Referans "Eczacı"

Ömür Çakmak Cu, 30/08/2019 - 11:43

Tüm Eczacı İşverenler
Sendikasının yaptığı ankete göre eczane sahibi eczacıların yüzde 73’ü hâlinden
hiç memnun değil. Hatta bunun yüzde 23’ü iş değişikliği yapmayı düşünüyor.
Sebebini az çok biliyorsunuzdur, kısaca değinelim.



Türkiye'de eczane işleten eczacılar son yıllarda "Sağlık harcamalarının kısıtlanması" politikalarından en olumsuz yönde etkilenen
meslek gruplarından biri hâline geldi. Sağlıkta bütçe açığından kaynaklı
olarak, diğer dikkat çeken harcamalar göz ardı edilip fatura en başta ilaç
harcamalarına kesildi. "Referans Fiyat Uygulaması" kapsamında bir
ilacın dünyadaki eşdeğerlerinden en ucuzunun fiyatı referans alınarak ilaç
fiyatları düşürüldü. Aslında bu temelde haklı ve doğru bir işti. Ancak bu süreç
doğru yönetilemediği için eczacıları madur etti. Eczacılar fiyat düşüşleri
oranında çok ciddi stok zararıyla karşı karşıya kaldılar. Maliyet ve girdileri
sürekli artmasına rağmen stok zararlarıyla birlikte, ciroların -doğal olarak-
nerdeyse %100'e varan oranlarda düşmesi eczacıları zor durumda bıraktı.
 Bu süreçte neredeyse dört-beş kat fiyatı ucuzlayan ilaçlar olduğunu
gördük. Zamanında ilaç sektörünün Türkiye'mizden büyük paralar götürmüş olduğunu
da böylelikle öğrendik. Fiyatlar düşürülsün, bir ilacın hakiki değeri ne ise
bedeli o şekilde ödensin eczacının buna itiraz ettiği yok. Nitekim her dönem
"Referanstan İlaç Fiyatı Düşüşleri" devam ediyor. Ancak bunlar yapılırken  vatandaş açısından
durum nedir, Türkiye'de sayısı 26 bini aşkın eczane ve orda çalışanlar
 açısından durum nedir, maduriyetler nasıl giderilebilir diye
bakılmalıdır.



İlaç fiyatları düşüyor da vatandaşın cebinden çıkan para düşüyor mu? Sigorta
primini ödemiş veya ödemekte olanlar dahil olmak üzere, her muayeneden ve
reçete edilen ilaç kutusu başına SGK vatandaştan "muayene ve reçete bedeli" adı altında para kesiyor. Eğer ki vatandaş
emekli statüsündeyse bu ücretler vatandaşın maaşından kesiliyor, eğer emekli
değilse Sosyal Güvenlik Kurumu adına vezneliği eczaneler yapıyor. Eczacılar
vatandaşla karşı karşıya kalıyor, bu ücretlerin devlete kesildiği anlatmakta
büyük sıkıntılar yaşanıyor.  Öte yandan birçok ilaç, fiyatını eşdeğer
referans ilaç fiyatına tam olarak çekmediği için, kurumun ödememesinden
kaynaklı çıkan fiyat farklarını da hastadan tahsil etmek yine eczacıya düşüyor.
Sosyal Güvenlik Kurumu tarafından bedeli hiç ödenmeyen ilaçlar ise cabası..
Neticede ilaç harcaması için vatandaşın cebinden çıkan para azalmadı bilâkis
arttı. Eczanelerin durumu ise gün geçtikçe daha da kötüleşiyor. Ciroların ciddi
oranda azalmasıyla düşen kârlılığın üstüne her dönem doğan yeni stok zararları
eklenince, üstüne üstük bir de gider kalemleri artınca eczaneler hızla kan
kaybediyor. Madem ki Avrupa'daki 5 ülkedeki ilaç fiyatları referans alınarak
fiyatlar düşecek, düşsün lâkin oralardaki eczanelerin durumu da referans
alınsın.



