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

Robertzes (doğrulanmamış) Pt, 28/04/2025 - 04:51

Look of the Week: Naomi Watts is twinning with her canine co-star
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What’s white and black and red all over? Naomi Watts and her 145lb co-star, Bing, a Great Dane, taking a dog walk on the crimson carpet for the New York premiere of “The Friend.”

Directed by Scott Mcgehee and adapted from Sigrid Nunez’s 2018 novel of the same name, the film — set to release in US theaters on March 28 and in the UK on April 25 — follows a solitary writer and teacher named Iris whose life is upended after a close friend bequeaths his giant pet dog to her following his death.

In front of the cameras Monday evening, the “Mulholland Drive” actor and Bing looked like they were cut from the same cloth — both in temperament and in their matching black polka dots. Watts was dressed in a white gown with fur-tufted spots that bore a striking resemblance to Bing’s own coat, but the Cruella de Vil comparisons ended there. Instead, Watts and Bing were captured in the throes of lots of paw-shakes, puppy kisses and head scratches.
The dress that Watts wore, titled the “Domino” and designed by Jacquemus, debuted during the Spring-Summer 2025 Paris couture shows in January. The look was both elegant and offbeat, with a high-cowl neck and open-back, asymmetrical waistline that mimicked a French tuck. It was styled with a skirt that sprouted furry black polka dots, which close up were unnervingly reminiscent of body hair. But from afar they gave the impression of soft-edged dabs of watercolor bleeding downstream.

The look was styled by Jeanann Williams, who has also been working with “The White Lotus” star Leslie Bibb. Williams’ decision to coordinate Watts with Bing was a new take on method dressing — the thematic styling trend that has dominated celebrity red carpets since Greta Gerwig’s “Barbie” in 2023. Since then, the sartorial trope, which connects actors to their on-screen characters through clothes, has become somewhat tired — with some observers claiming that the 7-month-long “Wicked” press tour, in which Cynthia Erivo and Ariana Grande became prisoners to the colors green and pink, was peak saturation.

Charlescix (doğrulanmamış) Pa, 27/04/2025 - 21:31

Aged 15, New Zealander Sam Ruthe has already run a four-minute mile. He would ‘love to try and qualify’ for the 2028 Olympics
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Sam Ruthe had the eyes of thousands on him when he stepped onto a running track in Auckland just over a week ago.

Undaunted by the occasion, Ruthe went on to become the first 15-year-old to run a sub-four-minute mile, even managing a nonchalant shrug of the shoulders as he crossed the finish line.

The race was almost entirely engineered for the high school student to break the fabled four-minute barrier – a feat first achieved by Roger Bannister more than 70 years ago – but the weight of running history was a burden that Ruthe seemed to bear lightly.

The first three laps, he later said in a video documenting the race, “felt pretty comfortable – nothing too crazy.”

Perhaps the most intimidating part of his achievement occurred when Ruthe returned to school the next day, only to be immediately called into the principal’s office.

“He’s like, ‘Alright, so you’re gonna have to go up on stage and we’ll get the whole school to clap you,’” Ruthe tells CNN Sports’ Patrick Snell. “It was really scary, actually. I headed into class and everyone thought I was famous.”

It’s easy to forget, given his history-making performance last week, that Ruthe is like most other 15-year-olds in New Zealand. He goes to school, spends time with his friends, and helps with chores around the house.

He also just happens to be one of the most exciting middle-distance runners on the planet, one of the latest star athletes to emerge from sports-mad New Zealand.

ByronCax (doğrulanmamış) Pt, 28/04/2025 - 04:37

Critics say this power imbalance is clear in the 2016 contract Guyana signed with Exxon. Under the agreement, Exxon keeps 75% of everything it makes from its oil operations in Guyana, with the remaining 25% shared equally between the company and the government, which also takes a 2% royalty.
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“It was a bad deal,” Ali said in the BBC interview, but he has rejected the idea of unilaterally changing the agreement, which was signed by the previous government. He says the next contract with Exxon will be on different terms.

An Exxon spokesperson said the contract is “globally competitive for countries at a similar stage of exploration” and said Guyana is averaging $1 billion a year in “oil profits.”

Exxon has also faced a number of lawsuits over its potential environmental impact, many filed by Melinda Janki, a Guyanese international lawyer, who drafted the country’s Environmental Protection Act back in the 1990s.

A big victory for Guyana’s people and environment came in 2023, when the court ruled Exxon should have unlimited liability for the costs of any oil spill. Exxon has since appealed the ruling and has posted a $2 billion guarantee while it awaits the appeal outcome.
Exxon said this commitment supplements “its robust balance sheets … and the insurance policies they already had in place.” Janki says this isn’t enough. Offshore oil spills can be extremely expensive to deal with, the 2010 Deepwater Horizon spill cost nearly $70 billion to clean up.

The push and pull between those who say oil offers Guyana a brighter future and those who fear the industry’s impact will continue.

Exxon said it’s had a positive impact on the country, including employing more than 6,200 people, investing more than $2 billion with local Guyanese businesses since 2015 and spending more than $43 million on community projects.

Colleensnusy (doğrulanmamış) Pa, 27/04/2025 - 22:10

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Danielephep (doğrulanmamış) Pa, 27/04/2025 - 22:41

“Every morning I come downstairs and he’s already done the dishwasher, he’s already packed his lunch, and he’s ready to go,” Ruthe’s father, Ben, tells CNN Sports.

