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It is widely appreciated in medicine that an essential approach must be the early prevention of chronic illnesses and the vast majority of chronic illnesses are preventable [1]. It has been clearly established that early and efficient medical management is associatedwith a good clinical outcome. Approximately half the decline in deaths in the United States from coronary heart disease from 1980 through 2000may be attributable to reductions inmajor risk factors [2]. Effective health care of themajority of chronic patients is also a challenge for developing countries. To try to address better health care, a performance system in the last decade was established by the Turkish Health Ministry. It was considered to undercontrol all patients without health insurance for better overall standards throughout the country in practical health care. The patients who do not have health insurance were given the free health insurance which was financed by the national budget [3]. It was planned that the insurance would cover the majority of chronic patients who need the precise medical management. Nevertheless, major problem is the absence of compulsory referral system, so all patients can visit a tertiary hospital without being referred by a primary health care [3]. This problem could lead to an overload in emergency units and outpatient clinics that could result in limited time for diagnostic procedures and couldmake a difficulty in identification of high risk group which is an important concern for quality health care. The national health authority has developed the performance system based on a proceduredependent income model for physicians. The number of private hospitals has gradually increased in the last decade and has reached from 271 in 2002 and to 550 in 2013 [4]. The potential danger is that health care by private hospitals may be seen as a profitable investment and may result in a largely financial perspective in health care rather than higher quality of health care for chronic diseases. The performance system also may produce an increase in number of procedures and may negatively effect on quality. In fact, since the health authority has started to act in 2002, the number of referred patients from primary care has decreased and operations has increased from 22%, 1.598.362 to 3%, 4.684.237 respectively in 2013 [4]. This may produce an uncomfortable work atmosphere for physicians, since more procedures mean more money. Since quality health care for chronic patients needs amore organized system which may not be provided by performance-based system, because comprehensive diagnostic tests can take a long time. We have emphasized the importance of combined cardiac imaging with exercise testing, diagnosis of exercise hypertension and cardiovascular translational imaging that has played a significant role in decline of mortality by identification of patients at risk by accurate diagnosis [5–7]. Therefore, early diagnosis is crucial for appropriate preventive medical care, but diagnostic attempts take time. Korhonen PE. et al. [8] have clearly documented that one of five patients with previously undiagnosed hypertension is associated with subclinical target organ damage including cardiac

Current obstacles in management of hypertensive patients by performance-based care and importance of diagnostic tests.