Responsible Students of Ministry:
Eleni Vlachou-Greece Elvin Tr1-Turkiye
Iliana Sideri- Greece Iviyan Petrov- Bulgaria
Niki Tsausi- Greece Rana Tr1- Turkiye
Ruslana Portna- Ukraine Savvas Efraimidis-Greece
Şerife Tr1-Turkiye Zehra Tr1-Turkiye
Toprak Efe - Turkiye Umut Loran- Turkiye

Frund Esteban - France Rana tr1- Turkiye
Mentor Teacher- Ferhat Şimşek

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Department of Health Services

Zehra,Ruslana

Best ideas for the Ideal World:

The healthcare system offers valuable education and clarification in universal health insurance, cost-efficient care through primary gatekeeping, and a strong focus on preventive health. These features, when expanded and adapted, can be integral to shaping a resilient, equitable, and sustainable healthcare system for an ideal world.

1. Affordability and Equity:

The NHIS ensures that healthcare remains affordable and accessible to all citizens, a core principle for an ideal health system.

2.Preventive Health Emphasis:

Public health campaigns (e.g., vaccination, screenings) play a vital role in improving overall population health.

3. Retention of Medical Professionals:

Addressing workforce emigration by offering competitive salaries, professional development, and improved working conditions is critical for long-term system sustainability.

Differences:

Bulgaria: utilizes a social health insurance model with compulsory contributions from employers and employees. Requires a referral from a family doctor for specialist and hospital care. Has a higher number of hospitals relative to its population. Ongoing reforms to address financing issues and improve efficiency.

Greece: More direct access to hospitals without needing a referral from a family doctor. Patients can directly access hospital services without referrals. Faces challenges with a lower number of hospitals and healthcare facilities. Reforms aimed at reducing informal payments and improving hospital management.

France: Has a mixed system with a strong public sector and mandatory health insurance, supplemented by voluntary private insurance. Patients have freedom of choice for healthcare providers but are encouraged to register with a primary care physician. Well-developed healthcare infrastructure with extensive hospital and specialist services. Continuous reforms to balance public and private sector roles and control healthcare costs.

Turkiye: Operates a universal health insurance system managed by the Social Security Institution, funded through premiums and government contributions. Emphasizes family medicine and primary care as the first point of contact. Significant investments in healthcare infrastructure, including new hospitals and modernization of existing facilities. Major health transformation program to expand

access and improve quality.

Ukraine: Recently transitioned to a mixed system with state-funded emergency and primary care, and insurance-based funding for other services.Focuses on primary care with a referral system for specialized services.Struggles with outdated infrastructure and ongoing reforms to improve healthcare facilities. Recent reforms to decentralize healthcare and introduce insurance-based funding.

Common features between partners'countries:

All countries aim to provide universal health coverage to their populations, ensuring that everyone has access to necessary health services without financial hardship.

They have compulsory health insurance systems, often funded through a combination of employer and employee contributions, as well as government funding.

Both public and private healthcare providers operate within these countries, offering a range of services from primary care to specialized treatments.

Emphasis on primary care and the role of general practitioners or family doctors as gatekeepers to more specialized services.

All these countries have undergone or are undergoing significant health system reforms to improve efficiency, access, and quality of care. This includes the introduction of e-health services like e-prescriptions and e-referrals.

Common challenges include managing healthcare financing, ensuring equitable access to services, and addressing regional disparities in healthcare provision.

