The effect of diagnosis-related groups on clinical autonomy in Turkey: The physician's perspective

Since the 2003 Health Transformation Programme, Turkey's health care system has been subjected to significant changes in financing, provision, and regulation. The diagnosis-related groups (DRGs) is among these regulations, which was fully introduced in 2013 to control increasing health care spending and secure efficient utilization of resources through standardization of reimbursement for medical services. This thesis explores physician perceptions of the impacts of the Health Transformation Programme and more specifically of the DRGs on their clinical autonomy. The thesis relies on an exploratory qualitative study that includes 14 in-depth semi-structured interviews with physicians from different specialities working at public and private hospitals (excluding university hospitals). The findings of this research reveal that physicians perceive clinical autonomy as key to appropriately performing their profession based on scientific evidence, and they feel that the reform and the DRG model negatively affected their clinical autonomy. The thesis argues that the implementation of the diagnosis-related group transformed medical practice into an optimization problem that involves balancing incomes and expenses of the hospitals and meeting the medical needs of patients. While the thesis demonstrates that physicians still enjoy a partial autonomy in navigating the DRG model by resorting to formal and informal strategies to serve the patients, the overall impact that these strategies have may remain limited unless the problems of the DRG model are addressed systematically.