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  • In the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases espec...ially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.Show more
    Rashed OA,Sabbah HA,Younis MZ,Kisa A,Parkash J
    Evaluation and program planning
  • This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where tran...splant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16,277 for the first year; the estimated cost of HD per patient averaged US$16,085 per year--nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life.Show more
    Younis M,Jabr S,Al-Khatib A,Forgione D,Hartmann M,Kisa A
    Inquiry : a journal of medical care organization, provision and financing
  • Electronic health records (EHRs) store health-related patient information in an electronic format, improving the quality of health care management and increasing efficiency of health care processes. H...owever, in existing information systems, health-related records are generated, managed, and controlled by health care organizations. Patients are perceived as recipients of care and normally cannot directly interact with the system that stores their health-related records; their participation in enriching this information is not possible. Many businesses now allow customers to participate in generating information for their systems, strengthening customer relationships. This trend is supported by Web 2.0, which enables interactivity through various means, including social networks. Health care systems should be able to take advantage of this development. This article proposes a novel framework in addressing the emerging need for interactivity while preserving and extending existing electronic medical data. The framework has 3 dimensions of patient health record: personal, social, and medical dimensions. The framework is designed to empower patients, changing their roles from static recipient of health care services to dynamic and active partners in health care processes.Show more
    Almunawar MN,Anshari M,Younis MZ,Kisa A
    Inquiry : a journal of medical care organization, provision and financing
  • Pneumococcal infection is an important and preventable cause of morbidity and mortality. The Turkish government introduced 7-valent pneumococcal conjugate vaccine (PCV) into the national immunization ...program in 2009. This suggests that replacing 7-valent PCV with a higher-valent version could at least maintain standard of care if not improve it, and that it could be affordable.Show more
    Türel O,Kisa A,McIntosh ED,Bakir M
    Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
  • Since the Black and Sholes published their work in option pricing in 1973, there have been a great number of dissertations, theses, and articles published on options pricing. Several articles discusse...d American options and European options. Many articles where empirical in nature. In this article, we review some of the literature in this area and then discuss in a descriptive way the effect of pharmaceutical companies announcements of new drugs on the market or drug withdrawals from the market on their stock options. This article should be the beginning of the discussion on how stock prices might affect the cost of drugs and the affect of the affordability of drug prices, if any.Show more
    Younis MM,Younies H,Kisa A,Hartmann M,Hussain AA,Al-Amro A
    Journal of health care finance
  • Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activitie...s can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospitals reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.Show more
    Tengilimoglu D,Yesiltas M,Kisa A,Dziegielewski SF
    Health marketing quarterly
  • The objectives of this study were to analyze the current structure of the Turkish pharmaceuticals market to explain the latest developments and to offer some insight into the likely policy issues that... this sector will face.Show more
    Kisa A
    International journal of technology assessment in health care
  • To thrive in this era of global competition, all organizations must explore new managerial approaches to get an edge in the marketplace. One increasingly appealing approach is outsourcing. Hospitals particularly fertile environments for outsourcing, given their role as providers of a broad and complex array of services, many of which may be bought from other institutions. The purpose of this study is to determine the types of services that hospitals in Turkey buy from other organizations. The study sample included 14 university hospitals, 20 Ministry of Health Hospitals, 15 Social Insurance Organization Hospitals and 31 private hospitals in Istanbul, Ankara, Izmir, Antalya, and Eskisehir, which are the biggest cities in Turkey. The following services were found to be outsourced: hospital management information systems (83.8%), cleaning services (81.3%), maintenance services (72.5%), leased medical devices (75.0%), food services (60.0%), patient direction services (63.8%), magnetic imaging services (60.0%), other imaging services (48.8%), laboratory services (42.5%), security services (38.8%), laundry services (36.3%), patient transportation services (33.8%), accounting services (26.3%), ambulance services (22.5%), patient satisfaction measurement services (13.8%), consultancy services (12.5%), and financial and investment services (9.5%). Private hospitals bought more services than public facilities did. The sampled hospitals chose to outsource services in order to decrease costs (78.8%), increase the quality of services rendered (65.5%), increase flexibility and share risk (36.6%), and increase profits (11.2%). The results of this study suggest that outsourcing, when applied judiciously through cost and risk analysis, is a cost-effective approach that can be used by most hospitals.Show more