Department of Health Policy and Planning

Şerife

BULGARIA:

Common features:

1- Universal health coverage (UHC)

2- Public sector dominance in healthcare

3- Rubal-urban divide

4- Financial Struggles and Healthcare System Issues

5- Aging Population and Chronic Diseases

6-Family Medicine Model

Differences:

1- Low Health Budget and High Out-of-Pocket Payments

2- Healthcare System and Quality Issues

3- Financial and Structural Challenges

4- Lack of Public-Private Partnerships (PPP)

5- Underdeveloped Health Tourism

6- Limited Healthcare Digitalization

The Most Interesting Things

Low Health Budget and High Out-of-Pocket Payments

GREECE:

Common features:

1- Universal Health Coverage (UHC) Goal

2- Dominance of the Public Sector

3- Rural and Urban Access Disparities

4- Financial Challenges in Healthcare Systems

5- Aging Population and Chronic Diseases

Differences:

1- Health Crisis and Economic Challenges

2- High Dependence on Public Health Insurance

3- Island and Regional Access Issues

4- Health Tourism

5-Healthcare Employment and Personnel Issues

The Most Interesting Things

Challenges in the Healthcare System Due to the Financial Crisis

FRANCE:

Common features:

1- Universal Health Coverage (UHC) Goal

2- Public Sector Dominance

3- Emphasis on Primary Healthcare

4- Challenges with Aging Population

5- Strong Focus on Preventive Health

Differences:

1- High-Quality Healthcare System

2- Sustainability Through Heavy Taxation

3- Private Insurance Involvement

4- Health Innovation and Research

5- Equitable Healthcare Access

The Most Interesting Things

High-Quality Healthcare System and Innovation

UKRAINE:

Common features:

1- Universal Health Coverage (UHC) Goal

2- Public Sector Role

3- Emphasis on Primary Healthcare

4- Challenges with Health Financing

5- Aging Population Issues

Differences:

1- Impact of War on Healthcare

2- Healthcare System Development

3- Donor Dependency

4- Rural-Urban Disparities

5- Health Sector Staff Shortages

The Most Interesting Things:

The Impact of War on Healthcare, donor depedency

TURKEY:

Common features:

1- aims to provide universal healthcare services and has implemented reforms toward this goal.

2- Rural and Urban Disparities

3- Financial Constraints

4- Public health systems play a significant role in all these countries.

Differences:

1- City Hospital Model

2- Experience in Migrant Healthcare

3- Health Transformation Program (Post-2003)

4- Public-Private Partnership (PPP) Model

5- Health Tourism

6- Digital Healthcare Services

7- Rapid Infrastructure Development

The Most Interesting Things:

City Hospital Model and Healthcare Transformation Reforms, Modern and Large-Capacity Hospitals, Ease of Access

Department of Medical Affairs

Toprak Efe

The Medical Affairs Department is vital across the pharmaceutical and healthcare industries, ensuring scientific accuracy, safety, and efficacy of products. Its structure and functions vary by country due to differing regulations, healthcare systems, and cultural factors.

Greece:

• In Greece, Medical Affairs focuses on ensuring compliance with European Medicines Agency (EMA) regulations while adapting to local healthcare needs. The department plays a key role in pharmacovigilance, managing relationships with healthcare professionals, and ensuring the scientific integrity of communications. Greece also emphasizes medical education and post-market safety monitoring, particularly as the country deals with resource constraints in certain regions.

Turkey:

• Turkey's Medical Affairs operates within a complex regulatory environment, managed by the Turkish Medicines and Medical Devices Agency (TITCK). The department focuses on ensuring product safety, regulatory compliance, and local clinical trials. As the healthcare market in Turkey grows, Medical Affairs is increasingly involved in market access, education, and post-launch surveillance. The role of Medical Affairs in Turkey is also influenced by government policies related to pricing and reimbursement.

Bulgaria:

• In Bulgaria, the Medical Affairs department works in alignment with European Union regulations, particularly those set by the EMA. The focus is on maintaining regulatory compliance and ensuring effective post-market surveillance. Medical Affairs teams in Bulgaria are often engaged in localizing global medical strategies to fit the regional healthcare needs and managing relationships with key opinion leaders (KOLs) and healthcare authorities. Public health initiatives also play a key role, as the country continues to improve its healthcare infrastructure.

