This is a best prospect industry sector for this country. Includes a market overview and trade data.
Last Published: 6/24/2019

Overview

 

2017

2018 (est.)

2019 (est.)

2020 (est.)

Total Local Production

768

778

919

968

Total Exports

429

494

543

597

Total Imports

1,945

1,605

1,501

1,483

Imports from the U.S.

398

377

375

370

Total Market Size

2,284

1,889

1,877

1,854

(total market size = (total local production + imports) - exports)                                                                                                                     
Unit: USD (millions)

With a population of 80 million, Turkey is a growing market for medical technologies and healthcare services.  The Ministry of Health (MoH) at the national level is responsible for planning the country’s healthcare policy and is also the largest provider of healthcare services.  Turkey spends 4.6% of its GDP on healthcare.  The central budget allocates nearly $15 billion to the provision of healthcare services.  According to OECD figures, Turkey’s per capita spending on healthcare has reached $857, which is a 3.5-fold increase since 2002, when the transformation program in healthcare started.  Turkey is a major importer of medical technologies with imports accounting for 85% of medical devices.  The share of imports coming directly from the United States is 20%.  The Turkish Government has been able to manage currency losses, which have been occurring since 2018, facing an increasing demand for healthcare services, by maintaining steady reimbursement prices of medical devices.  However, this has caused problems for foreign firms in dealing with these low and steadily decreasing rates (when accounting for inflation and currency fluctuations).

The Government of Turkey’s goal is to increase the country’s skill-set and knowledgebase to manufacture medical devices domestically.   To realize this objective, Parliament passed a law two years ago giving procurement guarantees to products purchased from medical device companies that partially or wholly manufacture in Turkey.  The first group of products subject to this procurement model were MRI, CT, digital x-ray, ultrasound devices and patient monitors.  However, this tender has already been canceled six times, and the deadline for the latest issuance is August 27, 2019.  The winning bid will receive a five-year procurement guarantee.  The aim is for the winning bidder to begin sourcing local content and partially manufacturing in the second year and to gradually increase the local content.  The Government of Turkey encourages partnering with a Turkish company to form a consortium.

The MoH is responsible for the construction, management, and medical operations in public hospitals, which cater to the medical needs of 90% of the population.  Private hospital investments are done by private entities.  Patients who can afford private healthcare are covered under a private insurance plan us private facilities.  Those with social security insurance may also be treated in private hospitals with agreements with the Social Security Institute (SGK).

Healthcare expenses of social security beneficiaries treated at a public hospital are reimbursed by the SGK if medical equipment and pharmaceuticals used are included on the reimbursement (SUT) list.  Medical equipment manufacturers who want to be part of the reimbursement system must ensure that their equipment is included on this list.  Private hospitals do not necessarily follow this listing and manufacturers deal with these hospitals on an account basis.

The MoH is the largest investor in and operator of healthcare facilities.  The table below shows the distribution of facilities by ownership type: 
 

 

 

2002

2017

Growth %

Type

# of Hospitals

%

# of Hospital Beds

%

# of Hospitals

%

# of Hospital Beds

%

# of Hospitals

# of Hospital Beds

Min of Health

774

67%

107,394

65%

879

58%

135,339

61%

13.5%

26%

University

50

4%

26,341

16%

68

5%

41,324

17%

36%

56,8%

Private

271

23%

12,387

8%

571

37%

49,200

21%

110%

297%

Other

61

6%

18,349

12%

0

0%

0

0%

-100%

-100%

Total

1,156

 

164,471

 

1,518

 

225,863

 

31.3%

37,3%

However, as can be seen in the table from the number of private hospitals, there is a strong privatization trend in Turkey's healthcare industry.  With more private hospitals, there are increased sales opportunities and less complicated procurement requirements compared with those used by MoH.

The MoH is also contracting the construction and management of a new group of hospitals, known as ‘city hospitals’ or ‘health campuses.’  The MoH has planned for 32 health campuses to be built. Nine are currently operational and 12 are under construction, with completion set for late 2021.  The remaining hospitals are at various stages in the tendering process.  These new hospitals will replace and renew about 50,000 beds in the current hospital bed stock.  By 2023, the MoH seeks to increase the total number of beds under its operation to 169,000.  The health campuses will be financed using the Public Private Partnership (PPP) model.  The winning contractor of each project finances the construction and operates the campus for 25 years against guaranteed annual lease payments from MoH.  Each campus has 500 to 4,000 beds and houses several general and specialized hospitals and labs with accompanying recreational areas.  There is international interest, including from U.S. companies, in these tenders.  These projects constitute business opportunities for U.S. medical device companies and healthcare service providers, often when they team with the Turkish construction companies.  For further information on these PPP projects, please visit the official website of the Private-Public-Partnership Directorate under the MOH. 

