{"id":2888,"date":"2009-02-13T15:21:04","date_gmt":"2009-02-13T13:21:04","guid":{"rendered":"http:\/\/www.ced.org.tr\/?p=2888"},"modified":"2014-05-21T01:37:08","modified_gmt":"2014-05-20T22:37:08","slug":"2004ten-bugune-yasanan-sorunlar-ve-surecin-genel-degerlendirmesi-1","status":"publish","type":"post","link":"http:\/\/www.ced.org.tr\/?p=2888","title":{"rendered":"2004\u2019TEN BUG\u00dcNE YA\u015eANAN SORUNLAR VE S\u00dcREC\u0130N GENEL DE\u011eERLEND\u0130RMES\u0130 – 1"},"content":{"rendered":"

\u0130la\u00e7, eczac\u0131l\u0131k ve sa\u011fl\u0131k al\u0131na yans\u0131yan, hizmetin niteli\u011fini de\u011fi\u015ftiren d\u00f6n\u00fc\u015f\u00fcm politikalar\u0131 2004 y\u0131l\u0131 ile ba\u015flad\u0131. DSP-ANAP-MHP koalisyon h\u00fck\u00fcmeti 2001 kriziyle sars\u0131lmaya ba\u015flam\u0131\u015f, imzalanan yeni \u0130MF program\u0131 da koalisyon h\u00fck\u00fcmetinin devam\u0131n\u0131 sa\u011flamaya yetmemi\u015fti. Yap\u0131lan 2002 genel se\u00e7imlerinde iktidar el de\u011fi\u015ftirmi\u015f, yerini tek ba\u015f\u0131na AKP iktidar\u0131na b\u0131rakm\u0131\u015ft\u0131. AKP iktidar\u0131 d\u00f6neminde de ekonomi politikalarda esasl\u0131 bir de\u011fi\u015fiklik olmad\u0131. Koalisyon h\u00fck\u00fcmeti d\u00f6neminde \u0130MF\u2019nin \u00f6ng\u00f6rd\u00fc\u011f\u00fc program oldu\u011fu gibi s\u00fcrd\u00fcr\u00fcld\u00fc. K\u00fcresel kapitalist d\u00fcnyadan esen neoliberal r\u00fczgar etkisini s\u00fcrd\u00fcrmeye devam etti<\/span><\/p>\n

\u00a0<\/span><\/p>\n

AKP iktidar\u0131 eliyle s\u00fcrd\u00fcr\u00fclen neoliberal politikalar en belirgin \u015fekilde sa\u011fl\u0131k alan\u0131nda boy g\u00f6sterdi.Do\u011frusu bu politikalar\u0131n sa\u011fl\u0131k alan\u0131ndaki izlerini 1990\u2019l\u0131 y\u0131llarda g\u00f6rmek m\u00fcmk\u00fcn..Program\u0131n o d\u00f6nem ki ad\u0131 \u2018Sa\u011fl\u0131kta Mega Reform Projesiydi\u2019. Siyasi konj\u00f6nkt\u00fcr gere\u011fi bu program uygulanamad\u0131. Ama \u00fclke g\u00fcndemindeki yerini hep korudu.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u0130MF ve D\u00fcnya Bankas\u0131 destekli bu program geli\u015fmekte olan t\u00fcm \u00fclkelerde uygulamaya konan tek tip bir sa\u011fl\u0131k program\u0131yd\u0131. Program\u0131n \u00f6z\u00fc ise; sa\u011fl\u0131\u011f\u0131n \u00f6zelle\u015ftirilmesi, neoliberal politikalar do\u011frultusunda serbest piyasa d\u00fczenine entegre edilmesiydi. \u0130\u015fte bu program 2004 y\u0131l\u0131nda AKP iktidar\u0131 eliyle hayata ge\u00e7irildi.1990\u2019l\u0131 y\u0131llarda ad\u0131 \u2018Sa\u011fl\u0131kta Mega Reform Projesi\u2019 olan program ad\u0131 AKP iktidar\u0131 d\u00f6neminde \u2018Sa\u011fl\u0131kta Devrime\u2019 d\u00f6n\u00fc\u015fm\u00fc\u015ft\u00fc!<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Sa\u011fl\u0131kta devrim, hizmetin niteli\u011finde toplumdan yana k\u00f6kl\u00fc de\u011fi\u015fikliklerin g\u00fcndeme geldi\u011fi, hizmetin herkesin ihtiya\u00e7lar\u0131na g\u00f6re ve paras\u0131z olarak sunuldu\u011fu, nitelikli bir kamusal sa\u011fl\u0131k hizmetinin \u00fcretilmesi demektir. Yap\u0131lan i\u015fin \u00f6z\u00fc ise hizmetin \u00f6zelle\u015ftirilmesi ve paral\u0131 hale getirilmesiydi!<\/span><\/p>\n