France:

• France has a well-established Medical Affairs system, largely aligned with European Union regulations. The French National Agency for Medicines and Health Products Safety (ANSM) oversees regulatory processes. Medical Affairs in France is highly involved in clinical development, regulatory submission support, and real-world evidence generation. Given the country’s strong healthcare system, Medical Affairs departments often focus on providing medical education, managing relationships with HCPs, and ensuring compliance with pricing and reimbursement policies.

Ukraine:

• In Ukraine, Medical Affairs is evolving in response to changing regulations and a growing pharmaceutical market. The Medical Affairs department works in conjunction with the Ukrainian State Expert Center (SEС) to ensure compliance with local regulations. Due to Ukraine’s ongoing healthcare reforms, Medical Affairs plays a significant role in post-market surveillance, education, and navigating local challenges. The department is increasingly involved in aligning global strategies with regional healthcare needs and improving healthcare access.

Key Differences:

• Regulatory Environment: Greece, France, and Bulgaria follow EU standards, while Turkey and Ukraine have more country-specific regulations.

• Cultural Context: In countries like Turkey and Ukraine, building personal relationships with healthcare professionals and stakeholders is important. In France and Greece, scientific transparency and evidence are prioritized.

• Healthcare Infrastructure: France and Greece have robust healthcare systems, whereas Turkey and Ukraine are in the process of improving access and infrastructure, requiring Medical Affairs to focus more on education and market access.

In summary, while Medical Affairs serves a similar function globally, it adapts to the regulatory and cultural landscape of each country.

Department of Emergency Health Services

Elvin, Iviyan

Common features about Emergency Health Servises in Bulgaria, Greece, France, Turkey and Ukraine.

Sustained investment, mutual learning and support, and regular monitoring of progress – ministers of health and high-level delegates identified these as critical to scaling up health emergency preparedness and response in the WHO European Region.

The priorities and actions compiled in the outcome summary of the ministerial consultation and high-level meeting held on 12–14 February 2019 in Istanbul, Turkey, will accelerate coordinated action to protect people from health emergencies of any type.

“This meeting shows that we have unprecedented momentum to translate our political commitments into action,” said Dr Nedret Emiroglu, Director of Programme Management and Director of the Division of Health Emergencies and Communicable Diseases at WHO/Europe.

“No single organization, no single sector and no single country can do it alone; we need everybody on board for joint action and accountability, and we need to make sure that all sectors and all parts of society, including communities, are part of the solution,” she explained.

More than 150 European delegates gathered in Istanbul to share challenges and best practices. Together they charted a path to operationalize the Action plan to improve public health preparedness and response in the WHO European Region, which Member States agreed upon at the 68th session of the WHO Regional Committee for Europe.

DIFFERENCES (SOMETHING THAT YOU CAN’T FIND IN ANY OTHER COUNTRY)

Bulgaria - Emergency medical numberDial 112 and ask for an ambulance.

The emergency care system in Bulgaria is evolving as a hybrid of the former “Soviet-style” health service and western-style emergency medicine. Bulgaria like other “Eastern bloc” Communist nations has undergone a sweeping socioeconomic transformation during the past 10 years. These changes have had profound consequences including the development of emergency services and the recognition of emergency medicine as a specialty in Bulgaria.

Greece - 112 - European emergeny service line.

Emergency service is free in Greece, and public ambulances are available in larger cities. However, it may be challenging to find one in a rural area or on some islands. As an expat, you can dial 166 in case of an emergency.

France - For life or death emergencies, dial 112 for immediate assistance.

In France, the SAMU is the national emergency organization. It has a 24-hour service and gives medical assistance for all medical emergencies. Its ambulances are manned by teams of trained personnel, and are equipped with emergency equipment for any cardiac or respiratory resuscitation.

Call SAMU for life-threatening conditions that require the assistance of trained medical professionals. These include: cardiac or respiratory emergencies (chest pain and/or shortness of breath), severe bleeding, severe asthma, stroke, and trauma resulting in multiple injuries.

