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What Is the Current State of Development in Turkey?

Turkey is one of the important actors in the medical tourism community. The tourism sector in Turkey has improved spectacularly over the last decade or so. In parallel with tourism, Turkey has also gained great success in health care. When the annual health spending growth rate in Turkey investigated, it is seen that per capita health spending rose by 5.4% in 2013. Based on these progresses in tourism and health, the growth in medical tourism in Turkey has also accelerated (Fig. 12.3).

Although Turkey has achieved great progress in 2013, annual health spending and health expenditure as a share of GDP are still below the OECD average. According to OECD, health expenditure as a share of GDP (excluding capital expenditure) for Turkey was 5.1% in 2013. Health expenditure per capita for Turkey in 2013 was totally US$941 OECD (2015a, b) (Fig. 12.4).

According to OECD data (2015a, b) the role of Turkey’s government in health spending has increased year by year. Expanding insurance coverage in connection with growing population is the most influential factor in this increase. The rate of government spending in total health spending reached 78% in 2013 (OECD 2015a, b). This rate was above the OECD average (73%) in 2013. As a result of this change, out-of-pocket spending for health care decreased to 22% in 2013. Turkey’s health-related exports reached to 0.98% of health expenditure in 2011 (OECD 2013). Annual growth rate reached 8.2% between 2006 and 2011 (OECD 2013).

In Turkish healthcare system, hospitals have an important place (OECD 2015 a, b). According to OECD data, hospital spending follows a growing trend and constituted 52% of all health spending in 2013. This rate is above the OECD average (40%). This increasing interest in hospitals has led to increased quality of health services in Turkish hospitals. Over the last two decades, private hospitals in

Table 12.1 Number of JCI-Accredited Organizations by Countries (JCI 2015)

Countries

Number of Accredited Organizations

Countries

Number of Accredited Organizations

1

Argentina

1

33

Kenya

1

2

Austria

6

34

Kuwait

3

3

Bahamas

1

35

Lebanon

4

4

Bahrain

1

36

Lithuania

3

5

Bangladesh

1

37

Malaysia

13

6

Barbados

1

38

Mauritius

1

7

Belgium

6

39

Mexico

9

8

Bermuda

1

40

Moldova

1

9

Brazil

54

41

The

Netherlands

4

10

Brunei

Darussalam

1

42

Nicaragua

1

11

Bulgaria

1

43

Nigeria

1

12

Cayman

Islands

2

44

Oman

3

13

Chile

2

45

Pakistan

1

14

China

52

46

Panama

2

15

Colombia

3

47

Peru

3

16

Costa Rica

2

48

Philippines

6

17

Czech

Republic

4

49

Portugal

19

18

Denmark

1

50

Qatar

14

19

Ecuador

1

51

Romania

1

20

Egypt

4

52

Russian

Federation

1

21

Ethiopia

1

53

Saudi Arabia

88

22

Germany

4

54

Singapore

21

23

Greece

1

55

Slovenia

2

24

Hungary

1

56

South Korea

26

25

India

25

57

Spain

22

26

Indonesia

20

58

Sri Lanka

2

27

Ireland

27

59

Taiwan

16

28

Israel

20

60

Thailand

47

29

Italy

24

61

Turkey

48

30

Japan

13

62

United Arab Emirates

120

31

Jordan

10

63

United

Kingdom

1

32

Kazakhstan

7

64

Viet Nam

2

Total

550

Annual health spending growth (%) (Per capita spending in real terms), 2010-2013 (OECD 2015)

Fig. 12.3 Annual health spending growth (%) (Per capita spending in real terms), 2010-2013 (OECD 2015)

Health expenditure as a share of GDP, 2013. Data extracted on January 30, 2016 from OECD.Stat

Fig. 12.4 Health expenditure as a share of GDP, 2013. Data extracted on January 30, 2016 from OECD.Stat

particular have made great progress in modernizing their infrastructure with the latest technology and in hiring the best qualified human resources. They are now able to provide the highest quality and world class healthcare services. Most of the hospitals collaborate with well-known international health organizations such as Johns Hopkins Medicine International and Harvard Medical School (Skylife 2011). As a result, Turkish healthcare organizations have proved themselves to the world health sector. Public healthcare providers have also made progress, but the most important role in medical tourism belongs to the private sector. Turkey is one of the countries with the greatest number of JCI-accredited healthcare providers in the world. Almost all of these accredited organizations are operated by private sector.

