Türkiye’de Aile Hekimliği Modeline Geçiş Süreci ve Sosyal Güvenlik Kurumu’nun Aile Hekimlerinin Sosyal Sigortalılık Statülerine İlişkin Uygulaması Hakkında Bir Değerlendirme

Ekonomi ve Hukuk Dergisi

Makalenin Dili

: tr

Doi :

10.54752/ct.1241213

Tam Metin (PDF)

Emre Yayın
Yusuf Alper

Türkiye’de Aile Hekimliği Modeline Geçiş Süreci ve Sosyal Güvenlik Kurumu’nun Aile Hekimlerinin Sosyal Sigortalılık Statülerine İlişkin Uygulaması Hakkında Bir Değerlendirme

ÖZ

Cumhuriyet tarihi boyunca sağlık hizmetlerini geniş halk kitlelerine ulaştırmaya yönelik çabalar birinci basamak sağlık hizmeti sunumunda, 5258 sayılı Kanun ile hayata geçirilen aile hekimliği modeliyle sürdürülmektedir. Ancak gerek hekimlik gerekse yönetsel vazifeleri dolayısıyla birinci basamak sağlık hizmetlerinin merkezinde yer alan aile hekimlerinin, 5258 sayılı Kanun’dan kaynaklanan önemli sorunları bulunmaktadır. Bu sorunların bir kısmı, kanun ve idarenin düzenleyici işlemleri vasıtasıyla birinci basamakta hekimlik görevini ifa eden bir kamu görevlisi grubuna alışılagelmemiş görev, yetki ve sorumlulukların yüklenmiş olmasından kaynaklanmaktadır. Bir diğer kısmı ise söz konusu hekimlerin, aile hekimliği hizmeti içerisindeki hukuki statülerinin tartışmalı niteliğinden ileri gelmektedir. Özellikle bu hususun, öncesinde kamu görevlisi olmayıp, aile hekimliği hizmet sözleşmeleri ile hizmete giren hekimler üzerinde yoğunluk kazandığı görülmektedir. Bu alanda yaşanan sorunların sosyal güvenlik hukukuna yansıması ise Sosyal Güvenlik Kurumu’nun hekimlerin sosyal sigortalılık statüsüne ilişkin uygulamaları üzerinden gerçekleşmektedir. Nitekim Kurum, 2013/11 sayılı Genelgesinin ilgili bölümünde gerekçesi belli olmayan bir yorumlamayla öncesinde kamu görevlisi olmayan aile hekimlerinin sosyal sigortalılık statüsünü, m. 4/I-a kapsamındaki sigortalılık olarak değerlendirmektedir. Halbuki idari hizmet sözleşmelerine dayalı bir şekilde istihdam edilen bu kişilerin 5510 sayılı Kanun’un açık hükmü karşısında m. 4/I-c kapsamındaki sigortalılıklarının kabulü gerekir.

Anahtar Kelimeler : Aile hekimi, Sosyal sigorta statüsü, Aile sağlığı merkezi

Transition to Family Medicine Model in Turkey and An Evaluation of the Social Security Institution's Practice on the Social Insurance Status of Family Physicians

ABSTRACT

Throughout the history of the Republic, efforts to deliver health services to large masses of people have been carried out with the family medicine model introduced by Act No. 5258 in the provision of primary health care. However, family physicians who are at the center of primary health care services due to both their medical and managerial duties, have important problems arising from the Act No. 5258. Some of these problems arise from the unconventional duties, powers and responsibilities assigned to a group of public servants performing the duty of medicine in primary care through the law and circulars. Another part is due to the questionable nature of the legal status of aforementioned physicians within the family medicine service. It is seen that this issue has intensified especially on physicians who were not public servants before, but who entered into service with family medicine service contracts. The reflection of the problems experienced in this field on the social security law is realized through the practices of the Social Security Institution regarding the social insurance status of physicians. As a matter of fact, the Institution evaluates the social insurance status of family physicians, who were not public officials before, as insurance within the scope of 4/I-a, with an interpretation of which the rationale is unclear in the relevant section of its Circular No. 2013/11. However, in the face of the explicit provision of the Law No. 5510, the insurance coverage of these people, who are employed on the basis of administrative service contracts, must be accepted within the scope of 4/I-c.

Extended Summary

In the Circular on Insurance Transactions No. 2013/11 of the SGK, the social insurance status of family physicians is differentiated according to the previous employment status of the physicians. According to the circular, if the physician is appointed to the position of family physician within the scope of Act No. 5258 while he is a staff member of the ministry or other public institutions or organizations, the person’s current insurance under 4/I-c will continue in his new position. In case of need, if the ministry signs a contract with physicians who are not currently public servants, these people will be deemed to be insured under 4/I-a due to their work subject to the Act No. 5258.

When the circular is examined as a whole, it is understood that there is no problem regarding the insurance of family physicians, whose relations with their staff are maintained, that is, they are currently public officials. As stated in the circular, their insurance within the scope of 4/I-c will continue as long as they serve in the family physician position. Because, in the Act No. 5258 application, there is no situation that terminates the current insurance of those who are in this scope. Being on unpaid or unpaid leave from the administrations does not have an effect that will change their current insurance status.

The main problem regarding the implementation of the SGK arises regarding the insurance of family physicians who did not have the qualifications of public officials before. The personnel of the SGK carries out their works and transactions in this direction based on the relevant part of the Circular No. 2013/11 and registers the aforementioned family physicians within the scope of 4/I-a. Although it has been stated that family physicians will be deemed to be insured under 4/I-a, there is no justification for this evaluation in the text of the circular.

In fact, family physicians, who are considered to be in the status of public servants due to the nature of the legal ties between them and the administration, should be deemed to be insured under 4/I-c against the explicit provision of Act No. 5510. Therefore, it would be appropriate for the SGK, which is obliged to fulfill all its actions and transactions in accordance with the law, to abandon this practice, which may cause serious loss of rights for family physicians working in this context.

Keywords : Family physician, Social insurance status, Family medicine

Kaynak Göster

APA

YAYIN, E., & ALPER, Y., & . ( 2023). Türkiye’de Aile Hekimliği Modeline Geçiş Süreci ve Sosyal Güvenlik Kurumu’nun Aile Hekimlerinin Sosyal Sigortalılık Statülerine İlişkin Uygulaması Hakkında Bir Değerlendirme. Çalışma ve Toplum, 1(76), 121-158. https://doi.org/10.54752/ct.1241213

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