***I will now be sharing the English version of the Turkish article I have written before (28.03.2021).
I am a physician who has been working , both clinically and as an academician , in the health sector for about 25 years. For the last 10 years, I have been working in close cooperation with both international and national health companies related to the field I am interested in such as Johnson and Johnson (Ethicon), Baxter, Eczacıbaşı, Novo Nordisk. With the occasion of the BAU Executive MBA education that I started in 2020,
I would like to put forward a different perspective on the sector by going beyond the scope of academia and sharing my observations and personal thoughts about the future of the health sector in Turkey.
It is possible to divide the health sector into 3 groups as public, university and private in Turkey. The group that creates the workforce on the base of this sector is the health personnels such as physician, nurse and health technician. According to a study published by the Ministry of Health in 2017, it is stated that the rate of Public Hospitals in Turkey is 58%, 37% of Private Hospitals and 5% of University Hospitals. When we consider the change of the number of private hospitals over the years , it was detected as 271 in 2002, 541 in 2012, 556 in 2014 and 876 in 2018. Considering the regions, it is observed that there is a density in the Marmara Region especially in Istanbul. The increase in the demands of people for private hospitals over the years creates a potential for new investments on this sector. In this context, Istanbul stands out as the city that receives the most investment. Big cities are preferred as a priority in terms of having more population and income.
According to the data of OHSAD, the highest satisfaction rate is in private hospitals with 78%, followed by university hospitals with 62% and state hospitals with 54%. On the other hand, the trend in the world is that international patients mostly prefer private health institutions. This trend is the same in Turkey and the number of international patients has increased continuously until 2014 when it is considered according to the years. This situation also reveals the health tourism potential of Turkey. However, there is a decrease in this rate due to the increase in terrorist incidents in 2015-2016. On the other side, high bed capacity city hospitals are being built with the Public/Private Partnership( PPP) model in Turkey. As of February 2018, 20 hospitals has been under construction within the scope of PPP. The total bed capacity of these hospitals is approximately 31.000. Turkey will become prominent in terms of healthcare environment in the near future and it is considered to be one of the issues that may cause a challenge for private hospitals.
TODAY’S ANALYSIS
After the short situation analysis I have made above, I think that the following inferences can be made with my personal field observations:
1. The rapid increase in the number of private hospitals pushes health towards privatization day by day. On the other hand, most of the private hospitals act with the strategy of being a chain hospital. After a point, this situation may cause health institutions to evolve into a cost oriented service tendency rather than value creation.
2. Many physicians working in private hospitals have troubles due to the method of earning income by looking at more patients and therefore many of them tend to open a clinic.
3. Private hospitals are in close contact with foreign markets to find new patients and increase their income.
4. Foreign patients constitute 30-50% of the patient potential of almost all and even 70% in some institutions.
5. Many products used in health sector are imported and this increases the cost input, so this situation encourages many institutions to use substitute products to reduce costs.
ANALYSIS OF THE FUTURE
1. Chain hospitals have now come to the point where they compete among their group hospitals and this situation causes a decrease in prices.
2. While trying to close this gap with the reduction of price to reach sufficient endorsement and number of patients, the rate of the profitability in health services is decreasing. However, the lower limit on prices should be determined and followed by state regulation for providing quality service in the health sector.
3. If the use of substitute products is made uncontrollably, the increase in possible complications will be inevitable. Especially in surgeries performed in the field of health tourism , such problems may cause a lack of confidence in the medium and long term and a negative separation on the preference of the country.
The implementation and transparency of the health regulation in the country is as important as the importance of the hospital and quality of the physician in the health tourism. The lack of confidence on this issue – especially during the Covid-19 Pandemic period – may cause the number of the patients coming from countries having high financial powers to decrease and may cause these patients to prefer different countries to get the health services. In this situation, chain hospitals will show the tendency for the countries with low price policies by searching for new external resources. The system based on more patient treatment with lower profits will become an unsustainable business model after a point
The bed capacity increasing with city hospital projects creates a need for more physicians in these institutions. Additionally, according to the structure of this system (state-private cooperation), the need for financing may lead to possible state regulation of the patients who are currently used by private hospitals as a source of income. Another important point is that the desire of many physicians who is working in private hospitals to open a clinic has increased recently. New state regulations may be encountered in this field in the future due to the similar reasons.
Even though there are still modern hospitals and experienced physicians in our country, it would not be a very negative approach to think that uncontrolled expansion (state – private) in the health sector may lead to serious problems in the future. On the other side, despite the increase in the number of Faculties of Medicine in recent years, it is known by all of us that the lack of sufficient academicians causes a decrease in the quality of physicians educated. Unfortunately, the speed of opening a hospital and the speed of training physicians isn’t the same. This may propose the transfer of imported physicians for the agenda in the future.
Finally, I will end my article with the motto of a famous brand : “Uncontrolled Power Is Not Power’’
Prof. Halil Coskun M.D. Istanbul Turkey