Investigation of factors affecting perceived access to health services: The case of İstanbul

In this master's thesis, the perception of individuals' access to health services and the factors affecting this perception are analysed in the province of İstanbul. The main purpose of this thesis is to demonstrate that access to health services is not only limited to physical proximity. At the same time, it is also aimed to reveal that multidimensional factors such as the individual's ability to access to the service, acceptability of the service, economic affordability and technological infrastructure affect this process in a decisive way and to formulate recommendations. In this context, community members living in four different districts of İstanbul (Bakırköy, Başakşehir, Küçükçekmece and Ümraniye) were sampled and data were collected and analysed through the 'Perceived Access to Health Services Scale'. The scale consists of four sub-dimensions: accessibility, availability, suitability and acceptability. When the findings of the research were evaluated, it was determined that the participants had the highest level of accessibility perception. On the other hand, it is among our findings that there are serious problems in the accessibility dimension. Especially the difficulties experienced with the individual who had problems with physical access to Çam Sakura City Hospital located in Başakşehir district were an effective factor in the formation of this perception. Especially due to the high economic burden of health services, the capacity of public health institutions is insufficient to meet the expectations in terms of quality. This situation negatively affects the satisfaction level of the individuals participating in the research at a high rate. It is noteworthy that the perception of access is weaker in individuals with low socioeconomic status. It reveals that inequalities continue due to this problem in health services. On the other hand, while higher perception of access is found in individuals who have access to technological tools, on the contrary, it creates a low perception in those who cannot access to technological tools. This thesis shows that trust in Turkey's health system, perception of service quality and health policies are shaped by individual experiences. This thesis emphasises the necessity of an equal, sustainable and inclusive health system design for Turkey in line with the results obtained with the findings.