Medical tourism, regarded as a sub-category of health tourism, signifies activities that combine health care with economical, short vacations. The rapid expansion and growth of the medical industry due to globalization, the problems related with health systems in some countries (for example, long waiting periods, increasing costs and dissatisfaction with the quality of service), the increasing awareness of consumers of treatment alternatives, and the dynamics affecting the healthcare industry such as conditions in the European Union (EU), should all be considered in the concept and development of both vacation and treatment elements.
Health tourism, which is divided into three branches, namely, healthcare tourism, tourists’ health and medical tourism, is an industry that is accelerating in importance. It has been providing employment and contributing on a serious scale to the economies of the countries in which it is being practiced.
While the first two types of health tourism have long been practiced in many countries such as Switzerland, Germany, Austria, Hungary, the United States of America, the United Kingdom and in some Caribbean countries, medical tourism only started to be organized in the early 1980s.
To date, the majority of medical tourists have been visiting countries that offer health services of first-rate quality but at lower costs. In these regions, many options such as tour programs are offered in the manner of sightseeing tours, shopping, discovery tours and even sunbathing tours and excursions.
The industry has grown rapidly and the establishments and the countries that provide these health services have already started to arrange for specialized services catering specifically to medical tourists.
In this study, we will delineate the opportunities of medical tourism in Turkey, along with its weak and strong aspects. We will elucidate how medical tourism can contribute to strengthening the country’s economy as well as providing high levels of employment, as we determine goals and objectives for the industry on the international level.
Dimensions of the Worldwide Medical Tourism Industry
Medical tourism has expanded its scope to reach large-scale proportions in the 21st century. Over the past years, individuals from advanced and developed countries such as the USA have been traveling to India, Thailand, Mexico, South Africa, Singapore, Hungary, Turkey and Costa Rica to seek medical attention. Complicated surgeries and dental work, kidney dialysis, cosmetic surgery and organ transplants topped the list of the most sought-after procedures.
It was estimated that in 2002, six hundred thousand medical tourists traveled to Thailand to seek treatment at medical centers in Bangkok and Phuket, while approximately one hundred and fifty thousand foreign patients visited India during that time. Today, India is leading the countries that have been enjoying the greatest portion of benefits resulting from the world’s interest in health tourism.
An increase of 30% has been observed annually in the growth rate of the health industry in India, and the income generated from health tourism is expected to reach two billion euros by the year 2012. The main reason for this popularity is that they had foreseen the potential of this tourism long before the others countries; as well, they had been able to operate with low costs and to make efficient presentations and advertisements about their capabilities.
Thailand and Singapore should also be considered among those that have received greater shares of the health tourism market. Thailand received one hundred and thirty thousand patients in its Bumrunghad Hospital in the year 2003, and was able to pay for 25% of its health budget through the revenue received from these patients. Singapore had set an objective to welcome one million medical tourists by the year 2007.
Eastern European countries that have been trying to reconcile rapidly with the facts of the capitalist world have also started to benefit from health tourism, by utilizing their European Union (EU) memberships, coupled with their low labor costs. Hungary has obtained an input of two million euros, which enables it to be among the shining stars of the health tourism industry. On the other hand, Belgium has found a significant place in the industry by offering aesthetic surgery and obesity treatments.
The major reason why medical tourism is so attractive to many people is that it offers treatments at a comparatively low cost. To begin with, there are an estimated 50 million people without health insurance and 120 million without dental coverage” in the United States. If these people require urgent health care, they are obliged to pay their health expenses by cash or by applying for bank loans.
Medical tourists are generally residents of the industrialized nations of the world. They primarily come from the United States, Canada, Great Britain, Western Europe, Australia and the Middle East. However, more and more people from many other parts of the world are seeking out places where they can both enjoy a vacation and obtain medical treatment at a reasonable price.
A myriad of options exist for medical tourists, from purely elective procedures such as rhinoplasty, liposuction, breast augmentation, orthodontics and LASIK to more serious and life-saving procedures such as joint replacements, bone marrow transplants and cardiac bypass surgery. Medical tourists can now obtain essentially any type of medical or surgical procedure abroad in a safe and effective manner for a fraction of the cost that they would face in their home countries.
