Turkey Report




Medical tourism
ready for take-off






To investigate the current state of medical tourism in Turkey, Callan Emery travelled to Istanbul, spoke to key stakeholders in the industry there and visited a number of hospitals in Istanbul that treat foreign patients on a regular basis.

There are four enormous passenger cruise ships docked in Istanbul and by nine in the morning when the gates open to Aya Sofia – the imposing, centuries-old church-mosque museum – the queue of tourists waiting to get in is already hundreds of metres long. The small district of Sultanahmet, home to Aya Sofia, the mesmerising Blue Mosque, the fabulous Topkapi Palace and the bustling Grand Bazaar is thronging with foreign visitors crammed into the art shops, the coffee shops and the roof top restaurants of the multitude of hotels overlooking the Bosporus. The Turks are smiling, business is booming and the place is riding high on a wave of tourist dollars.

Turkey is huge country relative to its European neighbours and it is only in the past decade or two that it has managed to lift itself out of relative economic obscurity to play an increasingly important economic role in the region – and a very large region it is. The country strategically straddles the crossroads between Europe and Asia with Europe to the west, the countries of the former Soviet Union to the north east and the Middle East counties to the south east. With developed neighbours on one side and developing on the other, there is huge opportunity for economic growth in Turkey, not least in the tourism industry.

The country is renowned the world over as an essential tourist destination and should be on every travellers’ itinerary. The country has a plethora of attractions – most of them historical and archaeological sites, but increasingly popular are the country’s many and varied beach resorts along the spectacularly beautiful Aegean and Mediterranean coasts.

So it doesn’t come as a surprise to see that Turkey has seen phenomenal growth in visitor numbers in the past decade, with tourist arrivals increasing from 8 million visitors in 2000 to a staggering 25 million in 2008. This has pushed the country into the elite group of top 10 destinations in the world in terms of the number of annual tourist arrivals.

Health Tourism

What is surprising, however, is the extent to which the health tourism sector has developed considering that this sector of tourism is still largely in its infancy around the world. We discovered when we visited the country in September that Turkey has several hospitals which have relatively well developed structures in place to handle foreign patients who come to the country specifically with the purpose of getting treatment. Impressively, some hospitals have set up International Patient Centres within their organisations specifically to manage foreign patient relations and patient concierge services.

Modern health tourism is a new, interesting phenomenon and is potentially big business. In 2004, revenues from health tourism worldwide totalled US$20 billion. This is projected to increase to $100 billion in 2012, according to Devon M. Herrick – Medical Tourism: Global Competition in Health, Nov 2007, National Center for Policy Analysis.

The key drivers of this new wave of patients seeking healthcare abroad include:

● An ageing population worldwide, which means more people seeking healthcare

● The high cost of healthcare in developed countries – patients will seek cheaper alternatives abroad

● Long waiting lists for tertiary care in several countries – patients will seek quicker access to care abroad

● The large uninsured and under-insured healthcare market means these patients will look for cheaper alternatives abroad

● Lack of tertiary care facilities in developing and under developed countries – these patients are forced to seek tertiary care abroad if they can afford it A study by McKinsey & Company in 2008 identified the main reasons why patients travel abroad. The study found:

● 40% travel from less developed countries to seek advanced, high quality care

● 32% travel from developed countries to seek higher quality care from advanced hospitals in developing countries

● 15% travel from countries with socialised medicine who seek faster access to treatment

● 13% travel from developed countries to seek healthcare at lower costs than available at home. (Source: Mapping the Market for Medical Travel by T. Ehrbeck, C. Guevara, P Mango. May 2008, McKinsey Quarterly)

Travel by the group seeking lower cost treatment has the largest growth potential, particularly following the global economic crisis. This plays to Turkey’s favour for two reasons: the country’s strategic position makes it easily and relatively inexpensive to access from Europe, the Middle East, and Turkey’s northern neighbours; and the quality of care and the number of advanced modern hospitals is high – it has a remarkable 35 JCI-accredited hospitals.

In 2007 the number of foreign patients in Turkey was 150,000. This increased to 200,000 in 2008. Although these figures are not entirely accurate as they include both foreigners holidaying in Turkey who required healthcare by accident and foreigners travelling to Turkey specifically for healthcare (the true medical tourist), they do give an indication of the potential growth of this industry in the country.

