Integrated foresight for the healthcare sector in Turkey

Submitted to International Journal of Foresight and Innovation Policy, April2007

Integrated Foresight for the Healthcare Sector in Turkey

Özgür KalanSiemens A.S., Corporate Strategies and Consulting Department,TR-34870 Kartal, Istanbul, TurkeyFax: +90 216 459 3915 E-mail: [email protected]

Alper Alsan*Siemens A.S., Corporate Strategies and Consulting Department,TR-34870 Kartal, Istanbul, TurkeyFax: +90 216 459 3915 E-mail: [email protected]* Corresponding author

Abstract: The accelerated globalization is opening up thefrontiers of countries to increased competition and societalchange. In order to manage this highly complex environment,more and more countries are developing capacities to carry outforesight studies on corporate, sectoral and national levelsand link it to their innovation policies. Sectoral foresightstudies had a slower start in Turkey compared to nationalstudies. In this paper, an integrated foresight process isintroduced which enables the integration of two differentmethodologies, i.e. Delphi and system dynamics modelling, witha balanced approach and hence the creation of future-relatedknowledge for sectors. The case study of the integratedforesight for the healthcare sector in Turkey is presented.With the integrated foresight process, a sector can create newfuture-related knowledge by answering critical questions aboutthe future and defining the causal loops in the sector systemin order to develop strategic action-plans for the future.

Keywords: sectoral foresight, integrated foresight, healthcare,Turkey, Delphi, system dynamics

Biographical notes: Alper Alsan, PhD (Engineering and Technology Management), has been the director at the Corporate Strategies and Consulting Department of Siemens A.S. since 2001.

mailto:[email protected]

mailto:[email protected]


Özgür Kalan, MSc (Business Administration), has been a consultant at at the Corporate Strategies and Consulting Department of Siemens A.S. since 1999.

Acknowledgements: We would like to thank to Mr. Ufuk Eren – thedirector of Medical Solutions of Siemens A.S. for sponsoring this research and Prof. Dr. Haldun Akpinar at Marmara University for his academic support.

1. Introduction

The accelerated globalization is opening up the frontiers ofmany countries to increased competition and societal change. Inorder to manage this highly complex environment, more and morecountries are developing capacities to carry out foresightstudies and link it to their innovation policies. Foresightstudies are being implemented on corporate, sectoral andnational level.

In Turkey, the national planning efforst of the stateunder the State Planning Organization in the 1960s was aforerunner of national foresight studies. In 1980s and 1990s,the science and technology policy documents were partiallyutilizing foresight methodologies. Especially, in the turn ofthe century, the Vision 2023 project by the Turkish Science andTechnology Foundation was the first generally accepted nationalforesight study.

Sectoral foresight studies had a slower start in Turkeycompared to national studies. First pilot studies on the sectorlevel were carried out between 2000 and 2003 (Alsan, 2003). Theobservations from these studies were the difference of timeforecasts of the events in Delphi studies between the domesticand abroad studies, the need to diversify the content of the


studies with the introduction of different methodologies tocreate future-related knowledge, the need to increaseparticipation, the positive contribution of activeparticipation of sectoral leaders to the study results, theinclusion of experts and practitioners and the need forassessment of the learning efficiency during the foresightprocess.

In this paper, an integrated foresight process isintroduced which enables the integration of two differentmethodologies with a balanced approach and hence the creationof future-related knowledge about the sector. The aim of thispaper is to show the results and the benefits of an integratedforesight process for strategic target setting of a sector.This study reports one of the recent sectoral foresight studiesin Turkey. The study was carried out in the healthcare sectorof Turkey in the last quarter of 2005 and first quarter of2006. The study was led by sectoral leader, i.e. the directorof Siemens Turkey Medical Solutions. The participants wereselected opinion leaders, investors and business executivesfrom two leading private sector organisations of Turkey, e.g.ACHE-TEN (American College of Healthcare Executives, Turkey)and TIPGÖRDER (Medical Imaging Association).

After the introduction in section one, a short overview ofthe healthcare sector in Turkey will be presented in sectiontwo. In section three, the integrated foresight proces will beintroduced. In section four, the case of the healthcare sectorin Turkey will be discussed in detail. In the last section,conclusions will be drawn and recommendations for futureresearch will be proposed.

