Türkiye'de bir kamu politikası sorunu olarak yabancı doktor istihdamı: Avustralya,Birleşik Krallık ve Kanada örnekleri

• Published in: Gazi Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi Vol. 11; no. 3; pp. 43 - 77
• Main Authors: SEZER, SERDAR. Mustafa, YILDIZ, Mete
• Format: Journal Article
• Language: Turkish
• Published: Gazi Üniversitesi 2009
• ISSN: 1302-2024

Bu çalışmada son dönemlerde Türkiye'de gündeme gelen yabancı doktor
istihdamı politikası, bir sağlık insangücü politikası olarak olumlu ve olumsuz
yönleri ile değerlendirilmiştir. Bu bağlamda, doktor sayısı azlığı ve mevcut
doktorlarının ülke genelindeki dağılımında sıkıntı yaşayan ve bu sıkıntıları
aşmak için yabancı doktorları istihdam etme yoluna giden ülkelerden olan
Avustralya, Birleşik Krallık ve Kanada'nın yabancı doktor istihdam etme
politikaları incelenmiş ve uzun süredir yabancı doktor istihdam politikası
uygulayan bu ülkelerin deneyimlerinden Türkiye için dersler çıkarılmıştır.
Çalışmanın başında Türkiye'deki sağlık reformu uygulamalarından özetle
bahsedilerek, sağlık insangücü içerisinde yer alan doktorların sayısına,
dağılımına değinilmiş ve doktor sayısının yeterliliğini ve yetersizliğini savunan
görüşlere ve her iki görüşü savunanların gerekçelerine yer verilmiştir. Ülke
incelemeleri kısmında Avustralya, Birleşik Krallık ve Kanada'nın yabancı
doktor istihdam etme uygulaması detayları ile incelenmiş; ayrıca yabancı
doktor istihdam eden ülkelerdeki sorunlardan olan, bu doktorların
lisanslanması konusunda Avrupa Birliği üyesi ülkelerin lisanslama
uygulamalarından da söz edilmiştir. Bu çalışmanın sonucunda yabancı
doktorların geldikleri ülkede geçici ve kalıcı bir şekilde lisanslanması, kültür ve
dil engellerinin aşılması, ülkelerarası karşılıklı antlaşmalarla tıp fakültesi
mezuniyetlerinin tanınması ve bu konudaki bir kanunla ilgili olarak
Cumhurbaşkanı Ahmet Necdet Sezer'in veto gerekçesi gibi bir çok değişken
incelenerek Türkiye için yabancı doktor istihdamı konusunda bir politika önerileri demeti oluşturulmuş ve yabancı doktor istihdamına alternatif
olabilecek politikalardan da bahsedilmiştir.
This study examines and evaluates the positive and negative factors
concerning the health services human resources policy of employing foreign
doctors, which has been placed lately on Turkey's agenda. To this end, foreign
doctor employment policies of Australia, United Kingdom and Canada, with the
objectives of solving the doctor shortage and geographical distribution
problems, are examined and evaluated with the intention of drawing lessons for
Turkey from the experiences of these countries.
The study begins with the brief explanation and evaluation of the current
reforms in Turkey in the area of health services. While doing that, particular
attention has been given to the problems of having an inadequate number of
doctors, and the uneven distribution of doctors within the geographical regions
of the country in question. In this section, the arguments for and against the
inadequacy in numbers and uneven distribution of doctors (and other health
services personel) are presented, with the eventual objective of diagnosing the
real problem. In other words, the analysis in this section was geared towards
determining whether the number or the geographical distribution of the
doctors/other health services personel is the real problem in the case of Turkey.
After determining the real problem with the help of longitudinal and
comparative data, derived especially from fellow OECD countries, and
numerous European countries, examples to the policy of employing foreign
doctors are evaluated. To this end, examples from Australia, United Kingdom
and Canada stood out as these countries confront the problem in question for a
long time -partly due to the downfall of the British colonialism and the following
immigration of white-collar workforce, and among them doctors, to the colonist
country and its remaining colonies- therefore have a lot to offer for countries
with similar public policy problems.
The analysis shows that one of the most important issues that comes up from
the comparative analysis of foreign doctor emplyment policies is the licensing of
foreign doctors, especially in the European Union countries, as well as in
Australia and Canada. The licensing issue has a time dimension attached to it.
That is, licensing can be temporary/short time or permanent/long time. The licensing issue is also related to the prevention and the legal compensation of
doctor-related medical mistakes from a legal point of view.
A second important issue is the cultural and lingustic barriers that make it
more difficult for foreign doctors to provide high-quality service to their
patients. This issue is also related to another critical issue of patient satisfaction
from the services of doctors, that can be affected negatively by various cultural
and lingustic barriers. The patient/customer satisfaction isssue, in return, is
related to issues of performance and performance-related pay for doctors and
other health services personnel.
A third critical issue is the signing of bilateral or multilateral legal
agreements between/among countries concerning the acceptance of medical
degrees earned from different countries other than the country of employment.
This particular issue is also related to the academic Exchange programs, such
as those within the borders of the European Union, such as the Erasmus
Academic Exchange Program, of which Turkey is a part.
The final section of the study provides an overall evaluation and analysis of
the public policy decision of employing foreign doctors. Within this section, the
alternatives to employing foreign doctors, such as increasing the number of
medical students in the already existing universities, or opening new medical
schools are also taken into consideration. Another important factor in this
debate, that needs to be carefully analyzed is the veto reasons of the former
President of the Turkish republic, Mr. Ahmet Necdet Sezer, to the law
concerning foreign doctor employment. The study concludes with the overall
evaluation of all these factors stated above.