Travel to Turkey

To find out more about medical tourism in Turkey, Middle East Health travelled to Istanbul. Our initial impressions were that Turkey, in particular Istanbul, is surprisingly advanced in terms of healthcare facilities and is well set to manage foreign patients visiting the country for specific procedures. Acibadem Healthcare Group, Anadolu Medical Centre, Medical Park and Dunyagoz, all of which we visited, are modern facilities with the latest medical equipment – particularly in the field of Oncology where several of the cancer centres have linear accelerators, gamma knives, cyber knives and da Vinci Robots. The staff appear well trained (Turkey has its own well established medical universities and nursing schools), and all had in place specialised management structures to handle all the ins and outs of treating foreign patients – from pre-operative longdistance video-consultations, visa arrangements, airport transfers, translators, arranging accommodation for accompanying family, facilitating medical insurance and payment issues, and post-operative follow-up.

These hospitals offer specialist services, with some being Centres of Excellence in: Oncology, Cardiology, Organ Transplantation, Neurology, IVF, Orthopaedics, Plastic & Reconstructive Surgery and Ophthalmology.

Dr Filiz Cevirme, the general co-ordinator of OHSAD (Private Hospitals and Healthcare Organisations Association), also sits on the executive board of Turkey’s Health Tourism Association based in Ankara. She told Middle East Health that although some hospitals seem well positioned to handle foreign patients, it was still early days for medical tourism in Turkey and that the country was still trying to gain “recognition in the world that Turkey is a good destination for healthcare”.

This view was supported Dr Dursun Aydın, chairman of the Health Tourism Development Association, who was quoted in the Hürriyet Daily News & Economic Review in October 2009 (www.hurriyetdailynews.com/n.php?n=turke y-needs-to-revamp-health-tourism-2009-10- 25) as saying that despite having many advantages over its competitors in the industry, including unparalleled natural beauty, high-quality tourism facilities, thermal baths and experienced medical staff, Turkey still lags behind many countries in medical tourism.

According to the report Turkey’s revenues from health tourism are around $500 million annually, a very small piece of the pie if projections of $100 billion globally in 2012 are accurate. Dr Ugur Baran, chairman of the Health Committee at the Istanbul Chamber of Commerce, told the newspaper that Turkey could offer much more than it does, adding that if Turkey realises its full potential, it could earn up to $10 billion from the industry annually.

Commenting on the current state of health tourism in Turkey Dr Filiz explained that “most patients coming to Turkey come from the Turkish republics, (Turkmenistan, Tajikistan, Georgia, Armenia, Uzbekistan, Kazakhstan, Kyrgystan) and Eastern Europe.”

She noted however, that, with the exception of Dunya Eye Hospital (see below), the number of foreign patients visiting Turkish hospitals is just a small percentage of the total number of patients these hospitals see.

“It is still very early, but we expect this industry to grow fast,” she said.

She said health tourists visit Turkey mainly for the following procedures; Bone Marrow Transplantation, Cardiology & Cardiovascular Surgery, Cyber Knife, Dental Services, Gamma Knife, Genetics, Neurosurgery, Obstetrics and Gynaecology, Medical & Surgical Oncology, Ophthalmology, Orthopaedics & Traumatology, Plastic Surgery, Reproductive Health, Preimplantation Genetic Diagnosis, and Transplantation.

“For patients travelling to Turkey, elective procedures such as liposuction, orthodontics, Lasik, rhinoplasty, breast augmentation as well as complex specialised procedures such as cardiovascular surgery, brain surgery, orthopaedic joint – knee & hip – replacements can result in savings of up to 75-90% compared to what they cost in the US and Europe,” said Dr Filiz.

She pointed out that the government has recently started playing a more active role in helping to promote health tourism. Dr Filiz explained that a health tourism department was recently set up within the Ministry of Health (MoH), which co-ordinates with the Ministry of Tourism to facilitate the marketing of health tourism to the country in the international arena. Prior to this, she said, marketing was done only by the hospitals themselves.