2. Healthcare sector in Turkey

The healthcare sector in Turkey has been undergoing a changeprocess in the last 5 years. The reason for this process istwo-fold: 1) the changing demographics and 2) the changingactors. Therefore, the short overview presented in this sectionwill cover these two issues.


2.1 Demographics

In the 67 years between 1935 and 2002, the life expectancy ofthe Turkish people increased by 22,4 years for men and by 24,7years for women. The current forecasts of life expectancy are71 years for women and 67 years for men. These figures arestill less than the European Union (EU) averages, 81 years forwomen and 74 for men. However, there are regional differenceswithin Turkey as well. On the other hand, the annual growthrate of the population by 1,5% is significantly larger than theaverage growth rate of the EU population which is 0,6%. With atotal population of 72 million in 2006, Turkey belongs to themost populated 20 nations in the world (MoH, 2004).

2.2 Actors

In Turkey, the Ministry of Health (MoH) is the responsiblegovernmental body for policy-making and implementation of thenational health programmes. The Turkish healthcare sector is afairly complex system. The direct and indirect agents of thesector is presented in Figure 1 according to their functions,i.e. policy formulation, administrative jurisdiction, financeand provision of services.

Figure 1 Agents by function of the Turkish healthcare sector

POLICY FORMULATIONThe ParliamentThe State PlanningOrganizationThe MoHThe Higher Education CouncilThe Court of Constitution

ADMINISTRATIVE JURISDICTIONThe MoHProvincial Health Directorates

FINANCEThe Ministry of Finance

PROVISION OF HEALTHCAREPublicThe MoHSocial Insurance OrganizationUniversity HospitalsThe Ministry of Defense

PrivatePrivate HospitalsFoundationsPrivatePractitioners/SpecialistsOutpatient ClinicsLaboratories and Diagnostic


Social Insurance Organization Private Insurance CompaniesSelf Funded SchemesInternational Agencies

CentersPharmacies

PhilanthropicRed CrescentFoundations

The people of Turkey are served both by public and privatehealthcare service providers. The three dominant providers arethe MoH, Social Insurance Organization and the universityhospitals. Other ministries such as defense, transportation andeducation, some governmental organizations and municipalitiesoffer limited capacities. The MoH is still the main provider ofprimary and secondary healthcare, the maternal healthcare andfamily planning services. Social Insurance Organizationprovides secondary healthcare and some primary healthcareservices. However, in the last 5 years, an increase of theprivate healthcare providers was observed in the market wherenew players entered with foreign collaborators in the form ofhospital chains. Some examples are the Acıbadem Group withJohns Hopkins and the Anadolu Health Center with HarvardMedical School.3. Integrated foresight: theoretical background and conceptual

framework

Creating new knowledge presumes that individuals recogniseuseful data and information, and are able to transform it,through some process, into knowledge that brings future valuefor the organisation (Senge,1990). In the last 50 years, a bodyof work for different foresight methodologies have beencreated. A recent study by Halal and Bojes (2005) points outthe top 5 most trusted and beneficial methodologies:scenarios, one-to-one interviews, delphi, media contentanalysis and system dynamics modelling.

Out of these five, especially Delphi and system dynamicsmodelling are methodologies which can create new knowledgeabout the future. One-to-one interviews can be used during thepreparation phases as well as media content analyses where noparticipation is required. Scenarios explore the simultaneousimpact of various uncertainties by changing multiple variablesat a time, and describe very complex models that cannot be


formally modelled (Coates, 2000; Schoemaker, 1997). However,scenario planning also requires variables and models which canbe created by using Delphi and system synamics modelling.

3.1 Delphi

Created by Olaf Helmer and Norman Dalkey in 1953 at the RANDcorporation to address a future military issue, the techniquebecame popular when it was applied a decade later to largescale technological forecasting and corporate planning (Helmer1983). From this beginning, the Delphi technique found its wayinto private corporations, think tanks, government, educationand academia. With such proliferation of use, the techniquealso came to be modified to the point where we now have afamily of `Delphi-inspired techniques' in a broad range ofapplications (Martino 1973, van Dijk 1990). Since 1953, muchhas been discussed about the process and the pro’s and contra’sof Delphi and also the circumstances under which it would bebest to employ Delphi (Linstone and Turoff, 1975; Gordon,2003).