    Yigit V,Tengilimoglu D,Kisa A,Younis MZ
    Journal of health care finance
  • Many countries are currently struggling with the public desire for improved health care and provision of basic services on the one hand, and the rising costs of health care on the other. Turkey is acu...tely experiencing this problem because of its relatively advanced level of economic development and its relatively low level of health status compared to Organization for Economic Cooperation and Development and European Union countries. Since 1990, there has been vigorous debate in the Turkish society regarding the best way to improve public health through improved primary health care. The current government is pursuing a proposal that has been mentioned before, but in a more serious effort than has been previously made. This is an approach to primary care based on systems such as those in the United Kingdom and in Germany, and the basic components are family physicians who have a particular list of patients whom they provide care for. Financing of the system is to be provided with a new general health insurance scheme. In this study, 38 family practice residents at the 3 major training hospitals for this specialty completed an investigator-designed questionnaire for the purpose of characterizing their concerns regarding this proposed system of primary health care delivery. The participants responses indicated that the new system, which is known as the Family Physician System, will contribute importantly toward raising the overall level of health in Turkey. Specific expected benefits include closer patient-physician relationships, increased job satisfaction on the part of family physicians, and an overall increase in income for the physicians working in the system.Show more
    Kisa S,Kisa A
    The health care manager
  • The Turkish health system is mainly financed by public sources such as taxes and premiums collected from workers. According to 2003 data, total health expenditures were 4.5% of the countrys Gross Dome...stic Product. Currently, 56% of the system is financed by the Ministry of Health, and services are also provided by the Ministry. The main sources of finance among the Ministry of Health hospitals are general budget contributions made by the Ministry and revolving funds. The purpose of this study is to evaluate the financial conditions of those Ministry of Health hospitals that have revolving funds. The financial trends of 2514 hospitals were followed from 1996 to 2000, and financial statement analyses were conducted. The results of the study show that the Ministry of Health hospitals are not professionally administered for their financial situation and also that their financial resources are not used effectively. The hospitals had difficulty in collecting debts and had problems in cash returns. At the end of the study, policy suggestions are made for health care managers toward improving financial conditions in these public hospitals.Show more
    Ozgulbas N,Kisa A
    The health care manager
  • Several recent reports show that many physicians feel discontented and unhappy with their work situation. This could be due in part to factors such as declining social status, loss of influence on hea...lth care organizations, and reduced income. The professional life of physicians is characterized by long working days and pressure for efficiency. This threatens the quality of patient care. In this study we investigated levels of job stress as well as job and life satisfaction among a sample of 168 physicians (80 women and 88 men) who work in a large government facility in Ankara, Turkey. A self-administered questionnaire was distributed to physicians to determine factors contributing to stress and job satisfaction. The most important results of the study show that the participants were unhappy with their salary, did not have enough time to follow developments in medicine, and had a limited social life due to heavy workloads. The results of the study show that physicians who work in public facilities have low motivation due to the nature of their organizations. Public hospital working conditions and staff salaries must be improved to promote health professionals and healthy society.Show more
    Kisa S,Kisa A
    The health care manager
  • Financial officers in health facilities currently face 2 main duties. The first is to help the management team in the decision-making process and the second is to ensure the integrity of financial rep...orts to outsiders and outside agencies. A roster of 191 private outpatient clinics in Ankara was drawn up. Fourteen private hospitals and 66 private clinics were included in the study via systematic sampling. Financial officers perceptions of involvement in 46 decisions (grouped as strategic decisions, accounting and assessment, and nonfinancial decisions) were gauged using a responsive scale ranging from 1 (no involvement) to 5 (greatly involved). Involvement was defined as the extent of participation in specific decision-making issues. High involvement is assumed to be tantamount to influence and can be visualized in the extent to which financial officers could challenge plans, recommend or disapprove, or take a very significant role in reaching decisions. The results of the study show that in the dynamic environment in which health facilities operate, the financial officers role is somewhat equivocal. The study suggests that the power and influence of financial officers should be defined in such a way so as to develop a clear role for these members of the management team.Show more