“The main target initially is Eastern Europe as well countries where there are long waiting lists for tertiary care, such as the United Kingdom. We’ll also look at some Middle Eastern countries like Syria and Iraq,” said Dr Filiz.

She added that the GCC countries weren’t on the initial list, but may be included in the second phase of marketing. “Nonetheless, the Gulf countries may be interested in our IVF treatments,” she said as an afterthought. “They are advanced and relatively inexpensive.”

Beside the low cost, advanced care and ease of access – the local food, the many mosques and the historical links to the Arab world should make Turkey an attractive option for medical tourists from the Middle East.

Cost of medical care

The cost of treatment is one of Turkey’s major attractions for medical tourism.

The following table compares the cost of medical procedures in Turkey and equivalent procedures in the United Kingdom. 
 


While in Istanbul Middle East Health visited a number of the leading hospitals involved in medical tourism and spoke to senior executives in their international patient centres in an effort to gauge the level of sophistication of the hospitals, the treatments they offer and  their ability to manage foreign patients. The following is a brief summary of what we found.

Acibadem Healthcare Group

Acibadem Healthcare Group is a large group of healthcare-related companies comprising 10 hospitals (a further two are being developed), several day surgery and outpatient medical centres, medical laboratories, a medical university and an insurance company. Several of its hospitals are well placed to treat foreign patients and the group has a well established International Patient Centre to take care of all the requirements of these patients. All its hospitals are accredited by the Joint Commission International. The group has state-of-the-art technology at its hospitals including:
● PET-CT
● Intraoperative 3T MR
● Flash CT
● Digital mammography with Tomosynthesis
● Gamma knife
● Cyber Knife
● Da Vinci Robot Linear Accelerator

Speaking to Middle East Health, Ola Ragipoglu, International Patient Centre Specialist, said the Acibadem International Hospital was due to start liver and kidney transplants in October.

Discussing from which countries foreign patients came, she said they treated patients from many countries. “We have IVF patients coming from the Gulf countries, such as Qatar. We see many from Iraq paediatric oncology patients .”

The showpiece of the Acibadem Healthcare Group is all-digital Acibadem Maslak Hospital in Istanbul, which was inaugurated in 2009. It houses an advanced cancer centre which serves as a referral centre for the region. This hospital also has a specially designed Children’s Clinic.

The Acibadem Maslak Hospital Cancer Centre provides a multi-disciplinary approach to cancer treatment with medical oncology, surgical oncology and radiation oncology departments. The centre also offers bone marrow and stem cell transplantation. The cancer centre houses some of the most advanced equipment available including a linear accelerator, RapidArc technology (Volumetric Modulated Arc Therapy), Flash CT, a Cyber knife and the da Vinci SI robot for laparoscopic procedures with robotic surgery.

The hospital offers services in all fields of medicine and has a number of specialty clinics including: ● Electrophysiology Lab ● Arrhythmia Clinic ● Headache Clinic ● Stroke Centre ● Breast Clinic ● Obesity Clinic ● Reproductive Health Centre ● Sexual Dysfunctions Centre ● Allergic Illnesses Centre. www.AcibademInternational.com

 


The Florence Nightingale Group

The Florence Nightingale Group of hospitals headquartered in Istanbul comprises three general hospitals, a medical centre, a teaching hospital and clinical research centre. Their hospitals are accredited by JCI.

The group offers patient-centred and specialised healthcare by integrating education, research and technology with clinical care. The Florence Nightingale Group has an established International Patient Services centre which serves patients from around the world, starting at the initial inquiry through to their follow-up care at home.

The group has alliances with a number of hotels and with Turkish Airlines and Lufthansa to offer international patients discounts on flights when travelling to Turkey for treatment.

Top 10 procedures
1. Coronary Artery Bypass
2. Coronary Angioplasty
3. Liver Transplantation
4. IVF
5. Robotic Prostatectomy
6. Knee Replacement
7. Abdominoplasty
8. Hip Replacement
9. Kidney Transplantation
10. Rhinoplasty

The group houses the renowned Istanbul Centre for Robotic Surgery.

