Over the last ten years, Turkish private hospitals have been struggling to survive as the contribution from the Turkish Social Security Institution (SGK) for accepting their patients, as they are obliged to do, has not increased in real terms despite their spiralling costs, especially energy. In addition, there has been a significant decrease in the number of private health insurance patients due to insurance companies increasing their premiums above inflation levels. With the onset of the economic recession over the last five years, people can no longer afford the more expensive private health insurance premiums and are turning to state hospitals. The result has been that private hospitals have lost as much as 20% of such patients since the beginning of 2019. The private sector’s share of the health sector has fallen from 27% in 2011 to 13% in 2019. In 2019 alone, due to a 6-7% contraction in the sector, some 30 private hospitals closed down, resulting in some 20,000 health workers becoming unemployed, and the number of private hospitals in Turkey falling to below 550. Despite the fact that private hospitals are now expanding their services towards providing organ transplants, heart surgery, and intensive care unit care for newly born children to social security patients, unless the SGK increases its contribution for its patients at private hospitals, the rate of closures of private health hospitals is likely to increase, such that they will one day only care for a certain section of the population. A new and additional adverse development is that especially in provinces where there are “state city hospitals”, recently built by the government to provide a central comprehensive health care service to the public, the emergency 112 service, which is the single ambulance operating service in Turkey, takes patients to the state hospitals first, and if there is no room there, only then on to private hospitals. As if there were not enough problems already facing the private health sector, it has now also become very difficult to acquire a licence to open a new hospital, clinic or even extra treatment unit, such as there is now a market for such licences between hospitals, where one hospital can purchase another’s licence.
Private hospitals and clinics with a bed capacity of under 100 have particularly been adversely affected, whereas larger hospitals have been able to create an alternative source of income – health tourism. Hospitals especially in more luxurious districts now earn as much as 30% of their income from health tourism, despite the fact that only 10% of their total patients are health tourists. When Turkey’s renowned and popular hot springs spa facilities are added, the total revenue of the health tourism sector in Turkey is calculated at between USD 1.5 and 2 billion.
Turkey has great potential for health tourism. The quality of doctors and health care personnel, and hospital and other treatment facilities are indisputably very high in Turkey. The main advantage though is that treatment is so affordable in Turkey. Whereas other health tourism centres further afield in the world may provide equally competent treatment at affordable prices, Turkey’s central geographical location between Europe and the Middle East means that patients in these two continents pay much less on travel and accommodation. Patients often for example fly in for hair scalp treatment, stay one night in a hotel near the hospital and fly back home the next day. Turkey is also a popular destination because it is rich in culture, history and beautiful and natural surroundings.
The Turkish government is keen to see the health tourism sector expanded, and has very ambitious targets for growth. Health care for some 2 million health tourists and a revenue of between USD 20 and 25 billion annually are foreseen in the coming years. A large number of health institutions in Turkey, including hospitals and laboratories have been accredited by the Joint Commissions International, and by world-renowned accreditation agencies.
Health tourism is generally divided into three areas : firstly and most important is medical tourism (treatment and surgery in hospitals, etc.), secondly is thermal tourism (rehabilitation and rest in thermal facilities, etc.) and the thirdly is elderly and disabled tourism (long-term stays at geriatric treatment centres with social activities). Rheumatism is a big problem especially in northern Europe and Scandinavian countries, and thermal centres in Turkey are very popular for visitors from these regions. Operations relating to eyes, scalp treatment for hair loss, dentistry work, and plastic surgery are most popular since these areas are not generally covered by insurance in the countries of the patients.