3.2 System Dynamics Modelling

The system dynamic modelling was founded by Forrester in 1956.Forrester (1961) mentioned that causal loop diagrams cancapture the rich array of interdependencies and feedbackprocesses in any organisation and its environment. Since then,causal loop diagrams have been used mainly as a bridge betweensystem insight and system modelling (Richardson and Pugh, 1981;Roberts et. al. 1983; Wolstenholme, 1990). The casual loopdiagrams can be built with less time and efforts than asimulation model and it can give important insights andunderstanding that clients demand (Colyle, 1998; Eden, 1988).

3.3People-System-Organisation Approach

People-System-Organisation (PSO) framework stems from the GoalDirected Project Management Methodology of Andersen, Grude andHaug (1995). The greater part of project literature concernstechnical projects, such as construction of bridges, roads,airports or oil platforms. But there should be a broaderperspective for project management. PSO projects are projects


where development of a “system” (a physical product or object),development of “people” (members or customers of thatorganization), and ”organizations” (which produce procedures.)will occur simultaneously as in foresight processes.

3.3 The conceptual framework for integrated foresight proces

Based on the above mentioned methodologies and approaches, theintegrated foresight approach was developed as in Figure 2. Therationale behind this approach is to use the knowledgegenerating methodologies, i.e. Delphi and system dynamicsmodelling, with an balance PSO approach where people element isreflected in sector leader and sector-specific reference group,system element is reflected in the outputs of the twomethodologies and organisation is reflected in workshops andone-to-one interviews/consultations.

The process starts with finding information sources andassessing the benefits and costs of these sources such that thevaluable information sources could be retrieved. The sectorspecific reference groups is determined and the sector-specificquestions are prepared with an expert subgroup of the referencegroup via one-to-one interviews.

In the second phase of the process, the Delphi study iscarried out. Two rounds are carried out with a workshop betweenthem in order to increase information sharing. The input forthe workshop are the round 1 results. The first output of theworkshop is the qualitative feedback on Delphi round 1 resultsand the second output is the theme presentations which weredetermined by the sectoral leader with consultation the expertsubgroup The second round of the Delphi is conducted at the endof the workshop.

The input for the final phase is the round 2 results.Using the quantitative as well as qualitative results of round2, system dynamics modelling is used to create the causal mapof the sector. This map is shared with the sector-specificreference group to come to a strategic action-plan regardingthe future of the sector.

Figure 2 Integrated Foresight Process


4. The case of integrated foresight for Healthcare sector inTurkey

4.1 Delphi study

The Process

After finding and assessing the information sources from MoHand preparing the questions with a selected sector specificreference group, the first round of the Delphi study started onNovember 29th, 2005 with an e-mail to the participants whichalso included the announcement of the “Healthcare 2015”workshop. The e-mail also directed the participants to the web-site of the Delphi survey. The first round ended on theDecember 12th, 2005.

At the “Healthcare 2015” workshop in March 3rd, 2006, theresults of the first round were presented. After thepresentations, the participants were allowed to make comments

DelphiRound 1

DelphiRound 2

Find and assessinform ation sources

W orkshop

Preparesector-specificquestions

Determ inesector-specificreference group

SystemDynam icM odelling

input:•Round 1 Results

output:•Feedback on Results•Them e Presentations

input:•Round 2 Results

output:•Causal M ap•Strategic Action Plan


about the results and these comments were recorded by note-taking. The participants also listened and shared theirfeedback to the five theme presentations during the workshop.At the end of the workshop, the second round was carried outand finished on the same day.

Participants

The participants of the Delphi survey and “Healthcare 2015”workshop were selected opinion leaders, investors and businessexecutives from two leading private sector organisations ofTurkey, e.g. ACHE-TEN (American College of HealthcareExecutives, Turkey) and TIPGÖRDER (Medical ImagingAssociation). The number of invited members were 140 where 45of them participated in the first round of the Delphi study.The number of workshop participants was 70. The number ofparticipants for the second round was 22. The participation atthe workshop was 50%. For the first round this rate was 32% andin the second round, it increased to 49%.