    Kisa A,Kavuncubasi S,Ersoy K
    The health care manager
  • In many developing countries, healthcare administrators are currently facing challenges that are representative of those in the United States. Most healthcare administrators here are physicians with n...o formal training in healthcare administration, and this is perhaps most apparent in their difficulties with time management. The authors purpose in this study was to characterize the time management difficulties of administrators working in primary healthcare facilities of the Ministry of Healthcare. In the study, 67 healthcare administrators each completed a 31-item time management questionnaire. Of the participants, 79.1% reported that they have never attended time management courses or workshops. Although 76.1% said they were free to choose the priority of their daily tasks, only 44.8% felt they knew how much time they should allow for each activity in their daily life. These and other findings in the study suggest that the need for time management education is a well-defined target for intervention, both in university-based programs for future healthcare administrators and in workplace-based programs, such as in-service training for healthcare administrators who are already working.Show more
    Kisa A,Ersoy K
    Hospital topics
  • The purpose of this study was to compare three alternative surgical therapies for Benign prostatic hyperplasia (BPH) in terms of their cost and effectiveness in a general hospital setting in Turkey. B...PH is an important potential burden on health care resources in developing countries like Turkey, not only because of the increasing incidence of the disease, but also because of the differences in cost and effectiveness that exist among the various available treatment technologies. In this study, three alternative surgical treatments for BPH, namely open prostatectomy, transurethral resection of the prostate (TURP), and laser prostatectomy were compared in terms of their cost and effectiveness. Effectiveness was measured through the use of the International Prostate Symptom Score (IPSS) before the operation and at 3 months after. Laser prostatectomy was found to be the most costly and least effective way of treating BPH. This conclusion was valid both in terms of cost per prostate symptom score and cost per improvement of quality of life index. This study shows how a rough estimate can be made of the potential burdens that alternative treatment methods would impose on a countrys health budget.Show more
    Agirbas I,Tatar M,Kisa A
    Journal of medical systems
  • By nature, hospitals are extremely complex organizations, combining many different professional groups within an intricate administrative structure. Conflicts therefore expectedly arise between indivi...duals, groups, and departments. It is in the interest of health care administrators to periodically assess the major factors giving rise to these conflicts. In this study, a questionnaire designed to measure sources of conflict in the workplace was completed by 204 staff members at Gazi University Hospital. Of the participants, 30.9% were physicians, and 12.5% were administrators at various levels; 61.5% were female, and 38.5% were male. In terms of work experience, 52.6% of participants had worked less than 5 years at the hospital. The results of the study show that educational differences among the hospital staff were a major barrier to good communication and information flow between groups. Professionals in the same specialties experienced fewer conflicts. Another source of conflict was that resource allocation was considered unfair across departments. Although the hospital management provided an ombudsman for staff concerns, staff rarely resorted to the ombudsman because of the stigma associated with complaining. A lack of opportunity for career advancement was mentioned by 52% of the participants as a source of conflict. At present, job performance and rewards are not closely related in public university hospitals in Turkey because promotions and pay raises are strictly limited by law. Bureaucracy was also perceived to be a source of conflict, with 48.4% of participants saying that their performance was less than optimal because of the presence of multiple supervisors. This pilot study suggests that in Turkey, legislative reform is needed to give public university hospitals more flexibility regarding work incentives, open-door policies at the administrative level, and social interactions to improve teamwork among hospital staff.Show more
    Tengilimoglu D,Kisa A
    The health care manager
