The Expansion of Turkey’s Medical Tourism Industry
Nefes Pirzada
Abstract
Photo by Engin Yapici on Unsplash ABSTRACT Medical tourism has excellent potential and downfalls, which this paper will extensively cover. While medical tourism has great economic benefits to the host country and calls for the increase of professionalism and skill of physicians, it also influences doctors locating to private hospitals and skewing healthcare costs and access for locals. Given the many weights and balances to consider, the discussion of expanding this type of healthcare into Turkey is ethically needed. INTRODUCTION I watched from the hotel lobby as a group of men with surgically wrapped heads strolled in line behind a young woman; she was speaking to them in English with a heavy Turkish accent. Across the room was another group like this one, but the women had bandages on their noses. As a Turk, this sight was not new to me: over the years, I witnessed the number of foreigners coming to Turkey for medical procedures increase by tenfold. And, I began to see how savvy Turkish tourist companies became over time, creating enticing packages for people to tour the beautiful city of Istanbul while receiving a hair transplant procedure or rhinoplasty. While I understood why individuals would come to Turkey for their procedure ― lower prices, expert physicians, and a lovely tourist destination ― I began to question whether profiting from the health care of others was ethical. This paper examines whether it is ethical for Turkey to invest in a growing medical tourism field, which has the potential for significant economic benefits yet could threaten health inequalities between locals and foreigners. Further, it will outline why tourists choose Turkey as a medical tourism destination, the reasons to favor medical tourism, and the reasons to oppose it. Finally, the paper will conclude that Turkey should cultivate and invest in medical tourism, with suggestions for expanding the field into a thriving market. ANALYSIS By definition, a medical tourist is an individual who travels to a foreign country to experience both cultural tourism and medical treatment.[1] Global medical tourism is a $55billion industry, and the industry in Turkey is experiencing an annual growth rate of 22.6 percent.[2] In 2017, more than one million individuals traveled to Turkey for medical tourism, putting approximately ten billion dollars of foreign currency into the economy.[3] Medical tourists who traveled to Turkey received, on average, more than one procedure during their stay.[4] Due to the increasing demand for medical tourism, the Ministry of Health in Turkey emphasized the expansion of medical tourism in its strategic plan, implementing initiatives to grow the industry.[5] These initiatives include improving the quality of Turkish hospitals and receiving Joint Commission International (JCI) accreditation, which is an internationally recognized quality healthcare index.[6] There are multiple reasons why individuals choose Turkey as their destination for medical tourism. First, it is easy to travel to: individuals need only an E-visa, which they can easily receive through an online application.[7] In addition, Turkey has lower prices compared to the Western hemisphere.[8] The Turkish government incentivizes medical tourism through lucrative advertising specials. For example, Turkish Airlines offers discounted airline ticket prices of 50 percent for patients who demonstrate a patient admission document from a Turkish-certified health institution.[9] Private hospitals have opened advertising offices in the Ataturk airport as well.[10] Lastly, hotels and hotel chains collaborate with hospitals to offer lucrative tourist packages for patients.[11] While these perks and incentives draw people to Turkey, the lack of insurance coverage, high cost of treatment, and long wait times in their home countries are the most significant reasons that tourists choose Turkey as their medical destination.[12] Arab tourists previously traveled to the United States and the United Kingdom for medical treatment, but due to the implementation of strict travel sanctions after the September 11 attacks, they have had to look elsewhere.[13] For Arab tourists, the similarity of culture and religion in Turkey, a predominantly Muslim country, is also an enticing factor.[14] And, while Thailand and Singapore offer lower health care costs than Turkey, the shorter distance from the home country plays an important role in choosing Turkey as a medical destination.[15] European tourists choose Turkey for different reasons. For example, some surgeries conducted in Turkey are not available in Europe.[16] Patients from the Balkans and Central Asia prefer Turkey because of Turkey’s highly trained physicians and brand new, well-equipped hospitals compared to those in their home countries.[17] Interestingly, the low costs rank lower in importance than cultural similarity among those seeking care in Turkey.