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

Harrytyday (doğrulanmamış) Cu, 02/05/2025 - 23:57

Broken spheres
Dyson died in 2020 before any of his spheres could be found — although they are just one of a dozen ideas that bear his name.
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“As a young scientist, Dyson showed that three competing quantum theories were actually the same theory — he summarily ended the competition,” said William Press, the Leslie Surginer Professor of Computer Science and Integrative Biology at the University of Texas at Austin. He was not involved in the study. “Later, he applied his genius to areas of astronomy, cosmology, the extraterrestrial realm, and also the very real problem of nuclear proliferation here on planet Earth. At the time of his death, he was recognized as a provocative and creative thinker.”

George Dyson also attested to his father’s fascination and comprehensive reach across disciplines.
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“Taking advantage of a short attention span and an aversion to bureaucracy, he contributed to five fields of mathematics and eleven fields of physics, as well as to theoretical biology, engineering, operations research, literature, and public affairs,” the younger Dyson said. “Many of his ideas were controversial, with one of his guiding principles being that ‘It is better to be wrong than to be vague.’”

The approach of the researchers behind the new study could offer a more fruitful path in the search for extraterrestrial intelligence, said Tomotsugu Goto, an associate professor of astronomy at the National Tsing Hua University in Taiwan. He also was not involved with the study.

“However, contamination by circumstellar debris disks, which mimic Dyson Sphere infrared signatures, remains a concern,” he added in an email. “Authors argue that the debris disks around (dwarf stars) are rare, but the 7 candidate authors selected out of 5 million sources are also rare. Despite this, the seven candidates warrant further investigation with powerful telescopes for a more definitive evaluation.”

Shanahow (doğrulanmamış) Cu, 02/05/2025 - 18:54

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Park’s 5×5 coaching technique stays a cornerstone of many strength-building packages at
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Not everybody will see these unwanted effects (or
care), but if it’s an necessary issue for you, you want to contemplate
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End the exercise with some HIIT which may enhance fat loss whereas preserving muscle.
HIIT includes alternating between brief bursts of intense exercise and periods of relaxation or lower-intensity activity.
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Examples of HIIT exercises include sprinting, burpees, and kettlebell swings.
Now, move to deadlifts which is another powerhouse train that targets
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Moody underwent a number of drug tests yearly throughout his reign and by no means failed
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If a jacked bodybuilder boasts about his natty status too
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You should check the principles and ensure your medicines
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Turkesterone additionally promotes lean weight acquire versus Dianabol, which causes notable amounts
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If you are a fan of the golden era aesthetics, you will
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Yes, the stress is "marathon-like" for essentially the most part, however your legs can't help it however get stronger.

TRT and even trenbolone might be part of an actor’s regime for a particular superhero/action function. In the past, nonetheless, the expectations have been decrease and
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We overcome obstacles, celebrate successes, and
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past the gym. This means they're unlawful and not using a doctor’s prescription.
Despite seeing actors change fast with steroids, pure ones
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Pioneers like Eugen Sandow promoted drug-free growth for a wholesome
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His 5×5 training method—five units of 5 reps—became a
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To turn bodybuilding success into revenue, one
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Profitable pure bodybuilders, who give attention to high-protein diets and
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But similar to different anabolic steroids, it has a more potent impact when taken alongside food regimen and exercise for
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Utilizing proper food plan and coaching can achieve impressive results.

By binding strongly to the androgen receptor, Dianabol amplifies the body’s anabolic exercise.
Sometimes, you achieve hypertrophy by way of strength training to increase the
volume of your muscular tissues. Others consider a pure athlete to be someone who is not at present utilizing steroids.
In the bodybuilding world, we name the period where you’re taking steroids a "cycle." Many
persons are comfy using "not currently on a cycle" to define whether someone is pure.

Forbes ranked him as certainly one of their top fitness influencers in 2017.

With his absolutely shredded and big physique, the UK-based fitness star is proof
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Plus, pure bodybuilding is a niche inside a niche, that means the money is tight for most of those natural
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A job for the Webb space telescope
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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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Broken spheres
Dyson died in 2020 before any of his spheres could be found — although they are just one of a dozen ideas that bear his name.
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“As a young scientist, Dyson showed that three competing quantum theories were actually the same theory — he summarily ended the competition,” said William Press, the Leslie Surginer Professor of Computer Science and Integrative Biology at the University of Texas at Austin. He was not involved in the study. “Later, he applied his genius to areas of astronomy, cosmology, the extraterrestrial realm, and also the very real problem of nuclear proliferation here on planet Earth. At the time of his death, he was recognized as a provocative and creative thinker.”

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The approach of the researchers behind the new study could offer a more fruitful path in the search for extraterrestrial intelligence, said Tomotsugu Goto, an associate professor of astronomy at the National Tsing Hua University in Taiwan. He also was not involved with the study.

“However, contamination by circumstellar debris disks, which mimic Dyson Sphere infrared signatures, remains a concern,” he added in an email. “Authors argue that the debris disks around (dwarf stars) are rare, but the 7 candidate authors selected out of 5 million sources are also rare. Despite this, the seven candidates warrant further investigation with powerful telescopes for a more definitive evaluation.”

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