardiac rehabilitation (CR) is not acknowledged enough in both public and private health sector in Turkey. Cardiologists and cardiovascular surgeons are not sufficiently demanding and awareness of health professionals on this issue is quite low. Therefore, cardiac rehabilitation practices could not become common enough and do not allow for routine service.
Turkish Ministry of Health and Turkish Society of Cardiology created a National Heart Health Policy that aims to decrease the burden of CV disease and its risk factors in Turkey in 2006.
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