While public hospitals and clinics are still playing an important role in the provision of the health care, the importance of private sector in this area has increased dramatically over the last 15 years (TUSIAD 2009). Increase in private healthcare investments has worsened the competition in the domestic healthcare market and forced private healthcare providers to search for new (international) markets. Medical tourism appeared to be a legitimate alternative. In order to increase their appeal to international patients, Turkish healthcare providers put a great emphasis on getting international accreditation. Turkey has 48 JCI-accredited healthcare organizations, the majority of these (42) being hospitals (JCI 2015). Turkey’s hospitals are shown among the top hospitals worldwide in different sources. For instance, Forbes shows Acibadem Hospital among “ten hospitals worth the trip” (Van Dusen 2007). The accreditation process provides standardization and quality. As a result of these, trust of medical tourists to the healthcare providers is strengthened. Although some state-owned medical providers are accredited by JCI, the majority of accredited organizations belong to the private sector. In Table 12.2, JCI-Accredited Healthcare Organizations in Turkey are listed.

Table 12.2 JCI-accredited healthcare organizations in Turkey (JCI 2015)

Healthcare Organizations

City

Accreditation Program

1

Acibadem Adana Hospital

Adana

Hospital Program

2

Acibadem Fulya Hospital

Istanbul

3

Acibadem Maslak Hospital

Istanbul

4

American Hospital

Istanbul

5

Anadolu Medical Center (Anadolu Saglik Merkezi)

Kocaeli

6

Ankara Gdven Hospital

Ankara

7

Antalya Hospital—Medical Park Healthcare Group

Antalya

8

Bahgelievler Hospital—Medical Park Healthcare Group

Istanbul

9

Bayindir Hospital

Ankara

10

?agin Eye Hospital

Kocaeli

11

Ddnya Goz Hospital

Istanbul

12

Emsey Hospital

Istanbul

13

Fatih University Sema Clinical Treatment & Research Center

Istanbul

14

Gayrettepe Florence Nightingale Hospital

Istanbul

15

Goztepe Hospital—Medical Park Healthcare Group

Istanbul

16

Hisar Intercontinental Hospital

Istanbul

(continued)

Table 12.2 (continued)

Healthcare Organizations

City

Accreditation Program

HRS Ankara Women’s Hospital

Ankara

18

Istanbul Florence Nightingale Hospital A.§.

Istanbul

19

Izmir University Medicalpark Hospital

Izmir

20

Kadikoy Florence Nightingale Hospital

Istanbul

21

Kent Hospital

Izmir

22

Liv Hospital Ulus

Istanbul

23

Medicana International Istanbul Hospital

Istanbul

24

Medistate Kavacik Hospital

Istanbul

25

Memorial Ankara Hospital

Ankara

26

Memorial Antalya Hospital

Antalya

27

Memorial Ata^ehir Hospital

Istanbul

28

Memorial Sisli Hospital

Istanbul

29

Npistanbul Neuropsychiatry Hospital

Istanbul

30

Ozel Doruk Yildirim Hospital

Bursa

31

Ozel Medline Adana Hospital

Adana

32

Ozel Pendik Bolge Hospital

Istanbul

33

Private Cankaya Hospital

Ankara

34

Private Konak Hospital

Kocaeli

35

Private Medicabil Hospital

Bursa

36

Private TOBB-ETU Hospital

Ankara

37

Sifa Universitesi Bornova Saglik Uygulama Ve Arastirma Merkezi

Izmir

38

§i§li Florence Nightingale Hospital

Istanbul

39

Uludag Universitesi Saglik Kuruluslari

Bursa

40

Hacettepe University Hospitals

Ankara

Academic Medical Center Hospital Program

41

Medipol Mega Hospitals Complex

Istanbul

42

Yeditepe University Hospital

Istanbul

43

Neolife Tip Merkezi (Neolife Medical Center)