Paran kadar sa\u011fl\u0131k hizmeti modeli sa\u011fl\u0131kta devrim olarak yutturulmaya \u00e7al\u0131\u015f\u0131ld\u0131!<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2004 y\u0131l\u0131nda sa\u011fl\u0131kta g\u00fcndeme gelen bu transformasyon politikalar\u0131n\u0131n, ila\u00e7 ve eczac\u0131l\u0131k alan\u0131na da ciddi etkileri oldu. Sa\u011fl\u0131kta yayg\u0131n \u00f6zelle\u015ftirme politikalar\u0131n\u0131, SSK eczaneleri ve ila\u00e7 fabrikalar\u0131n\u0131n tasfiyesi izledi. Sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcm politikalar\u0131n\u0131n gere\u011fi olarak yap\u0131lan bu tasfiye s\u00fcreci, d\u00f6nemin TEB y\u00f6netimi taraf\u0131ndan \u201cSSK ila\u00e7 pazar\u0131n\u0131 serbest eczanelere kazand\u0131rd\u0131k\u201d diye lanse edildi. Bu tasfiye s\u00fcreci sonras\u0131nda emekli sand\u0131\u011f\u0131, ba\u011f-kur ve ssk sistemleri sosyal g\u00fcvenlik kurumu \u015femsiyesi alt\u0131nda birle\u015ftirildi. SGK ismi o tarihten ba\u015flayarak literat\u00fcr\u00fcm\u00fcze yerle\u015fmeye ba\u015flad\u0131. Ve devlet ad\u0131na ila\u00e7 al\u0131m ko\u015fullar\u0131n\u0131 belirleyen, ila\u00e7 ve sa\u011fl\u0131k alan\u0131n\u0131 d\u00fczenleyen, kurallar koyan bir kurum haline geldi.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Yeni d\u00f6nemde SGK, provizyon sistemi, protokoller, s\u00fcrekli de\u011fi\u015fen kurallar s\u0131k\u00e7a g\u00fcndemimizde yer almaya ba\u015flad\u0131.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2004 Y\u0131l\u0131nda ba\u015flayan sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcm\u00fcn \u00f6nemli sac ayaklar\u0131ndan biride ila\u00e7 fiyat kararnamesiydi. \u0130la\u00e7 ve eczane alan\u0131n\u0131 do\u011frudan etkileyen bu kararname ile maliyet esas\u0131na dayanan fiyatland\u0131rma sistemi yerini referans fiyat sistemine b\u0131rakt\u0131. \u0130la\u00e7 fiyatlar\u0131 euro \u2019ya<\/span><\/p>\n

endekslendi. Referans fiyat uygulamas\u0131n\u0131n eczane ekonomilerine ciddi bir maliyeti oldu. Eczanelerde bedelsiz kamula\u015ft\u0131rma d\u00f6nemi ba\u015flad\u0131.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u0130la\u00e7 fiyat kararnamesiyle eczac\u0131 k\u00e2rl\u0131l\u0131\u011f\u0131 tarihinde ilk kez de\u011fi\u015ftirildi. \u0130la\u00e7 fiyatlar\u0131na g\u00f6re kademelendirildi. Y\u00fczde 25 olan eczac\u0131 k\u00e2rl\u0131l\u0131\u011f\u0131 fiyat\u0131 0-10YTL olan ila\u00e7larda %25,10-50YTL<\/span><\/p>\n

