Social Policy Forum Research Centre, Boğaziçi University, Istanbul, Türkiye.
School of Law and Government, Dublin City University, Dublin, Ireland.
BMC Health Serv Res. 2023 Feb 3;23(1):112. doi: 10.1186/s12913-023-09108-0.
The influence of healthcare system factors on treatment pathways for breast cancer has been studied extensively in lower-middle-income countries (LMICs), but in upper-middle-income countries (UMICs), this area is understudied. This article focuses on the experiences of breast cancer patients in Türkiye, a UMIC with a universal healthcare system. It explores variations in treatment pathways based on the type of health insurance provider (private or state).
The study uses an exploratory qualitative method based on in-depth interviews with 12 breast cancer patients. The inclusion criteria were Turkish nationality, female gender, and having received treatment from a private hospital within one year of the interview. A purposeful sampling strategy was employed to recruit patients who had either social health insurance only or who had private health insurance in addition to their social health insurance. A two-stage thematic analysis of the interview data was conducted. First, we examined whether the type of insurance provider makes a difference in treatment pathways; we then identified healthcare system factors that explain these differences.
The study revealed two distinct pathways to treatment. These differ in terms of financial protection, service coverage, and patients' sense of equity. Patients with private insurance reported easy access to timely and comprehensive treatment. Those without, however, had to navigate complicated routes to treatment; they generally had to resort to seeking treatment from more than one hospital. We found two healthcare system factors that explained the differences: a failure to fully enforce the mandates of the state's social health insurance in the private hospital sector and growing reliance on private insurance to gain access to essential services.
Based on data from the Turkish case, we conclude that healthcare system factors are indeed influential in shaping treatment pathways for breast cancer in UMICs with universal healthcare. These factors include a failure to fully enforce the mandates of the state's social health insurance programme in the private hospital sector and a growing reliance on private insurance to gain access to essential services. We note that this contrasts dramatically with the situation in LMICs, where the main factors are low-quality care and shortages of medical staff, medicines, and technologies.
医疗系统因素对乳腺癌治疗途径的影响在中低收入国家（LMICs）中已得到广泛研究，但在中上收入国家（UMICs）中，这一领域的研究还不够充分。本文关注的是土耳其乳腺癌患者的治疗途径，土耳其是一个拥有全民医疗保健系统的 UMIC。它根据健康保险公司（私人或国家）的类型来探讨治疗途径的差异。
本研究采用基于深入访谈的探索性定性方法，共访谈了 12 名乳腺癌患者。纳入标准为土耳其国籍、女性、在访谈前一年内接受过私立医院的治疗。采用目的抽样策略招募仅参加社会医疗保险或除参加社会医疗保险外还参加私人医疗保险的患者。对访谈数据进行了两阶段主题分析。首先，我们研究了保险提供者的类型是否会影响治疗途径；然后确定了解释这些差异的医疗保健系统因素。
研究揭示了两种截然不同的治疗途径。这些途径在财务保障、服务覆盖范围和患者的公平感方面存在差异。有私人保险的患者报告说可以轻松获得及时和全面的治疗。而没有私人保险的患者则需要通过复杂的途径来治疗；他们通常不得不从一家以上的医院寻求治疗。我们发现了两个解释差异的医疗保健系统因素：未能完全执行私营部门国家社会医疗保险的规定，以及越来越依赖私人保险来获得基本服务。
基于土耳其案例的数据，我们得出结论，医疗保健系统因素确实会影响 UMIC 中全民医疗保健的乳腺癌治疗途径。这些因素包括未能完全执行私营部门国家社会医疗保险计划的规定，以及越来越依赖私人保险来获得基本服务。我们注意到，这与 LMICs 的情况形成鲜明对比，在 LMICs 中，主要因素是医疗质量低和医疗人员、药品和技术短缺。