  • The purpose of this study was to determine the extent of inappropriate days of stay in a Turkish military hospital, and to explore the variables correlated with these. A review was made of the medical... records of surgery patients admitted to the hospital of Gülhane Military Medical Academy. To determine the appropriateness of lengths of hospitalization, a Turkish version of the Appropriateness Evaluation Protocol (AEP) was applied retrospectively. A total of 375 patientsfiles were reviewed; and 21.3% of the hospital admissions were evaluated as inappropriate. Multiple logistic regression analysis showed that inappropriate length of stay was significantly increased with relation to age, emergency status, military rank, and distance from the hospital to the patients home. The results of the study suggest that changes in physicians behavior and in the organization of hospital activities may be effective in improving the quality and efficiency of hospital care.Show more
    Teke K,Kisa A,Demir C,Ersoy K
    Journal of medical systems
  • In many developed countries, the physician/pharmaceutical sales representative relationship has increasingly become the focus of ethical questions. Given this context, the purpose of the present study... was to determine the ethical dilemmas faced by pharmaceutical sales representatives in Turkey in their relations with physicians, and to identify possible solutions. Through an investigator-designed questionnaire, the ethical problems perceived by 215 pharmaceutical sales representatives were quantitatively analyzed. Nearly all of the participants (96.7%) reported that they had faced ethical dilemmas in marketing drugs to physicians. The most commonly reported problems included paramedical requests (for free lab test kits, etc.) and the necessity of bargaining with physicians over the use of their firms drugs by offering gifts and sponsorships. The participants in the study felt that physicians were the primary source of ethical problems in the marketing of drugs, and the participants most highly ranked potential solution to these ethical problems was a better understanding, on the part of physicians, of the role of pharmaceutical sales representatives. At the end of this study, suggestions are given with a view to helping health policy makers understand and address the current controversies involving drug company representatives and physicians.Show more
    Tengilimoglu D,Kisa A,Ekiyor A
    Health marketing quarterly
  • Awareness of the activities of commercial sex workers can be an important step toward understanding the transmission of sexually transmitted infections (STIs) in developing countries. This study discu...sses how sex workers are viewed in Turkey and the process of mandatory registration. To support the information provided and the conclusions drawn, a sample of 150 sex workers who made regular visits to a STI hospital was interviewed. Information on socio-demographic characteristics, family and support information and certain risk behaviors were solicited. Recommendations for increasing preventive education are made, with considerations for increased attention and support for this group of individuals.Show more
    Simsek S,Kisa A,Dziegielewski SF
    Journal of health & social policy
  • Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors. After the Un...ited States, the countrys national defense expenditures are the highest among the NATO countries. Therefore, Turkey allocates only 3-4% of the gross domestic product for health care expenses. Overall, the health status in Turkey is the lowest among the European Union countries; infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is $120. Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage. The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%). This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people.Show more
    Kisa A,Kavuncubasi S,Ersoy K
    Journal of medical systems
  • Today, the social, economic, cultural, ethical, and political climate has given rise to an international movement, that is re-evaluating the importance of patients rights. In Turkey, as competition co...ntinues to increase between public and private hospitals, the emphasis on presenting health care services in the most advantageous way has become a focal point of debate. As a result, patients rights issues are being actively discussed in both the private and public health care sectors in the country. In this study, the development of patients rights issues in Turkey is reviewed and the results of some selected descriptive studies are summarized. Suggestions are made toward policies for effective and efficient health care provision in terms of both broad and specific issues that have arisen in the field of patients rights.Show more
    Kisa A,Tengilimoglu D
    Medicine and law
  • Sexual harassment remains a universal factor that can affect nursing performance and worker productivity in any type of health care facility. There are few studies in this area that have been conducte...d in developing countries. To measure the occurrence of sexual harassment, a questionnaire was given to 353 nurses in two different hospitals yielding a response rate of 61%. Overall, the majority of the respondents (n = 157 out of 251) reported that they had been subjected to sexual harassment in the workplace, and the harassment experience was strong enough to affect worker productivity. In addition, many nurses reported the belief that sexual harassment remains a disturbing problem in this developing country that should not be ignored. Based on these findings, implications for policy and further study are suggested.Show more
    Kisa A,Dziegielewski SF,Ates M
    Journal of health & social policy