\u0130la\u00e7larda %24,50-100YTL aras\u0131nda %23,100-200YTL\u2019de %16 ve 200YTL ve \u00fczeri ila\u00e7larda ise %10\u2019a d\u00fc\u015f\u00fcr\u00fcld\u00fc. Eczac\u0131 k\u00e2rl\u0131l\u0131\u011f\u0131n\u0131n kademelendirilmesini, eczanelerin cirolar\u0131na g\u00f6re kademelendirilmesi izledi. Bu da eczac\u0131l\u0131k tarihinde ilk kez ger\u00e7ekle\u015ftirilen bir uygulamayd\u0131!<\/span><\/p>\n

1980\u2019li y\u0131lardan itibaren uygulanan neoliberal politikalar serbest eczaneleri kendi i\u00e7inde zaten farkl\u0131la\u015ft\u0131rm\u0131\u015ft\u0131. SGK protokol\u00fc ile var olan bu farkl\u0131la\u015fma bir bak\u0131ma resmile\u015fmi\u015f oluyordu!<\/span><\/p>\n

SSK\u2019l\u0131lar\u0131n serbest eczanelere y\u00f6nelmesi eczaneler aras\u0131 farkl\u0131la\u015fmaya yeni bir boyut kazand\u0131rd\u0131. Piramidin alt ve \u00fcst dilimlerindeki farkl\u0131la\u015fma daha da derinle\u015fti. Ve bu s\u00fcre\u00e7 10 binin \u00fczerindeki eczaneyi fiili iflas\u0131n e\u015fi\u011fine getirdi! 23 bin eczanenin oldu\u011fu bir \u00fclkede yar\u0131ya yak\u0131n eczanenin seleksiyonu meslek alan\u0131nda kar\u015f\u0131m\u0131za \u00e7\u0131kan en ciddi sorunlardan biriydi! Sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcm bu y\u0131k\u0131m s\u00fcrecini daha da tetikledi!<\/span><\/p>\n