Another major transformation in the Turkish healthcare system is the introduction of first-level healthcare services, known as the Family Practitioner System.  In December 2010, a nationwide system was initiated whereby every Turkish citizen was assigned a family practitioner for primary and preventative medical care.  This service has already increased demand for pharmaceuticals and preventative medical solutions and devices for management of chronic illnesses such as obesity, diabetes, and many others where U.S. companies have solution offerings.

Medical tourism is a rapidly developing new sector in Turkey.  Increasingly, patients from Europe and the Middle East come to Turkey for medical treatment as high-quality healthcare services are offered at relatively economical prices.  In 2018, 750,000 international patients visited Turkey and the MoH expects this number to reach 1,500,000 by 2023.  There are 46 Joint Commission International (JCI)-certified hospitals in Turkey, making Turkey the country with the third highest number of JCI-certified hospitals (excluding the United States).  The most popular procedures are cosmetic, dental and ophthalmology procedures.  Turkey also has a good reputation in cardiology, endocrinology, gastroenterology, rheumatology, nephrology, oncology, neurology, dermatology, gynecology/obstetrics, orthopedics, organ transplantation, and otolaryngology (ear, nose & throat).  As some of these surgical procedures have long waiting lists in European countries, Turkey has become an attractive country for medical procedures.

Turkey has taken a very progressive approach towards utilizing health IT solutions in the country’s healthcare structure.  When a citizen visits a doctor in Turkey, all his/her healthcare information is recorded in an Electronic Health Record (EHR).  ICD-10 coding is the standard for the description of illnesses in these records.  All doctor visits, diagnostics, treatments and prescription are entered in the record.  The system produces e-prescriptions, which are filled at pharmacies.  This also makes it possible for the pharmacies to claim their receivables from the Social Security Institute online.  Data collected throughout the country is centrally stored on MoH servers.  In April 2015, the MoH launched a mobile application, making it possible for every citizen to access his/her healthcare record.  The MoH uses this data to forecast population health management and to analyze illness patterns in Turkey.  They also use it to encourage citizens to access their record and be more active in managing their own healthcare.  The MoH is also working on integrating ‘Clinical Decision Support’ elements into the current EHR systems to reduce diagnosis errors.  There is also a ‘radiology’ telemedicine application used in public hospitals.  The MoH works with HIMSS to make the EMRAM assessment of public hospitals.  According to latest figures, there are 164 Turkish public hospitals at EMRAM Scale 6 and 1 hospital at EMRAM Scale 7, making Turkey a leading country in terms of hospital digitization.

For a U.S. company to market its medical equipment and health IT solutions in Turkey, it should find representatives in the Turkish market with strong business development capabilities.  Turkey adopted the EU’s CE Mark and medical device directive, which require that medical devices bear the CE Mark in order to enter the Turkish market.  U.S. company representatives in Turkey must register products in the National Data Bank (UTS) that tracks all medical equipment marketed in Turkey.  To learn more about registering in this data bank, e-mail U.S. Commercial Service Turkey Healthcare Specialist Ebru Olcay at ebru.olcay@trade.gov.  If the product is under the reimbursement system, it should also be registered with the Social Security Agency.

Leading Sub-Sectors

There are approximately 6,000 companies in the medical device and disposables market in Turkey.  Local manufacturers primarily manufacture disposables, surgical tools, stents, prosthetics and hospital furniture.  In general, all major categories of medical equipment are present in the market, both in private and public hospitals.  At this point, they seek state-of-the-art and innovative medical equipment and solutions.  Turkey imports the following medical equipment and devices:

  • Advanced pre-screening and diagnostics devices

  • Advanced point-of-care devices

  • Advanced surgical devices

  • Cancer treatment devices

  • Wound management devices

  • Surgical devices using robotics technologies

  • Dental equipment

  • Implants used in orthopedics and traumatology

  • Health IT solutions, especially for critical decision-making processes

  • Remote patient monitoring devices

  • Telemedicine systems

Opportunities

Total bed capacity in Turkish hospitals exceeds 200,000.  Privatization and transformation of the healthcare system with the establishment of new healthcare facilities under the PPP model, and ongoing MoH hospital projects present opportunities for U.S. companies involved in medical technologies and services.  As Turkey continues to expand the number of private and public hospitals, purchases of advanced medical equipment will continue.  There are now some large hospital chains that operate not only in large cities but also in more remote parts of the country.  These new hospitals are all state-of-the-art facilities that use advanced medical equipment.

Web Resources

For further information on this section or for more on potential opportunities, contact:

Ebru Olcay
Senior Commercial Specialist – Healthcare Sector Lead
U.S. Commercial Service
U.S. Consulate Istanbul, Turkey
Ebru.Olcay@trade.gov
www.export.gov/Turkey

 

Prepared by our U.S. Embassies abroad. With its network of 108 offices across the United States and in more than 75 countries, the U.S. Commercial Service of the U.S. Department of Commerce utilizes its global presence and international marketing expertise to help U.S. companies sell their products and services worldwide. Locate the U.S. Commercial Service trade specialist in the U.S. nearest you by visiting http://export.gov/usoffices.