The participants were also asked to name the number ofyears they have been working in the healthcare sector. Theresults in Table 1. show that in the first round 82% of therespondents have 5 or more years of experience. The share ofthis kind of respondents increased to 91% in the second round.An interesting observation is that the share of respondentswith more than 15 years of experience showed the greatestinterest in foreseeing the next 15 years in the second roundwith 68% which increased from 42% in the first round. Therespondent with 3-7 years of experience literally disappearedin the second round.

Table 1. The distribution of the respondent’s years of experience

in the healthcare sector during the Delphi roundsNumber of years in the healthcare sector

Round 1 Round 2

0-3 years 11,1% 9,1%3-5 years 6,7% 0%5-7 years 11,1% 0%8-10 years 8,9% 9,1%


10-15 years 20,0% 13,6%More than 15 years 42,2% 68,2%Participants 45 22

Survey structure

The time dimension of the Delphi survey was 10 years since thegoal of the study was to foresee 2015. The questions werestructured in such a way that all respondents can have equalopportunity to access the As-Is situation of the Turkishhealthcare sector. This was achieved in the questionnaire byadding the latest available figure in brackets next to theindicator.

The Delphi study had 3 main sections with 23 questions asin Table 2. in addition to the identification of theparticipant, e.g. name, e-mail, occupation and the number ofyears in the healthcare sector. The content and the structurewas designed together with two experts – one expert beingfreelance and the second one being from the Under-Secreteriatof the Ministry of Health. This balanced approach enabled afair view of the content in terms of private and publicinterests.

The first section contained the macro drivers of thehealthcare sector. These indicators were namely the demographicand macroeconomical indicators. The second section includedhealthcare specific indicators such as expenditures, number ofhospitals and personnel etc. This second section also includedexpectations about the future of the 5 main themes of the“Healthcare 2015” workshop regarding 2015. The third sectionwas a section specifically designed regarding the“Transformation Program for Healthcare” which was designed bythe Ministry of Health with the belief that it couldrestructure the future of the sector through its normativetargets. The participants were expected to assess theintentions of the program.

Table 2 The sections and its main questions of the Delphi survey Section Question


Macro Indicators Comparable Regions/CountriesRequired Data for Strategy ManagementPopulation in 2015Demographics in 2015Expected Lifespan in 2015Birth Rate in 2015Gross Domestic Product (GDP) in 2015Unemployment in 2015Share of Urban Population in 2015

Healthcare Indicators

Share of Healthcare Expenditure (HE) in GDP in 2015Share of Preventive Healthcare Expenditure in HE in 2015Share of Drug Expenditure in HE in 2015Growth rate of the hospitals until 2015Number of hospital beds per 10.000 people by2015Technology Infrastructure per 1 million people in 2015Growth rate of the healthcare personnel until 2015(WS Theme) Healthcare Finance Expectations (WS Theme) Healthcare Services Expectations (WS Theme) Healthcare Technologies Expectations(WS Theme) Healthcare Education&Employment Expectations (WS Theme) Drug Expectations

Transformation Program for Healthcare

Expectations about the intents of the “Transformation Program in Healthcare”Other Comments and Expectations

Results

In this section, we will report selected results of the Delphistudy since all results of the study can not be presentedwithin this paper. The selected results were the ones whichcreated intensive discussions during the “Healthcare 2015”workshop observed by the researchers.

Macroindicators


In the first round, around 64% responded that the population ofTurkey in 2015 will be between 80 and 85 millions as in Table3. However, in the second round this rate increased to 71%. Theresponses to “less than 80 millions”, “90-95 millions” and“More than 95 millions” almost disappeared. Hence, asignificant consensus was reached for “80-85 millions”.

Table 3 Results of the “Population in 2015” questionPopulation in 2015(2006: 72 millions)

Round 1 Round 2

Less than 80 millions 11,1% 0%80 - 85 millions 63,9% 71,4%85 - 90 millions 19,4% 28,6%90 - 95 millions 5,6% 0%More than 95 millions 0% 0%Participants 36 21

Considering demographics, the participants did not changetheir minds considerably between the two rounds as in Table 4.The development clearly shows that the share of the populationwith “0-14 years of age” will decrease from 29% in 2003 to 24%in 2015 while the share of “15-54 years of age and over” willbe stable around 59% for the same period. The share of “55years of age and over” will increase from 12% in 2003 to 18% in2015.

