Human-Centered Gatekeeping: “Neyim Var?"

Abstract

Information asymmetry, which is physician-oriented, unilateral domination of information, is the main characteristic of healthcare services and the main justification for clinical autonomy. A person who needs healthcare can only express his/her complaints and symptoms. Therefore, the decision to initiate the care process and determine the limitations of care is under the authority and responsibility of the healthcare professional. This causes information asym-metry by excluding the patient from the responsibility during the healthcare processes. Thus, “gatekeeping” is an important way of controlling patient traf-fic in the healthcare system. According to the Health Transformation Program which characterizes the Turkish Health System for the last 20 years, anyone can directly apply to any healthcare facility without using a referral chain from primary care to tertiary care although the referral chain system has been defined as a main component of the program. Because of a populistic reason which was rendered as a barrier in the front of the accessibility of the care for patients, a referral chain system has never been implemented in an administrative con-text for Turkish citizens. In other words, the efficiency and effectiveness of the health system were sacrificed to avoid bureaucratic barriers for the care for citizens. “Neyim Var?", which can be translated into English as “What do I have?", is an artificial intelligence-based technology that was developed by the Ministry of Health, and it has become a popular application among citizens. Anyone can log in to the system by using their own e-government code and then enter their own complaints and symptoms. The system directs the patient to the appropriate healthcare facility and clinic according to the predetermined clinical algorithms. The patient can easily arrange an appointment by the inte-gration between “Neyim Var?" and “Central Hospital Appointment System”. This text asserts that the “Neyim Var?" system can serve as an e-gatekeeper and provide some recommendations to initiate an administrative referral chain without exposing patients to bureaucratic barriers.