Istanbul

Ambulatory Care Program

44

Yeditepe University Dental Healthcare and Research Center

Istanbul

45

Oukurova University Medical Faculty, Central Laboratory

Adana

Clinical Laboratory Program

46

Turkish Red Crescent Society - The Aegean Regional Blood Center

Izmir

47

Turkish Red Crescent Society Middle Anatolia Regional Blood Center

Ankara

48

Turkish Red Crescent Society North Marmara Regional Blood Center

Istanbul

Total Accredited Healthcare Organizations

48

The number of tourists visiting Turkey has increased considerably. In line with the significant growth in tourism sector, medical tourism sector has also made great progress in Turkey. While in 2008, 74,000 medical tourists visited Turkey (Ministry of Health 2011); in 2013, the number of medical tourists increased to 308,500; and it is expected that by 2018, this number will reach 750,000 medical tourists (Ministry of Health 2014). The Minister of Health reported that the approximately 500,000 health tourists who visited Turkey in 2015 spent US$2.5 billion in the country (AA 2016). Revenue from medical tourism is expected to increase to US$9-10 billion in 2018 and to US$20-25 billion in 2023 (AA 2016). All these data show that Turkey has experienced rapid growth in the last two decades.

Thanks to this rapid growth, Turkey started to be listed in top medical tourism destinations by the international authorities (Patient Beyond Borders 2014) especially in the fields of eye surgery, dentistry, orthopedics and traumatology, internal medicine, ear, nose, and throat diseases, in vitro fertilization, cardiology, oncology, plastic surgery, and neurosurgery (Ministry of Health 2011, 2013). The result of a British survey shows that Turkey is one of the three countries British medical tourists prefer to visit especially for dental treatment and fertility treatment (www. eturbonews.com 2008).

The main advantage Turkey has over its competitors is given by the reasonably priced healthcare services while offering JCI-accredited and high quality hospitals, qualified healthcare professionals and other healthcare personnel, high quality medical procedures, no waiting time, high technology, and developed tourism and healthcare infrastructure (especially in the major cities).

The most preferred cities by medical tourists in Turkey are Istanbul, Antalya, and Ankara (Ministry of Health 2013). According to the Ministry of Health, medical tourists who want to get treatment for eye diseases and gynecology and obstetrics prefer to visit Istanbul, while medical tourists who want to get treatment for internal diseases and ear, nose, and throat diseases prefer to visit Antalya. Tourists also generally prefer to visit Antalya and Istanbul for orthopedics and traumatology. Availability of direct transportation from many countries to these two cities is one of the most important factors influencing medical tourists’ destination selection (Table 12.3).

According to the Ministry of Health (2013), the first ten markets for Turkey’s medical tourism are Libya, Germany, Iraq, Azerbaijan, Russia, UK, Holland, Romania, Bulgaria, and Norway (Fig. 12.5). Taking into consideration, these countries could be claimed that territorial proximity and cultural and historical proximity were important factors in the decision of these medical tourists to choose Turkey for their medical needs.

Table 12.4 shows the distribution of medical tourists according to top 10 countries of origin and top 10 clinics they visit. As it is seen, most Germans visit Turkey for the treatment of eye diseases, while the majority of Russians visit for treatment of gynecology and obstetrics.

Table 12.3 Medical tourism-number of patients in top 10 Cities based on Top 10 Clinics, 2012 (Ministry of Health 2013)

Cities

Eye

diseases

Orthopedics

and

traumatology

Internal

diseases

Ear, nose, and throat diseases

Gynecology

and

obstetrics

General

surgery

Mouth, dental and

maxillofacial

diseases

Brain

and

nerve

surgery

Dermotology and venereal diseases

Pediatrics

and

diseases

Total

Istanbul

11341

5127

4253

3472

4147

2317

2244

1906

2772

3160

55985

Antalya

5355

6404

7489

6858

2699

4023

3436

2288

1162

102

47649

Ankara

1434

1602

1089

1307

2039

833

1151

829

978

773

16596

Kocaeli

191

370

482

298

991

666

54

311

184

235

13256

Izmir

673

981

516

613

760

664

1041

244

506

82

8324

Mugla

521

712

1046

344

421

442

304

188

178

16

5430

Adana

233

697

124

195

302

120

237

262

139

104

3459

A yd in

79

424

604

299

133

492

218

55

52

423

3093

Gaziantep

168

208

167

144

256

93

92

219

88

109

2198

Bursa

171

114

160

111

279

73

353

31

70

116

1998

Top 10 markets for Turkey’s medical tourism, 2012 (Ministry of Health 2013)

Fig. 12.5 Top 10 markets for Turkey’s medical tourism, 2012 (Ministry of Health 2013)

We should also mention here that to the success of Turkey’s medical tourism providers governmental incentives have played an important role. This issue will be discussed in further sections.

 
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