Table 4 Results of the “Demographics in 2015” questionDemographics in 2015 Round 1 Round 20 - 14 years of age(2003: 29.4%)

25,4% 23,7%

15 - 54 years of age(2003: 59.0%)

58,4% 59,4%

55 - 64 years of age(2003: 6.0%)

8,9% 9,2%

65 years of age and over(2003: 5.9%)

7,3% 7,7%

Participants 31 10

The expected lifespan had a very wide distribution ofresponses in the first round with 33 participants as in Table5. 21% of the participants believed that it will be less than70 years. In the second round with a good 21 participants, the


response changed. Only 5% believed that the expected lifespanwill be less than 70 years. 81% of the responses in the secondround believed that the expected lifespan will be between 70and 74 years.

Table 5 Results of the “Expected Lifespan in 2015” questionExpected Lifespan in 2015 (1990: 66,4; 2003: 68,7)

Round 1 Round 2

Less than 68 years of age 6,1% 0%68 – 70 years of age 15,2% 4,8%70 – 72 years of age 36,4% 57,1%72 – 74 years of age 33,3% 23,8%74 years of age and over 9,0% 14,3%Participants 33 21

The result of the first round for birth rates in 2015 wasbetween 1.8 and 2.0 in Table 6. However, in the second roundthis result changed and moved to between 2.0 and 2.2.

Table 6 Results of the “Birth rates in 2015” questionBirth rates in 2015 (1990: 3.0 ; 2003: 2,4)

Round 1 Round 2

Less than 1,5 6,1% 4,8%between 1.5 -1.8 18,2% 14,3%between 1.8 – 2.0 30,3% 23,8%between 2.0 – 2.2 33,3% 57,1%between 2.2 – 2.4 9,1% 0%More than 2.4 3,0% 0%Participants 33 21

In the first round, 58% of the participants estimatedthat the GDP will be more than 450 billion USD. Thispreference increased to 72% in the second round as in Table 7.

Table 7 Results of the “GDP” question


GDP in 2015 (2004: 300 billion USD)

Round 1 Round 2

between 300 – 350 billionUSD

9,1% 0%


18,2% 16,7%


18,2% 16,7%


27,3% 16,7%

More than 500 billion USD 30,3% 55,6%Participants 33 18

In the first round, 66% of the participants estimatedthat the share of urbanisation will be between 70% to 80%. Thispreference increased to 77% in the second round as in Table 8.

Table 8 Results of the “Urbanisation” questionUrbanisation in 2015 (2006: 65%)

Round 1 Round 2

Less than 65% 0% 0%between 65% - 70% 15,5% 9,1%between 70% - 75% 21,9% 31,8%between 75% - 80% 43,8% 45,5%More than 80% 18,8% 13,6%Participants 32 22Healthcare Indicators

The response to the question regarding the share of healthcareexpenditure in GDP in 2015 was rather consistent in both roundsas in Table 9. The participants responded with a strong 95%that this share will be over 6.5% and even cross the 7.0%level. The feedback included that there is a lackingtransparency about this share and the reality could be about15%. The prospect of becoming the “EU health village” couldincrease HE considerably.

Table 9 Results of the “Share of HE in GDP” questionShare of HE in GDP in 2015 (2005: 6.9 %)

Round 1 Round 2

Less than 6% 3,4% 0%between 6,0% - 6,5% 0% 5,0%


between 6,5% - 7,0% 13,8% 20,0%More than 7,0% 82,8% 75,0%Participants 29 20

Another question where a change in the opinions wasobserved was the share of drug expenditures in HE in 2015. Inthe first round only 39% of the respondents believed that thisshare will stay put as of today. However, this rate increasedto 62% in the second round where the shares of the otheranswers decreased dramatically as in Table 10. The feedbackincluded the belief that drugs are being overuses in Turkey anda decent amount of health problems arise due to the side-effects of drugs. The increase in preventive healthcare canalso dampen the drug use in the next 10 years.