\u00a0<\/span><\/p>\n

SGK ile yap\u0131lan protokol s\u00fcre\u00e7leri 2004 y\u0131l\u0131ndan ba\u015flayarak s\u00fcrekli sorun \u00fcretti.SGK provizyon sistemi kendi ba\u015f\u0131na bir sorun oldu.S\u00fcrekli de\u011fi\u015fen kurallar ila\u00e7 al\u0131m hizmetinde ciddi sorunlara yol a\u00e7t\u0131.Bu sorunlar\u0131n ya\u015fand\u0131\u011f\u0131 ve sorun olu\u015fturdu\u011fu alanlar ise serbest eczanelerdi!Bu sorunlar yetmiyormu\u015f gibi paral\u0131 hale getirilen sa\u011fl\u0131k hizmetleri nedeniyle vatanda\u015ftan al\u0131nan, muayene \u00fccretlerinin tahsildarl\u0131\u011f\u0131 g\u00f6revi de eczac\u0131lara y\u00fcklendi!Eczac\u0131lar tarihinde yine bir ilki daha ya\u015famak zorunda b\u0131rak\u0131ld\u0131..D\u00fcnya da e\u015fi benzeri g\u00f6r\u00fclmemi\u015f bir uygulaman\u0131n muhatab\u0131 oldu.Bu uygulaman\u0131n alt\u0131nda da yine d\u00f6nemin TEB Merkez Heyeti\u2019nin imzas\u0131 vard\u0131!<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00d6yle anla\u015f\u0131l\u0131yor ki sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcme uyum sadece AKP iktidar\u0131n\u0131n de\u011fil, TEB\u2019in de politikas\u0131 haline gelmi\u015fti.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2004 y\u0131l\u0131 ile ila\u00e7 ve eczac\u0131l\u0131k literat\u00fcr\u00fcne giren bir uygulamada ikili fiyat sistemi oldu. Art\u0131k \u00fcretilen her ilac\u0131n piyasada iki fiyat\u0131 vard\u0131. Perakende sat\u0131\u015f fiyat\u0131 ve kamu fiyat\u0131! Sosyal g\u00fcvenlik \u015femsiyesi alt\u0131nda olanlar ila\u00e7lar\u0131 kamu fiyat\u0131ndan, olmayanlar ise daha fazla para \u00f6deyerek perakende fiyat\u0131ndan sat\u0131n almak zorunda kald\u0131lar. Bu uygulama birincisi etik de\u011fildi, ayr\u0131ca sosyal g\u00fcvenlik \u015femsiyesi alt\u0131nda olmayan vatanda\u015flar\u0131 da cezaland\u0131r\u0131yordu. \u0130kili fiyat uygulamas\u0131 da sistemin \u00fcretti\u011fi sorunlardan biri oldu.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2004 y\u0131l\u0131 ile ba\u015flayan s\u00fcrecin \u00fcretti\u011fi \u00f6nemli sorunlardan biride sanayi iskontosu sorunu oldu. Devlet en b\u00fcy\u00fck ila\u00e7 al\u0131c\u0131s\u0131 olarak sekt\u00f6r\u00fc olu\u015fturan bile\u015fenlerin her birinden kamuya iskonto yapmalar\u0131n\u0131 istiyordu. Sekt\u00f6r\u00fcn bile\u015fenleri ise eczaneler, ecza depolar\u0131 ve ila\u00e7 sekt\u00f6r\u00fc olarak tan\u0131mlan\u0131yordu. Protokol g\u00f6r\u00fc\u015fmeleri ba\u015flang\u0131\u00e7ta bu eksende s\u00fcrd\u00fcr\u00fcld\u00fc. Ancak AKP iktidar\u0131na yak\u0131n bir da\u011f\u0131t\u0131m tekelinin \u00e7abalar\u0131 sonucu ecza depolar\u0131 \u00f6zel bir iltimasla bu uygulaman\u0131n d\u0131\u015f\u0131nda tutuldu. Sekt\u00f6r bile\u015fenleri olarak geriye eczaneler ve ila\u00e7 sekt\u00f6r\u00fc kald\u0131.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Protokol g\u00f6r\u00fc\u015fmeleri sonucunda ila\u00e7 sekt\u00f6r\u00fcn\u00fcn kamuya %4 ile %11 aras\u0131nda de\u011fi\u015fen oranlarda iskonto yapmas\u0131 kararla\u015ft\u0131r\u0131ld\u0131. Sanayii iskontosunun faturaland\u0131r\u0131lmas\u0131 i\u015fleminin de yine eczaneler \u00fczerinden y\u00fcr\u00fct\u00fclmesine karar verildi. Bu karar\u0131n alt\u0131nda da yine d\u00f6nemin TEB Merkez Heyetinin imzas\u0131 var! SGK ile imza alt\u0131na al\u0131nan protokol\u00fcn alt\u0131nda ila\u00e7 sekt\u00f6r\u00fcn\u00fcn imzas\u0131 yoktu. \u00d6zel bir uygulama ile ila\u00e7 sekt\u00f6r\u00fc de yasal sorumlulu\u011funun d\u0131\u015f\u0131nda tutulmu\u015ftu! Devlet ila\u00e7 sekt\u00f6r\u00fc ile ge\u00e7mi\u015fte oldu\u011fu gibi ayr\u0131 bir pr\u0131tokol yapabilir yada ila\u00e7 fiyatlar\u0131 yap\u0131lan iskonto oranlar\u0131nda geri \u00e7ekilerek bu sorun, sorun olmaktan \u00e7\u0131kar\u0131labilirdi. Sistemi eczaneler \u00fczerinden y\u00fcr\u00fctmeyi al\u0131\u015fkanl\u0131k haline getiren SGK b\u00fcrokratlar\u0131 bununda kolay yolunu bulmu\u015flard\u0131. Uygulama eczaneler \u00fczerinden y\u00fcr\u00fct\u00fcld\u00fc. Faturas\u0131 da eczac\u0131lara \u00e7\u0131kt\u0131. Sanayii iskontosu nedeniyle eczaneler kamuya %2-3 oran\u0131nda ek bir iskonto yapmak zorunda b\u0131rak\u0131ld\u0131.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

