Evaluation of stakeholder views on the implementation of the chain of referral in the health system in Turkey

In every period, some regulations and innovations have been made in the field of health services in Turkey. In 2003, a comprehensive implementation plan called the Health Transformation Program (SDP) was carried out. In this context, the planned components include the creation of a widespread, easy-to-access and friendly health service system; this plan is planned to be realized by establishing health enterprises with strengthened primary health care services and family medicine, effective gradual referral chain and administrative financial autonomy. However, despite the transition from the planned practices to the family medicine system, an effective gradual referral chain application could not be implemented. With this study, it is aimed to evaluate the different aspects of the failure to implement the referral chain application. Within the scope of the study, which was carried out using the qualitative research method, the opinions of all stakeholders (family physicians, political actors, managers of secondary and tertiary health institutions, consumers) who are thought to be effective or affected by the compulsory referral chain application were evaluated. As a result of the interviews, the effects of the referral chain application on quality, cost and satisfaction in health services and whether it can be put into practice were evaluated. Data in the research; In order to reveal the views of policy-influencing actors, hospital administrators, family physicians and consumers, a semi-structured interview form was used and obtained as a result of face-to-face or zoom interviews with stakeholders. As a result of the analyses, when the views of the stakeholders are evaluated with a common approach, the majority of the stakeholders; sees the application of the referral chain as necessary, but states that it cannot be applied within the existing structure. Stakeholders stated that in order to be implemented, first of all, primary health care institutions should be developed, the level of expertise of family physicians should be developed, public awareness should be increased, the system should be supported with trainings and everyone's participation should be ensured. In addition, they stated that the referral chain application would increase the quality of care in health services, reduce costs by preventing unnecessary processes and resource use in the system, increase the satisfaction of service providers by preventing unnecessary patient load, and on the other hand, it would reduce patient satisfaction as it is seen as a restrictive practice that patients are not used to. This study reflects the views of stakeholders about the referral chain implementation and reveals the arrangements that are thought to be made in order to switch to the referral chain implementation.