The Turkish government is starting the “second phase in its transformation of the health sector” with a view to attracting patients from abroad, according to Health Minister Recep Akdağ.
The country will attract foreign patients with new city hospitals, designed to attract not only through the quality of their healthcare but also through “five-star hotel” accommodation services, combining affordable but high-quality healthcare with high-quality accommodation services, Akdağ told the Hürriyet Daily News.In your second term as minister you are starting a “second phase in health transformation.” Can you tell us about it?
When we came to power in 2002 there was a serious need for transformation. Currently our citizens have full access to healthcare. We succeeded in establishing universal health coverage and we did it at low cost, by spending $500-550 per person. Why the second phase? Because our needs have changed. People’s expectations have changed and our burden of illness has changed, starting to resemble developed countries. Risk factors are the same too: Obesity, physical inactivity and smoking. These risk factors have changed the burden and we need to develop our system in order to handle these problems.
You also said expectations have changed?
In the past, getting hospital treatment over many days free of charge was considered a big benefit by our citizens. Today, no such problem is left. Our citizens have free of charge healthcare in hospitals, with the use of the highest technology, and without waiting lists. People who used to consider it normal to wait six months do not see it as normal to wait six days. In the past it was enough for our citizens to be able to find a bed in hospital; today they want single rooms with their own bathroom and TV, etc. Some critics say that while access to healthcare has increased, the time afforded to patients and therefore quality has fallen.
On the contrary, in the past doctors were not made to work efficiently. They got low salaries so there were dual practices, as they were allowed to have a private practice. The time allocated to patients was much shorter. Currently we have an average of 10 minutes for each appointment and obviously we need to increase that to 15 or 20 minutes.
We are initiating the second phase with a strategy where the system is set up based on quality healthcare at low cost, attracting foreign patients to Turkey. We are not only targeting countries in our region or our neighbors. We are shaping our strategy to get patients from Africa, the Middle East and Europe.
While our developed private sector will continue to provide health services to foreign patients, we as the public sector will also provide health services to those coming from abroad.Why should foreign patients come to Turkey?
First of all, the health service they will receive in Turkey will be at least as good as the service provided in any other European country on the United States. Second, it will cost much less. There is a benchmark we have set in Turkey. Low cost benchmark enabled the private sector to provide low cost services too.
We use high technology in a very efficient way. A magnetic resonance imaging (MRI) machine is used nearly 24/7, and the scan taken by an MRI machine in Turkey takes a third of the time it takes on average in Europe. That means an MRI scan costs less. In addition to the fact that we use the machines intensively, the cost of health personnel is also lower compared to Europe. An MRI machine technician earns around $700 per month, while this is perhaps $4,000 in Europe. Are you planning to make some bilateral agreements so foreign patients can use their health insurance even in Turkey?
We are in talks with Saudi Arabia and some countries in the Gulf. Recently I was visited by union of private health sector companies from Africa. When we explained them the means in Turkey, they said they will bring patients to Turkey as it costs twice as much to take them to Europe.
That’s the private insurance dimension. There are also countries where healthcare is provided directly by the state or by public insurance. When the need arises, they can send patients to another country, and in that case we need to talk to these states. But since there are waiting lists for those patients with private insurance, as the awareness of these patients increases they will force their own insurance companies to secure healthcare in Turkey.
Foreign patients coming to Turkey are getting health services from private hospitals that are very comfortable in terms of accommodation. Our new city hospitals are becoming even better in that sense too. We have suite hospital rooms for middle-income citizens, as well as grand suites or king suites for very rich people or state protocols.
The health minister of a country will obviously praise the healthcare provided by that country. Do you have any international input to support it in order to be more convincing for foreign patients?
There are no such system that compares states in that sense. But hospitals do provide certain figures, such as on how many complications are experienced after an operation, the rate of success, the rate of mortality in risky operations, etc. But what really matters is the reputation you gain over time. Everybody can voice claims but patients and insurance companies learn from each other.
As the Health Ministry we are taking measures to keep the reputation sustainable and developing certain regulations to monitor the quality of healthcare provided to foreign patients.
What is so different about the city hospitals?
They are patient-friendly places. The architecture is designed according to the needs of different disciplines and to accommodate all medical needs in the same building.
Even abroad the general set up is like this: Let’s say you go to have cancer treatment but also come up with a cardio problem, then you need to go to another hospital or different building in the same campus. But in city hospitals you do not need to go outside.
Intensive care is different too. The person who accompanies the patient will be able to be present in intensive care, obviously without ignoring medical requirements. Each intensive care space is composed of a single room, and there is nothing you cannot find in terms of high technology in city hospitals in big cities. How will you incorporate health tourism in this transformation?
Private hospitals have tended to do this kind of organization. We also have to set up a system that should work like a tour operator. We are currently discussing how to proceed with the Health Ministry. One alternative is to set up an agency; another is to set up a company.Tell us about your experience abroad.
Since 2012 I have been on the advisory board of the ministerial leadership in a health program jointly organized by Harvard University’s School of Public Health and Kennedy Governance School. From South Africa to Vietnam I have advised many countries. One of my observations is that dual practice is a key problem in many countries, which decreases efficiency. But states find it difficult to stand against doctors’ lobbies. Another problem is that compared to private insurance, public insurance is less developed.
How do you manage with lobbies?
There are two main lobbies: One is the cigarette lobby, the other is the drug lobby. You have to have the support of the political authority behind you, otherwise you have no chance. When we were fighting against smoking previously I would not have been able to continue this struggle if [then Prime Minister] Recep Tayyip Erdoğan
had not stood behind me. At Harvard I was once asked how I was successful against the smoking industry and how I conducted talks with cigarette companies. I thought for one minute: I’ve never even spoken with a cigarette company.
Another issue is this: If you can answer the needs of the people in a prompt way, providing low-hanging fruits, you win the support of society. When I became a minister in 2002, the first decree I ever issued was banning the practice of hospital administrations effectively taking patients hostage if they did not pay a fee. We unfortunately had such a practice in the past.
All stakeholders are important but two are the most important: The political power above you - meaning the prime minister or the president - and the people.
Who is Recep Akdağ?
Health Minister Recep Akdağ was born in Erzurum in 1960.
After training as a pediatrician, he earned the title of professor from the Atatürk
University School of Medicine. Between 1994 and 1998, Akdağ worked as the Deputy Chief Medical Director, the Chairman of the Procurement Commission and the Deputy Editor of the Medical Bulletin in the research hospital of the Medical Faculty of Atatürk
After being elected as a member of parliament from Erzurum province he served as Turkey’s minister of health between 2002 and 2013. During his tenure, he oversaw the implementation of the influential Health Transformation Program (HTP) reforming healthcare in Turkey.
He received the WHO’s “World No Tobacco Day” Award in recognition of his efforts in the fight against smoking and in the promotion of tobacco control initiatives and policies. He has been an advisory board member of the Ministerial Leadership in Health (MLIH) Program at Harvard University since 2012.
Akdağ was reappointed as health minister last May.