Table 10 Results of the “Share of drug expenditure in HE” questionShare of drug expenditure inHE in 2015 (2005: 24.8 %)

Round 1 Round 2

Less than 15% 3,6% 0%between 15% - 20% 7,1% 4,8%between 20% - 25% 39,3% 61,9%between 25% - 30% 28,6% 19,0%More than 30% 21,5% 14,3%Participants 28 21

In the first round of the question regarding the growthrate of the number of hospital beds per 10.000 people until2015, 52% of the response was for between 10-15%. However, inthe second round, the growth rates of 5% to10% received 63% ofthe responses although the responses for more than 15% stillreceived 27% of the responses as in Table 11.

Table 11 Results of the “Number of hospital beds” questionGrowth of number of hospitalbeds per 10.000 until 2015 (2005: 24.8 %)

Round 1 Round 2

between 0% - 5% 4,0% 0%between 5% -10% 13,0% 63,0%between 10% - 15% 52,0% 9,0%between 15% - 20% 28,6% 0%More than 20% 30,0% 27,0%


Participants 29 18The participants of the Delphi and the workshop brought in notonly their expectations but also valuable feedback to thesurvey questions and workshop themes as in Table 11. Since wehave limited space for this paper, all qualitative feedbackcould not be reflected here. However, it was observed that thisintense discussion caused a significant change in the opinionsfor some questions and did not cause a change but rather showan already available consensus as in Table 4 and Table 9.

Workshop Themes

The WS themes were also a part of the Delphi survey. Thecomments and feedbacks of the respondents were collected underthe five WS topics and the five most critical ones weretabulated as in Table 12.

Table 12 Comments and Feedback to Workshop ThemesWS Theme Comments and FeedbackHealthcare Finance Expectations

Public Health Assurance will be realized

Prevention of unregistered Healthcare services

Alternative financing models, e.g. Venture Capital

Price schemes should include qualitycriteria

External sources such as EU-Funds should be articulated

Healthcare Services Expectations

Management and Leadership of healthcare services

Prevention of chronic diseases is a must

Increasing share of private sector Ethical issues gain importance Optimization of healthcare service

processes for diagnosis managementHealthcare Technologies Expectations

Increasing sahre of population as users

Infrastructure investments for IT Remote-Diagnosis gains importance Emerging radiology technologies


Avoidance of chronical diseasesHealthcare Education&Employment Expectations

Quality Controlling Specification of professionals Qualification programs for general

practitioners Lack of healthcare management

professionals Certicification of schools

Drug Expectations Adaptation to EU Alternative medicine gains

importance Decelerating drug expenditures Decreasing prices due to generic

drugs Payback systems gain importance

4.2 Causal mapping

The results of the Delphi survey, its feedback and the feedbackto the theme presentations were used as inputs for causalmapping of the sector. This input already included importantvariables and relationships for the sub-systems of the wholesystem. Archetypes were utilized to clarify the relationshipsbetween the variables. The causal map was also converted into astock-flow diagram in order to increase the transparency amongthe system elements as in Figure 3.