Avrupa ülkelerinde ve Dünyanın diğer ülkelerinin çoğunda; halk sağlığına
dönük kamu hizmeti ve danışmanlık yaptıkları için eczacılara "meslek
hakkı" ödenmektedir. Örneğin; Hollanda'da reçete başına 6.10 euro,
Fransa'da ilaç kutusu başına 0,53 euro sisteme girme bedeli olarak 0.10 euro,
Almanya'da reçete başına 8.3 euro, Avusturya reçete başına 4.8 euro, İngiltere
reçetelenen ürün başına 90 peni ambalaj ödeneği olarak 3,24 peni, ABD'de reçete
başına 9 dolar meslek hakkı ödenmektedir. Referans göstererek fiyat düşürülen
ülkelerde eczanelerin yaşatılması ve itibarını koruyabilmesi için referans
uygulama genellikle budur. Ne var ki Türkiye'mizde eczacıların meslek hakkı
talebine henüz olumlu yanıt verilmemiştir. Bahane olarak SGK, ilaç bedeli
ödemelerinin %40'ının sadece 1000 küsür eczaneye yapılmakta olduğunu, eğer
meslek hakkı ödenirse bu tutarları ödemenin bütçeyi zorlayacağı gibi bu uygulamanın
eczacıların çoğunluğuna değil zengin küçük bir azınlığına (%4'üne) yarayacağını
öne sürmektedirler. Halbuki bu durumu eczacıların çoğunluğunun leyhine çevirmek
öyle zor bir iş değildir. Meslek hakkı uygulamasında ortalama bir üst sınır
koymak veya reçete sayısına göre meslek hakkı belirlemek suretiyle ortaya
çıkacak dengesizlik giderilebilir. Öte yandan devletin özel sektöre çok
görmediği harcamaları; halk yararına kamu sağlığı hizmeti ile birlikte,
devletin tahsildarlığını bile yapmakta olan eczacıya çok görmek açık bir çifte
standarttır. Geçmişte uygulanan yanlış bütçe politikalarının sorumlusu
eczacılar ve diğer vatandaşlar değildir, o yüzden o sorumluluğun bedeli de,
sağlık giderlerinin faturası da eczacılara veya vatandaşlara ödetilmemelidir.



Eczacılar bu ülkenin tahsil görmüş, sağlık hizmeti veren öz evlatlarıdır.
Mevzubahis "referans" ise hakkaniyet ilkelerine uyulması gerekir.
Kamu leyhine olan "referansları" görüp, eczacı ve vatandaş leyhine
olanları görmezden gelmek adil bir yaklaşım olarak değerlendirilemez.



Ecz. ÖMÜR ÇAKMAK

Yorumlar

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Kate Winslet had a surprising ‘Titanic’ reunion while producing her latest film ‘Lee’
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Kate Winslet is sharing an anecdote about a “wonderful” encounter she recently had with someone from her star-making blockbuster film “Titanic.”

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Winslet recounted that while she had previously executive produced a number of her projects, “Lee” was the first movie where she served as a full-on producer. That required her involvement from “beginning to end,” including when the film was scored in post-production.

She explained to Norton that when she attended the recording of the film’s score in London, while looking at the 120-piece orchestra, she saw someone who looked mighty familiar to her.

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Finally, at the end of the day, the “Reader” star went in to where the orchestra was to meet the mystery violinist, and she was delighted to realize he was one of the violinists who played on the ill-fated Titanic ocean liner as it sank in James Cameron’s classic 1997 film.
“It was that guy!” Winslet exclaimed this week, later adding, “it was just wonderful” to see him again.

“We had so many moments like that in the film, where people I’ve either worked with before, or really known for a long time, kind of grown up in the industry with, they just showed up for me, and it was incredible.”

“Lee” released in theaters in late September, and is available to rent or buy on AppleTV+ or Amazon Prime.