While offering expertise in all fields of medicine with their laboratories, radiology and nuclear medicine centres, intensive care units, with advanced technology and professional staff, the group has attained “Center of Excellence” status in the following specialisation centers:

● Center for Cardiology and Cardiovascular Surgery - Angiography and Rhythm Disorders
● Center for Organ Transplantation (Liver, Kidney, Pancreas)
● Comprehensive Cancer Center
● Center for Plastic and Reconstructive Surgery & Hair Implantation
● IVF Center
● Istanbul Center for Robotic Surgery (Urology, Cardiovascular Surgery and General Surgery)
● Center for Orthopedics & Istanbul Spine Center

http://groupflorence.com
 



Anadolu Medical Centre

Anadolu Medical Center is a modern, state-of-the-art integrated healthcare facility in Istanbul. The centre has been affiliated with Johns Hopkins Medicine from the outset when it began operations in 2005. It is accredited by Joint Commission International.

The hospital is well prepared for foreign patients and has an established International Patient Services centre. They will organise visas, accommodation – the hospital has a 5-star hotel built on the same grounds as the hospital – airport transfers and care co-ordinators.

Asli Akyavas, International Services Director, Anadolu Medical Center, told Middle East Health the hospital sees on average about 400 foreign patients every month which makes up about 25% of hospital revenue.

“As of August 2010, 30% of our patients are foreign. We have capacity for considerably more foreign patients and are aiming to have foreign patients make up around 40-50% of the total number of patients we see,” she said.

And although most of their patients come from Eastern Europe, the Turkish republics and the Middle East they do see patients from Europe and the United States for specific procedures.

“Patients from Eastern Europe are attracted by the better quality healthcare, while patients from Western Europe are attracted by the relatively low cost,” Akyavas explained. “Our costs are about 30% below European prices.”

“From the Gulf countries patients mostly come from Bahrain, UAE and Saudi Arabia,” she said Anadolu Medical Center offers a comprehensive set of services and treatments, with specialist services in:

● Oncology ● Cardiac Care ● Neurological Sciences ● Women's Health ● IVF ● Orthopaedics ● Plastic & Reconstructive Surgery ● Executive Health Programmes It is a Centre of Excellence in: ● Oncology ● Cardiology ● Orthopaedics ● Traumatology ● IVF ● Women’s Health

“We are well known in the region for our advanced oncology care and serve as a referral centre in the region for oncology. We can take on complicated cases with our multispecialty ‘tumour board’,” Akyavas said.

Anadolu Medical Center has assembled a team of 120 full-time physicians. They are highly skilled professionals, consisting of US board-certified physicians and academic medical professionals who work collaboratively as an integrated unit for optimal patient care.

The centre has a range of advanced technoly including:

● CyberKnife ● Linear Accelerators (IMRT) ● PET-CT ● IMRT treatment ● Straton-CT ● TIM-MR ● PYXIS ● PACS ● Telemedicine ● Electronic patient records

www.AnadoluMedicalCenter.com
 



Dunyagöz (World Eye)

Dunyagöz is one of the world’s largest eye hospital groups. It has 7 hospitals and 5 clinics in Turkey and 5 clinics abroad. All have JCI accreditation. Three new clinics are due to open in Moscow, Ukraine and Vienna. There are plans to build and eye hospital in Bahrain.

The group’s ophthalmology departments cover all spheres of ophthalmology:

● Laser correction of refractive errors (Lasik, Intralasik, Wavefront) ● Refractive Intraocular Lens Treatment ● Prebyopia Treatment (for ages above 40) ● Cataract ● Glaucoma ● Strabismus and Paediatric Ophthalmology ● Retinopathy of Prematurity ● Retinal Diseases and Intraocular microsurgery ● Diabetic Eye Care ● Neuro-Ophthalmology and Electrophysiology ● Photodynamic Treatment ● Corneal Diseases and Corneal Transplantation ● Keratoconus ● Blepharoplastic Surgery ● Ocular Prosthesis ● Lacrimal Canal Surgery ● Uvetis-Behcet’s Eye Disease ● Contact Lens Examination and Application ● Artificial Eye Application ● Aesthetic and Reconstructive Oculoplasty

“We were the first group to start health tourism in Turkey in 2000,” Arzu Ajun, International Affairs Supervisor, told Middle East Health. With a decade of experience behind them Dunyagöz is now one of the most successful health tourism groups in Turkey.

