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)

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

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)

(continued)

Table 12.2 (continued)

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)

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.