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Tbilisi, Georgia — Jailed journalist Mzia Amaghlobeli gets weaker every day as her hunger strike has reached three weeks in Rustavi, a town near the Georgian capital of Tbilisi, her lawyer says. Now the 49-year-old is having difficulty walking the short distance from her cell to the room where they usually meet, and human rights officials, colleagues and family fear for her life.
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Amaghlobeli was arrested Jan. 12 during an anti-government protest in the coastal city of Batumi, one of over 40 people in custody on criminal charges from a series of demonstrations that have hit the South Caucasus nation of 3.7 million in recent months.
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The political turmoil follows a parliamentary election that was won by the ruling Georgian Dream party, although its opponents allege the vote was rigged.

Protests highlight battle over Georgia's future. Here's why it matters.
Its outcome pushed Georgia further into Russia's orbit of influence. Georgia aspired to join the European Union, but the party suspended accession talks with the bloc after the election.

As it sought to cement its grip on power, Georgian Dream has cracked down on freedom of assembly and expression in what the opposition says is similar to President Vladimir Putin's actions in neighboring Russia, its former imperial ruler.
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“We got 53 candidates for anomalies that cannot be well explained, but can’t say that all of them are Dyson sphere candidates, because that’s not what we are specifically looking for,” said Gabriella Contardo, a postdoctoral research fellow at the International School for Advanced Studies in Trieste, Italy, who led the earlier study. She added that she plans to check the candidates against Suazo’s model to see how many tie into it.
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“You need to eliminate all other hypotheses and explanations before saying that they could be a Dyson sphere,” she added. “To do so you need to also rule out that it’s not some kind of debris disk, or some kind of planetary collision, and that also pushes the science forward in other fields of astronomy — so it’s a win-win.”

Both Contardo and Suazo agree that more research is needed on the data, and that ultimately they could turn to NASA’s James Webb Space Telescope for more information, as it is powerful enough to observe the candidate stars directly. However, because of the lengthy, competitive procedures that regulate use of the telescope, securing access might take some time.
If Dyson spheres really exist, what could they be used for? “If you picture ourselves having as much energy as the sun is providing every second, we could do unheard of things,” Suazo said. “We could do interstellar travel, maybe we could even move the entire solar system to our preferred location, if we wanted.”

But don’t hold your breath, because the technology and the raw materials required to build the hypothetical structures are far beyond humanity’s grasp.

“They are so big that everything we have on Earth would not be enough to build them,” Suazo added. “Freeman Dyson said that we should dismantle Jupiter — the whole planet (for the raw materials).”

That supercolossal scale probably means that Dyson spheres, if they exist at all, are very rare.

ModestoNut (doğrulanmamış) Ct, 03/05/2025 - 06:12

Tbilisi, Georgia — Jailed journalist Mzia Amaghlobeli gets weaker every day as her hunger strike has reached three weeks in Rustavi, a town near the Georgian capital of Tbilisi, her lawyer says. Now the 49-year-old is having difficulty walking the short distance from her cell to the room where they usually meet, and human rights officials, colleagues and family fear for her life.
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Amaghlobeli was arrested Jan. 12 during an anti-government protest in the coastal city of Batumi, one of over 40 people in custody on criminal charges from a series of demonstrations that have hit the South Caucasus nation of 3.7 million in recent months.
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The political turmoil follows a parliamentary election that was won by the ruling Georgian Dream party, although its opponents allege the vote was rigged.

Protests highlight battle over Georgia's future. Here's why it matters.
Its outcome pushed Georgia further into Russia's orbit of influence. Georgia aspired to join the European Union, but the party suspended accession talks with the bloc after the election.