Figure 3 Causal map of the healthcare sector in Turkey


Bevölkerungzwischen0-16

Bevölkerungzwischen16-65

Bevölkerung65+Alternrate 1 Alternrate 2Geburtenrate

Gesam tBevölkerung

++

+

+ +Todesrate 3

Todesrate 1 Todesrate 2

+

+

+

W irkung derLebenserwartung auf

Geburtenrate

+

EffektiveAngestellte

Arbeitsloser-+Arbeitsloser

Bruch+

-

BIP+

BIP pro Kopf +-

+

Kapitalverm ögen

TechnologischesNiveau

Investitionsrate 1Abschreibungsrate1

Investitionsrate 2Abschreibungsrate2

+

+

++

vorhandenesBudget+

Budget vonGesundheitsbranche

+

Budget von anderenBranchen

+-

+

+Gesundheitsbranche

Ausgaben

+

<Gesam tBevölkerung>E pidemien

F requenz

Bevölkerung mitEpidemien

+ +

Typen vonE pidemien

+

auf FußbehandelndeBevölkerung

Bevölkerung ins Bettbehandelt

++Bett

Verbrauchsrate

+

1-BettVerbrauchsanteil +

Cost per person perbad per day

durchschnittliche Anzahlder Tage für

BettenverbrauchKosten für

Behandlung ins Bett+

+ +Kosten für

Behandlung auf FußKosten pro

Person ++

BetteInvestitionen für

Bett

<Gesam tBevölkerung>

Bett pro Person+ -

Medizinkosten proPerson, der auf F uß

behaldelt wird M edizinkostenMedizinkosten pro

Person, der ins Bettbehandelt wird

++++

Ausrüstungskosten proPerson auf F uß

behaldelt

Ausrüstungskosten proPerson ins Bett

behaldelt

Ausrüstungskosten+ +++

Kosten per Personper Operation

Operationkosten++

Operationsbruch

+

Verteilung vonGesundheitsAngestellte

Angestellte derGesundheitsbranche

+

+

Kosten proAngestellte

Arbeitskosten+

+

Artz Bruch

Aerzte+

+

<Gesam tBevölkerung>

Artz proBevölkerung

+-

Einstellungsrate

Gesam tkosten

<Kosten fürBehandlung auf Fuß>

<Kosten fürBehandlung ins Bett>

<M edizinkosten>

<Ausrüstungskosten>

++ + + +

<GesundheitsbrancheAusgaben>

Budget Lücke+

-

Population 0-16

Death rate 1 Death rate 2

Population 16-55

Population 65+ Death rate 3aging rate 2aging rate 1birth rate

Im pact of lifeexpectancy on

birth rate

GDP per capita

Totalpopulation

unem ployedunem ploym ent

G DP

Effective em ploym ent

Cost perem ployee

Distribution of healthcareem ployees

Healthcareem ployees

availablebudget

W orking Costs

< Total Population >Doctors

Doctorsper population

Doctors rate

em ploym entrate

Budget ofHealthcare Sector Budget of

other Sectors

Healthcare ExpenditureTechnology

Level

Capital Assets investm ent rate 1

investm ent rate 2

depreciation rate 1

depreciation rate 2

populationtreated on-feet

populationtreated in bed

cost for populationtreated on-feet

cost for populationtreated in bed

Cost of drugs

operational costs Total costs

< Total Population >investm ent

pro bed

Beds

Bed per person

Budget deficit< Total

Population >

<Health Expenditures>

<Investm ent Costs>

<Cost of drugs>

<Cost for treatm ent in bed>

<Cost for treatm ent on-feet>

Cost per personper operation

O peration rate

Cost per person per bed per day

Bed utilisationrate

Average spent daysper bed usage

Cost per person

Usage perbed

Typesof epidem ics Epidem y

frequency

M edical costsper person

treated in bed

M edical costsper person

treated on-feet

Investm ent costsper person

treated on-feet

Investm ent costsper person

treated in bed

Investm ent costs

populationwith epidem ics

5. Conclusions

It is clear that as nations build on national foresightcapabilities, they should also build up sectoral foresightcapabilities in order to secure the future of its sectors.Based on the recent studies regarding foresight methodologies,two methodologies which can create future-related newknowledge, i.e. Delphi and system dynamics modelling, wereintegrated under the PSO approach in order to manage this newprocess in a successful way.

The integrated foresight process was used in the beginningphase to find the effective information sources, define thereference group includin opinion leaders, investors andbusiness executives and determine the questions. The Delphisurvey with two rounds was supported with a themes workshopwith five themes which were determined with a expert sub-group.The Delphi results showed in most questions consensus and insome questions further exploration could have been helpful.


The feedback to the theme presentations and Delphi resultswere used as inputs for the causal map. Archetypes wereutilized as a helpful guide for defining the causal loops.Stock-flow diagrams were also drawn in order to increasetransparency n the model. The causal map was shared with theparticipants in order to draw action plans for the healthcaresector.

We have come up with two major recommendations for futureresearch. First, as mentioned above, some Delphi questionscould have benefited from extra rounds. In order to overcomethis, the Real-Time (RT) Delphi (Gordon and Pease, 2006)approach could be used in the future. RT Delphi does notinvolve the use of sequential rounds and as a result, greatlyimproves the efficiency of the process and shortens the time toperform such studies. RT Delphi in combination with themeworkshops could increase the efficiency of the integratedforesight process. Second, the causal map could be converted toa complete stock-flow diagram with mathematical modelling. Aweb-based version of the model could be combined with the RTDelphi approach which is already a web-based approach. Thiscould increase the quality of the integrated foresight approachas well such that sources of new future-related knowledge couldbe utilized under the same roof.


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Integrated foresight for the healthcare sector in Turkey

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