Large price disparities exist across the board for numerous medical and surgical procedures. The cost savings are enormous. For example, a couple can obtain a hair implant operation as well as enjoy the natural and historic beauty of Turkey, inclusive of airfare, board and lodging, personal tour guide/concierge, for the price of the same operation in their home country in Europe.
Another major appeal of medical tourism is that people can get medical treatments abroad in less time than it would take in their home countries. In developed countries, the public healthcare system is so overburdened that it can take years to get needed care. Frederick J. DeMicco further remarks that, &”in Britain and Canada, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane”.
Opportunities for Turkey in the Medical Health Industry
European countries, like the rest of the Western World, are faced with some major health problems: an ageing population, the decreasing working hours of health personnel, the increasing workforce population in comparison with the retired population, chronic disorders, the rapidly increasing health costs, and long waiting periods that delay and complicate the treatment process.
Various European countries have altered their health policies due to existing economic problems, excluding health services such as dental treatments, aesthetic operations, eye surgery with excimer laser, and green light prostate surgery from insurance coverage. For these reasons, Europeans have started to seek their treatments in countries where the health service fees are relatively lower. In particular, Central European countries benefit from the services provided by Eastern European countries.
However, Turkey has become an alternative among those countries, especially with the currently decreasing costs of airfare. Some European countries welcome rich tourists to their countries and provide treatments at higher charges while sending their own insured patients to safe countries where the health service costs are lower. In reality, however, their waiting periods are much longer.
There is a great potential for health tourism in Turkey, with around 20 million tourists visiting Turkey each year, 4.5 million Turkish people living abroad, and thousands of foreigners residing in Turkey. Furthermore, Turkish people living abroad have communication problems with foreign doctors and health personnel. Failure or difficulties in expressing themselves and their health problems to the doctors abroad are the most important reasons why they prefer to return to Turkey for the health services.
Another reason why they prefer Turkey’s health services is that the quality and scope of health services in Turkey are equal to those found abroad. First- and second-generation Turkish people living abroad keep close ties with their motherland, and they are not able to establish integration with the foreign society they are living in. These factors exert a great impact on their increasing feelings of homesickness, along with the increase in their ages and the diseases that afflict them.
For these reasons, they frequently return to visit Turkey and stay on for months. It has become obligatory for European insurance companies to cooperate with the hospitals in Turkey especially for cases of HT, diabetes, chronic kidney failure and for follow-up procedures for other chronic diseases.
In other words, it is inevitable that the hospitals in Turkey will provide not only emergency health services to these people, but also other routine and elective health services. Otherwise, insurance companies may think that they would be encountering greater health expenses.
Aside from this, our consanguine living in the Balkans, the Middle Eastern countries and in the lands covered by the former Ottoman Empire also wish to benefit from Turkish medicine as long as their financial status will permit them. After the attacks of 9/11, people from the Middle Eastern and African countries with high financial abilities are no longer able to travel to the Western countries where they used to visit, due to stringent visa and security regulations.
They are actively searching for alternative places where they can receive treatment. For instance, the total amount spent by African patients for treatment abroad is around 17 billion US dollars. Nigerians alone spent one billion US dollars for treatments abroad.
Turkey receives patients mainly from the United Kingdom, the Netherlands, Belgium, Azerbaijan, Russia, Bulgaria, Romania, Kosovo and Syria. Turkey is preferred mostly for eye, dental, prostate and fertility operations. When we evaluate the state of our medical tourism in terms of contributions from Turkish citizens living in Europe, the variety of the services provided have been very high, as shown by annual economic earnings that have yielded more than 100 million euros thus far.
Strengths and Weaknesses of Turkey’s Health Industry
Turkey holds a promising position for a bright future in medical tourism. Many improvements have been recorded in the health aspects of the country, which has been advancing on the road to full membership in the European Union. For one, the number of hospitals that provide health services in accordance with EU standards has increased rapidly.
For about 10 years now, the technological infrastructure, as well as the comfort and quality of services of the hospitals in Istanbul, Ankara and Izmir, have been on the same level as their European counterparts. Moreover, the majority of doctors and other health personnel who are experienced, skilled and knowledgeable reside in these cities.