[18] The most important factor for choosing Turkey was quality: most tourists came from countries with a healthcare system marred by a lack of expertise or technological advancement.[19] One Turkish physician stated, “[Turkey] really ha[s] practices, doctors, services, hospitals and treatments that are above world standards in terms of health care.”[20] l. Ethical Permissibility of Medical Tourism in Turkey Health tourism has the potential to make a significant impact on the economic and social life of countries.[21] As a developing country, Turkey cannot afford to overlook this economic possibility.[22] The expansion of medical tourism in Turkey has allowed the country to reform its healthcare system into one that competes with health care quality in the Western hemisphere. Since 2010, there has been a significant increase in patients traveling to Turkey for health care.[23] The AK Party in Turkey pledged to promote health tourism in its campaign in 2011.[24] This inspired health care reform in 2013, with Turkey instituting a publicly funded and organized healthcare system.[25] In 2013, the Turkish government created publicly funded city hospitals. These hospitals were formed for medical tourism, meeting quality levels never-before-seen in the country.[26] In 2014, the Ministry of Health began granting accreditation to medical providers for medical tourism services and supporting translation services, patient transportation, and marketing.[27] Additionally, strategic initiatives were implemented to increase the number of Turkish medical school graduates.[28] The number of private medical schools increased from five before 2013 to 24 by the end of 2015.[29] A 50 percent tax reduction was granted to healthcare institutions that provided health care to foreigners.[30] Finally, Turkey began reforming hospital systems to obtain JCI accreditation. The growth of medical tourism in Turkey has resulted in positive reform of Turkey’s healthcare system. Turkey has over ten city hospitals in Istanbul, with qualified professionals proficient in English and other languages.[31] These hospitals are public and thus open and available for use by the general Turkish community, offering excellent quality health care to the country’s citizens. However, private hospitals have also flourished and, in some cases, have drained some of the doctors from public hospitals. With the increase in quality measures and regulatory healthcare committees, such as the Health Tourism Coordination Council (SATURK), Turkey’s healthcare system rivals the West's with highly trained professionals, competitive medical schools, and modern medical facilities.[32] Turkey has even reached the forefront of medical advancement: the World Eye Hospital is renowned for its cutting-edge ophthalmology services.[33] The investment in medical tourism has allowed Turkey to invest more in its private sector as well: the total expenditure on health as a proportion of the GDP rose from 2.4 percent in 1980 to 6.1 percent in 2008,[34] with an almost $2 billion national income from medical tourism in 2010. ll. Arguments Against the Ethical Permissibility of Medical Tourism in Turkey While public city hospitals were opened with the potential to support the Turkish medical tourism industry, private hospitals support 83 percent of the medical tourism market, and the gap between private and public hospitals has been growing yearly.[35] Private hospitals have mostly opened in urban areas, such as Istanbul, Ankara, and Antalya.[36] As a result, there has been a “brain drain,” in which members of the health workforce have left rural areas and have moved to urban cities where they can make larger profits from the medical tourism industry.[37] In addition, the use of public city hospitals has been met with concern regarding whether inequalities in health care between foreigners and Turkish citizens will arise. The Ministry of Health pays rent for the city hospitals in US dollars, exacerbating inflation in the Turkish lira currency and increasing reliance on high-paying medical tourists to support the public hospital system.[38] Due to this pressure, the prices for medical services are not consistently kept at affordable levels for Turkish citizens.[39] The head of The Private Hospitals and Health Institutions Association, Resat Bahat, stated, “Turkish citizens must receive priority for public resources. You cannot treat a Libyan or a Dutch when your own citizen is shaking at home with pneumonia. You [the public sector] can perhaps engage in medical tourism if you have excess bed capacity. But it is hard to do this [medical tourism] with the public sector.”[40] Rapid growth has also compromised patient safety and health care quality. While clinics must receive medical tourism certificates to provide treatment, fraud has risen.[41] In 2016, six out of ten hair transplant clinics were operating illegally.[42] These clinics offered hair transplants for as low as $800 when the treatment costs approximately $2000 i