Be brief and concise when speaking with SAMU. and give the precise address or location (if at home or in another building, please indicate the floor and the door code if any), your phone number, the caller and victim’s names, the age of the victim and a description of his medical condition.

You may be transferred directly to an English-speaking specialist in the emergency services who will identify the type of emergency based upon the information you give (he/she may decide to refer your call to another ambulance service, i.e. SOS Medecins, in the case of a less critical emergency). SOS Medecins is a private company for less critical medical emergencies and house calls. They can be reached at 01 47 07 77 77.

A family member or bystander who is aware of the situation may escort the emergency medical team if needed.

Turkey - Emergency medical numberDial 112 and ask for an ambulance.

Emergency care at public hospitals in Turkey is free, but non-emergency cases may incur fees. Private hospitals charge for all services, so clarify costs upfront. Dial 112 for 24/7 emergency health services at both public and private hospitals.

Ukraine - In Ukraine, emergency medical services are provided by the Ukrainian Emergency Medical Services (UEMS), a special type of government rescue service, the main task of which is to provide free of charge medical assistance to victims, rescuers and any other persons who take part in the response to and/or recovery process after incidents of any kind.

Ukrainian Emergency Medical Service (UEMS) is a state service, that functions at both a national level (central level) and regional level.

The national level is represented by the Ministry of Health of Ukraine and the Ukrainian national disaster and emergency medicine centre.[1] At the Regional level there are 24 regional centres (one for each oblast) and a further special regional centre for the Autonomous Republic of Crimea. There are additional municipal command posts in the autonomous cities of Kyiv and Sevastopol.

What are the best things which can be used in Ideal World

Improve the responsiveness of urgent and emergency care and increase its capacity

Ensuring sufficient capacity to meet expected demand

Increase the call taking capacity of 999 and NHS 111 services.

Ensure all emergency departments have appropriate services in place to stream lower acuity patients into such as urgent treatment centres.

Scale up the use of virtual wards to care for patients who would otherwise require a hospital admission.

Review wider NHS capacity requirements against expected demand and seek to increase capacity where there are identified capacity deficits.

Recover ambulance service responsiveness

Reduce avoidable conveyance to hospital through reducing unwarranted variation in hear and treat and see and treat.

Enable senior clinical advice to be remotely available to emergency centre operations as well as paramedics and technicians at scene.

Reduce handover delays at hospital through supporting the provision of ambulance service liaison officers and sharing best handover practice to ensure ambulances are free to respond to new patients in the community.

Maximise the use of alternative urgent care pathways

Expand the use of urgent community services.

Scale up the provision of virtual wards to keep appropriate patients out of hospital.

Maximise the utilisation of same day emergency care services.

Improve the utilisation of the NHS directory of services to ensure citizens calling NHS 111 or 999 can directly access the full range of UEC services that are available locally.

Improve flow and reduce delayed hospital discharge

Implement the best practice interventions identified by the Health and Social Care Discharge Taskforce to reduce delays to hospital discharge.

Launch the Integration Front Runner programme to test new initiatives to reduce discharge delays.

Support systems to deliver an appropriate range of services seven days a week.

Department of International Health Affairs

Zehra Rana

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"Compared Laws of Countries (Similarities and Differences) for eTwinning Project "An Ideal World""

Name: Compared Laws of Countries (Similarities and Differences) for eTwinning Project "An Ideal World"
Author: FERHAT ŞİMŞEK

FERHAT ŞİMŞEK, Efe-tr7, umutsimsek, Ивиян Петров, Руслана Портная

A collaborative educational project comparing healthcare systems in Bulgaria, Greece, France, Turkey, and Ukraine, covering emergency services, pharmaceuticals, and research to propose laws for an ideal world.

(37 pages)

Privacy level: PUBLIC

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