D\u00f6nemin TEB y\u00f6netiminin AKP iktidar\u0131n\u0131n politikalar\u0131na ve sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcme uyum ad\u0131na s\u00fcrd\u00fcrd\u00fc\u011f\u00fc politikalar\u0131n soncu olarak eczac\u0131lar sanayii iskontosunun y\u00fck\u00fcn\u00fc ta\u015f\u0131mak zorunda kald\u0131lar. Bu konuda TEB Y\u00f6netimi\u2019nin tarihi sorumlulu\u011fu hi\u00e7bir \u015fekilde g\u00f6z ard\u0131 edilemez. Bu politikalar\u0131n semeresi 2007 genel se\u00e7imlerinde g\u00f6r\u00fcld\u00fc! <\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u0130la\u00e7 firmalar\u0131 yasal sorumluluk ta\u015f\u0131mad\u0131klar\u0131 i\u00e7in sanayi iskontosunu bildikleri gibi uygulad\u0131lar. Uygulamada %0-11 aras\u0131nda 57 \u00e7e\u015fit iskonto oran\u0131 ortaya \u00e7\u0131kt\u0131. Sanayii iskontosunu hi\u00e7 \u00f6demeyen firmalarda oldu. Eksik \u00f6denen, hi\u00e7 \u00f6denmeyen iskontolar\u0131n faturas\u0131n\u0131 da eczac\u0131lar \u00f6demek zorunda kald\u0131.2009 protokol g\u00f6r\u00fc\u015fmelerinde \u00c7al\u0131\u015fma ve Sosyal G\u00fcvenlik Bakan\u0131\u2019n\u0131n ve SGK b\u00fcrokratlar\u0131n\u0131n sanal dedikleri sanayi iskontosu uygulamada eczanelerin s\u0131rt\u0131nda ciddi bir y\u00fck olarak varl\u0131\u011f\u0131n\u0131 s\u00fcrd\u00fcrd\u00fc.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00d6zetle 2004 y\u0131l\u0131nda ba\u015flayan sa\u011fl\u0131kta d\u00f6n\u00fc\u015f\u00fcm politikalar\u0131 ile sistemin ila\u00e7 aya\u011f\u0131na serbest eczaneler yerle\u015ftirildi, a\u011f\u0131rl\u0131kl\u0131 y\u00fck\u00fcn\u00fc eczaneler \u00e7ekti. Sistem serbest eczaneler \u00fczerinden y\u00fcr\u00fct\u00fcld\u00fc ve b\u00f6ylece sa\u011fl\u0131kta oldu\u011fu gibi eczanelerde de y\u0131k\u0131m s\u00fcreci ba\u015flam\u0131\u015f oldu!…<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Devam edecek\u2026..<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

\u0130la\u00e7, eczac\u0131l\u0131k ve sa\u011fl\u0131k al\u0131na yans\u0131yan, hizmetin niteli\u011fini de\u011fi\u015ftiren d\u00f6n\u00fc\u015f\u00fcm politikalar\u0131 2004 y\u0131l\u0131 ile ba\u015flad\u0131. DSP-ANAP-MHP koalisyon h\u00fck\u00fcmeti 2001 kriziyle...<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[51],"tags":[],"class_list":["post-2888","post","type-post","status-publish","format-standard","hentry","category-ecz-rafet-sahin"],"aioseo_notices":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/2888","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2888"}],"version-history":[{"count":1,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/2888\/revisions"}],"predecessor-version":[{"id":3980,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/2888\/revisions\/3980"}],"wp:attachment":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2888"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2888"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2888"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}