“We see around 22,000 foreign patients a year, from 97 countries” Arjun said, adding that the group offer travel and ophthalmology packages and that patients generally “visit in groups”.

A typical package looks like this:

● 3 nights’ accommodation in 5 star hotel ● Round trip air tickets ● Airport-hotel transfers ● Istanbul city tour ● Guiding services ● Pre- and post operative laser surgery examinations ● Lasik treatment for both eyes ● Medication

Ophthalmology is ideally suited to health tourism as procedures are day surgery or outpatient procedures. The patient can fly in, receive treatment the next day, do a bit of sightseeing and fly home.

“Most of our patients come from Europe,” said Arjun. “They come because is less expensive and Istanbul is quick and easy to access.” “We also find that corneal transplant patients use our services because they can get the procedure done quicker than in their home countries where there are often long waiting lists for replacement corneas.”

She said Dunyagöz has a 24-hour call centre. “We can communicate in 19 languages, including Arabic,” she pointed out. Interestingly, at one of the eye hospitals in Istanbul, which we visited, Arjun showed us an area of the building reserved for prayer with Islamic, Christian and Jewish prayers rooms set side by side.

“We receive patients of all religions and we find this is a place they can come to seek peace and calm before treatment,” Arjun explained.

www.dunyagoz.com
 



Medical Park Hospitals Group

The Medical Park Hospitals Group has 12 hospitals and two hospital complexes in Istanbul and various cities across Turkey.

“The group also has a number of clinics abroad that offer consulting services,” explained Aysun Uçar, the recently appointed International Marketing Director. “They’re in Georgia, The Netherlands, Azerbaijan and the Ukraine. In Albania, Medical Park has a well equipped clinic.”

Uçar was previously Deputy General Manager at Medical Park Private Bahçelievler Hospital. The creation of her new position, enabling her to work full time on the international market, is a sign of the importance Medical Park is placing in the international medical tourism business. Several of the group’s hospitals have JCI accreditation. Being such a large group, it covers all fields of medicine.

Transplant unit

The Medical Park Antalya Hospital Complex, Organ Transplant Department, in Antalya on the Mediterranean coast of southwest Turkey, has one of the region’s leading organ transplant programmes and performs more than 500 organ transplants a year. The department has received patients from across Turkey as well as Germany, France, Georgia, Azerbaijan and England.

This hospital also houses the Bone Marrow Transplantation Unit, which is accredited by the European Community for non-relative bone-marrow transplantation. According to the Cancer Unit at the hospital, cure rates following bone marrow transplants average 70%. The unit performs 60-80 bone marrow transplants a year.

Cardiology


The Medical Park Antalya Hospital Complex also has an advanced Cardiovascular Diseases Hospital.

Neurosurgery

The Medical Park Bahçelievler in Istanbul is renowned for its neurosurgery department and is one of a handful of centres worldwide recognised for treating Parkinson Disease. The surgical team use a microelectrode recording and stimulation technique to act on the brain cells responsible for the disease. A ‘brain battery’ is implanted after surgery enabling patients to return to normal health.

Oncology

Medical Park Bahçelievler has specialised branches of tumour surgery, such as thyroid, breast, liver and pancreas; orthopaedic tumour surgery and gynaecologic tumour surgery as well as advanced oncologic diagnosis and treatment units with PET-CT and Linear Accelerator.

Medical Park Goztepe Hospital Complex in Istanbul incorporates three separate but connected hospitals; General Hospital, Cancer Hospital and Dental Hospital. The Cancer Hospital offers multi-disciplinary treatment including medical oncology, radiation oncology, surgical oncology, genetics, complementary medicine, psychology, nutrition and diet departments all under one roof.

Genetics

The Centre for the Diagnosis and Treatment of Genetic Diseases at Medical Park Goztepe Hospital Complex is a stateof- the-art laboratory that performs routine genetic tests, cancer genetics, pharmacogenetics, predisposition/risk tests and preimplantation genetic diagnosis – one of a just a few centres worldwide that does this.


 D
ate of upload: 19th Dec 2010

 

                                  
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