As it sought to cement its grip on power, Georgian Dream has cracked down on freedom of assembly and expression in what the opposition says is similar to President Vladimir Putin's actions in neighboring Russia, its former imperial ruler.
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ModestoNut (doğrulanmamış) Ct, 03/05/2025 - 07:47

Tbilisi, Georgia — Jailed journalist Mzia Amaghlobeli gets weaker every day as her hunger strike has reached three weeks in Rustavi, a town near the Georgian capital of Tbilisi, her lawyer says. Now the 49-year-old is having difficulty walking the short distance from her cell to the room where they usually meet, and human rights officials, colleagues and family fear for her life.
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Amaghlobeli was arrested Jan. 12 during an anti-government protest in the coastal city of Batumi, one of over 40 people in custody on criminal charges from a series of demonstrations that have hit the South Caucasus nation of 3.7 million in recent months.
<a href=https://kra26-at.com>kra28.cc</a&gt;
The political turmoil follows a parliamentary election that was won by the ruling Georgian Dream party, although its opponents allege the vote was rigged.

Protests highlight battle over Georgia's future. Here's why it matters.
Its outcome pushed Georgia further into Russia's orbit of influence. Georgia aspired to join the European Union, but the party suspended accession talks with the bloc after the election.

As it sought to cement its grip on power, Georgian Dream has cracked down on freedom of assembly and expression in what the opposition says is similar to President Vladimir Putin's actions in neighboring Russia, its former imperial ruler.
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Tbilisi, Georgia — Jailed journalist Mzia Amaghlobeli gets weaker every day as her hunger strike has reached three weeks in Rustavi, a town near the Georgian capital of Tbilisi, her lawyer says. Now the 49-year-old is having difficulty walking the short distance from her cell to the room where they usually meet, and human rights officials, colleagues and family fear for her life.
<a href=https://kra23at.cc>kra23 cc</a>
Amaghlobeli was arrested Jan. 12 during an anti-government protest in the coastal city of Batumi, one of over 40 people in custody on criminal charges from a series of demonstrations that have hit the South Caucasus nation of 3.7 million in recent months.
<a href=https://kra27-at.cc>kra23 at</a>
The political turmoil follows a parliamentary election that was won by the ruling Georgian Dream party, although its opponents allege the vote was rigged.

Protests highlight battle over Georgia's future. Here's why it matters.
Its outcome pushed Georgia further into Russia's orbit of influence. Georgia aspired to join the European Union, but the party suspended accession talks with the bloc after the election.

As it sought to cement its grip on power, Georgian Dream has cracked down on freedom of assembly and expression in what the opposition says is similar to President Vladimir Putin's actions in neighboring Russia, its former imperial ruler.
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“We got 53 candidates for anomalies that cannot be well explained, but can’t say that all of them are Dyson sphere candidates, because that’s not what we are specifically looking for,” said Gabriella Contardo, a postdoctoral research fellow at the International School for Advanced Studies in Trieste, Italy, who led the earlier study. She added that she plans to check the candidates against Suazo’s model to see how many tie into it.
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“You need to eliminate all other hypotheses and explanations before saying that they could be a Dyson sphere,” she added. “To do so you need to also rule out that it’s not some kind of debris disk, or some kind of planetary collision, and that also pushes the science forward in other fields of astronomy — so it’s a win-win.”

Both Contardo and Suazo agree that more research is needed on the data, and that ultimately they could turn to NASA’s James Webb Space Telescope for more information, as it is powerful enough to observe the candidate stars directly. However, because of the lengthy, competitive procedures that regulate use of the telescope, securing access might take some time.
If Dyson spheres really exist, what could they be used for? “If you picture ourselves having as much energy as the sun is providing every second, we could do unheard of things,” Suazo said. “We could do interstellar travel, maybe we could even move the entire solar system to our preferred location, if we wanted.”

But don’t hold your breath, because the technology and the raw materials required to build the hypothetical structures are far beyond humanity’s grasp.

“They are so big that everything we have on Earth would not be enough to build them,” Suazo added. “Freeman Dyson said that we should dismantle Jupiter — the whole planet (for the raw materials).”

That supercolossal scale probably means that Dyson spheres, if they exist at all, are very rare.

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Korporativnoye… (doğrulanmamış) Ct, 03/05/2025 - 10:24

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