“He’s just a disciplined kid. He goes to bed early, he looks after himself, he eats well, he looks after his sister. He’s just a good kid around the house in all ways, really. We’re very lucky.”
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Ruthe is next due to compete in the 1,500 meters at the Maurie Plant Meet in Melbourne on Saturday, and one target time to aim for will be his dad’s fastest time of 3:41.22 – three hundredths of a second faster than Ruthe’s current personal best.
But he still has a way to go before he can call himself the most decorated runner in his family. Dad Ben and mom Jess are both former national champions who represented New Zealand on the world stage, while his maternal grandparents won European championship medals for Great Britain.

His grandmother, Rosemary Stirling, arguably had the most impressive achievement: an 800m Commonwealth Games title from 1970.

Despite his family pedigree, Ruthe was never under any pressure to take running seriously. His parents, in fact, didn’t allow him or his sister Daisy to train at all until they were 13, never wanting their identities to be tied solely to running.

“It feels like it’s the right decision about now,” says Ben.

But as he gradually starts to realize his potential, Ruthe, when pushed, admits to having big goals in the sport.

“If I had to pick one thing, definitely Olympic gold,” he says. “I feel like that’s most runners’ dream and the biggest thing you can actually win. So that’ll definitely be the top of my bucket list.”
The 2032 Olympics in Brisbane, Ruthe adds, would be a nice target. And as for the Los Angeles Games in three years’ time? “I’d actually love to try and qualify for LA 28,” he says. “I feel like that’ll be a tough goal. But if I do that, I’ll be really happy.”

Already, Ruthe’s name is being mentioned in the same breath as Norway’s Jakob Ingebrigtsen, the most successful middle-distance of this generation. It was his record as the youngest-ever four-minute miler that Ruthe took last week, and the New Zealander also beat Ingebrigtsen’s 1,500m record for a 15-year-old earlier this year.

Ingebrigtsen’s success, Ruthe says, has given him hope that he too can “have a good future” in the sport. But his biggest source of motivation comes not from the two-time Olympic champion, but from those closest to him – his training group led by coach Craig Kirkwood and athlete Sam Tanner.

The pair were instrumental in Ruthe’s recent mile time of 3:58.35, and it was five-time national champion Tanner who paced him perfectly around four laps of the track on his way to the record.

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сервисные цент… (doğrulanmamış) Pt, 28/04/2025 - 01:17

Профессиональный сервисный центр по ремонту бытовой техники с выездом на дом.
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HowardHen (doğrulanmamış) Pt, 28/04/2025 - 01:25

Tyler O’Neill hits record-extending sixth straight Opening Day home run
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For six seasons in a row, Tyler O’Neill has homered on MLB Opening Day.

Making his debut for the Baltimore Orioles on Thursday, O’Neill started the season with his record-extending sixth straight home run on Opening Day during his team’s 12-2 win against the Toronto Blue Jays.

No other player has homered on more than four consecutive Opening Days, with the 29-year-old outfielder’s three-run shot sending the Orioles into a 5-0 lead at the top of the third at Rogers Centre.
Todd Hundley (1994-97), Gary Carter (1977-80) and Yogi Berra (1955-58) all hit four consecutive home runs on Opening Day, while the Major League Baseball record for the total number of Opening Day home runs is held jointly by Adam Dunn, Ken Griffey Jr. and Frank Robinson on eight.

“I’m just not trying to make too much of it,” O’Neill told reporters about his streak. “I’m just trying to go out, have a good first at-bat and see what the game gives me from there.

“Obviously, I understand what’s going on, but it’s not like I’m going out there trying to do anything crazy.”

O’Neill, who signed a three-year, $49.5 million contract to join Baltimore from the Boston Red Sox in the offseason, finished three-for-three with three RBIs and two walks against the Blue Jays.

“It’s a little different when the lights turn on and you’ve got to show up, so it was really cool to see all the guys show up today,” he said. “We got after it out there.”

While the first two games of the MLB regular season took place between the Chicago Cubs and Los Angeles Dodgers in Tokyo last week, Thursday marked the first official day of the season in the United States.

DarrellMum (doğrulanmamış) Pt, 28/04/2025 - 01:55

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прокарниз (doğrulanmamış) Pt, 28/04/2025 - 02:51

Деревянные горизонтальные жалюзи с электроприводом: функциональность и дизайн
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ByronCax (doğrulanmamış) Pt, 28/04/2025 - 04:05

Critics say this power imbalance is clear in the 2016 contract Guyana signed with Exxon. Under the agreement, Exxon keeps 75% of everything it makes from its oil operations in Guyana, with the remaining 25% shared equally between the company and the government, which also takes a 2% royalty.
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“It was a bad deal,” Ali said in the BBC interview, but he has rejected the idea of unilaterally changing the agreement, which was signed by the previous government. He says the next contract with Exxon will be on different terms.

An Exxon spokesperson said the contract is “globally competitive for countries at a similar stage of exploration” and said Guyana is averaging $1 billion a year in “oil profits.”

Exxon has also faced a number of lawsuits over its potential environmental impact, many filed by Melinda Janki, a Guyanese international lawyer, who drafted the country’s Environmental Protection Act back in the 1990s.

A big victory for Guyana’s people and environment came in 2023, when the court ruled Exxon should have unlimited liability for the costs of any oil spill. Exxon has since appealed the ruling and has posted a $2 billion guarantee while it awaits the appeal outcome.
Exxon said this commitment supplements “its robust balance sheets … and the insurance policies they already had in place.” Janki says this isn’t enough. Offshore oil spills can be extremely expensive to deal with, the 2010 Deepwater Horizon spill cost nearly $70 billion to clean up.

The push and pull between those who say oil offers Guyana a brighter future and those who fear the industry’s impact will continue.

Exxon said it’s had a positive impact on the country, including employing more than 6,200 people, investing more than $2 billion with local Guyanese businesses since 2015 and spending more than $43 million on community projects.

рабочий промок… (doğrulanmamış) Pt, 28/04/2025 - 06:35

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