Aside from the three major cities, there are also hospitals that provide health services at par with European standards in the provinces of Antalya, Konya, Kayseri, Bursa, Adana, Kocaeli, Gaziantep and Samsun. Patients who visited Turkey and benefited from the health services provided in these hospitals, as well as the insurance companies of these patients, have mentioned the advanced technological infrastructure and the vocational experience and knowledge of the doctors in these hospitals as being as high as the ones in Europe.
A major strength of the medical health industry in Turkey is that it has sufficient capacity for domestic and foreign patients. There are many highly qualified doctors in Turkish hospitals, which are equipped with the latest technology and staffed by personnel who provide good and qualified health care.
Private hospitals are top-notch, while almost all hospitals have the ISO 2001 quality management certification. More than ten first-class hospitals have been accredited by the JCI while others are still in the process of accreditation. There are no waiting periods for treatment.
The elements of Turkey’s competitive advantage in health tourism can thus be identified as follows: the high quality of infrastructure and hardware in the hospitals; the high experience levels of the doctors and health service providers at par with European standards; the price advantages in comparison with other countries; the country’s natural and historical prosperity and its unique geographical location as a bridge between Europe and the Middle East; and the appropriate climatic conditions combined with quality tourism administration and well-known Turkish hospitality.
These factors, coupled with the desire of the almost five million Turkish individuals living abroad to receive their health treatments in Turkey, can be mentioned as Turkey’s strengths in the health tourism industry.
On the other hand, Turkey has some weak aspects as well. Despite its strengths and advantages, there have been insufficient efforts to present and introduce the industry to the international market due to the lack of organization among the industry members. There is also difficulty accessing the right person assigned to medical tourism in the hospitals.
Furthermore, the inadequacy of the translations in the websites of some of these hospitals, and the deficient English language levels of the individuals who have contacts with patients and broker institutions lend an amateurish image to these well-respected institutions and obscure the credibility of their high level of medical standards.
The lack of professional brokers has also been preventing Turkey from obtaining its well-deserved share of the international medical tourism market. In particular, the negative image and perception of Turkey in some countries such as the United Kingdom, Belgium and France is also a matter that has to be taken into consideration.
Other weak points of the industry can be listed as follows: the lack of knowledge of the hospitals with respect to the documentation to be issued to foreign patients, problems with many foreign insurance and assistance companies, and the lack of professional companies that can serve as a link between the health institutions and the medical tourists.
The rapid expansion and growth of the medical industry due to globalization, the problems relative to the health systems in other countries (for example, long waiting periods, increasing costs and dissatisfaction with the services), the increasing awareness of consumers, and the dynamics affecting healthcare such as conditions in the European Union (EU) are some of the factors that should be considered in the concept and development of a medical tourism program consisting of both vacation and treatment elements.
Turkey has a unique position in that it harbors more than enough of these two elements. However, in order to evaluate its medical tourism potential, Turkey should emphasize an organized introduction and presentation of the entire industry, highlighting the topnotch, internationally accredited modern hospitals and the experienced, young and dynamic physicians and health personnel employed in these hospitals, along with the advanced technological facilities and the advantage of affordable prices.
In this introduction and advertisement for which the State must be required to provide aid and support, priority should be given to the countries from which medical tourists mainly originate, such as Europe, the Middle East, Central Asia and Africa. Probably, the first thing to be done is to encourage professional organizations that can link consumers with the medical tourism industry. Turkey has the greatest potential to obtain and attract medical tourists, especially Turkish people with EU citizenships living in Europe.
The realization of this potential depends on a few conditions and terms. The State is required to facilitate conveniences and provide reinforcement (investment incentives for the private sector, presentation and visa conveniences, etc.).
Insurance companies should be convinced to give priority to the first and second generations of Turkish people living abroad who spend most of their yearly vacations in Turkey. These people’s chronic diseases and other health problems should be attended to in a more comprehensive, professional and cost-effective manner.
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Bahattin ADAM, M.D., Institute of Social Sciences, Department of Healthcare Management, University of Selcuk, Konya, Turkey
Muammer ZERENLER, Assist. Prof., University of Selcuk, Faculty of Economics and Administrative Sciences, Konya, Turkey
Corresponding Author: Bahattin ADAM, M.D., Professor