Current Market Trends
GDP*:$733.6 billion (2015 est.)
Currency: Turkish Lira (TL)
Turkey has a population of 79 million and is a growing market for medical technologies and healthcare services. The Ministry of Health (MoH), at a national level is responsible for the planning of the country’s healthcare policy and is also the largest provider of healthcare services. $17.5 Billion is allocated from the central budget to MoH for the provision of these services. Turkey’s per capita healthcare spending is recorded as $793 in 2013 by OECD, which grew to this level from $330 in 2002. However, OECD average per capita healthcare spending is at $2,548 in 2013 which shows the strong potential for continued investment in healthcare in Turkey over the course of the coming years. However, it should also be noted that there is also a strong push for localization of medical devices and pharmaceuticals in Turkey which may mean some 5-10% decrease in the amount of imported medical devices over the next 5 years.
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 made by private entities. Patients who benefit from private hospitals are those who can either afford private healthcare, are covered under a private insurance plan, or social security insurance holders who are treated in private hospitals that have agreements with the Social Security Institute (SGK).
U.S. medical equipment manufacturers can either open their own offices in Turkey and equip it with their own sales and marketing force or appoint national and, most of the time, exclusive distributors in Turkey. The distributor/importer should have strong reseller base to market and service the products all around the country, follow the tenders and also be knowledgeable about importing medical devices into Turkey.
The MoH is the biggest player in the healthcare market as far as investing in healthcare facilities and operating these facilities are concerned. The table below shows the distribution of healthcare facilities by type of ownership:
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. Construction of many private hospitals offers increased sales opportunities and less complicated procurement requirements compared to the tender requirements used by MoH.
MoH is also contracting the construction and management of a new group of hospitals, known as ‘city hospitals’ or ‘healthcare campuses’. There will be 41 such developments. Contracts of 17 of these campuses have been tendered and given to various consortiums. These new hospitals will replace, thus, renew, about 50,000 beds in current hospital bed stock. By 2023, MoH targets operating 169,000 hospital beds of high quality. These new healthcare campuses will be financed by Public Private Partnership (PPP) model. The winning contractor of each project finances the construction cost of the project and operates the campus for 25 years against guaranteed annual lease payments made by MoH. Each of these campuses has 500 to 4,000 beds and house several general and specialized hospitals and labs with accompanying recreational areas. There is international interest in the tenders including interest from U.S. companies. These projects constitute business opportunities for U.S. medical 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 Ministry of Health - http://www.saglikyatirimlari.gov.tr/
Another major transformation in the Turkish healthcare system is the introduction of first-level healthcare services, known as the Family Practitioner System. Since December 2010, a nationwide system has been initiated whereby every Turkish citizen was assigned a family practitioner for primary and preventative medical service. This service has already increased demand for pharmaceuticals and preventative medical solutions and devices for management of chronic illnesses like obesity, diabetes, and many others where U.S. companies have offerings.
Medical tourism is a new sector developing very rapidly in Turkey. Increasingly, patients from Europe and the Middle East come to Turkey for medical treatment as healthcare services are offered at relatively more economical prices and the quality of medical services is high. There are 46 Joint Commission International (JCI)-certified hospitals in Turkey which makes Turkey the country with the third highest number of JCI-certified hospitals (excluding U.S.) 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). Some of these surgical procedures have long waiting lists in European countries, which is another reason why Turkey is 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 reports to a medical 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 visits made to the doctors, diagnostics, treatment applied, and prescription are entered in the record. The system produces e-prescriptions which are fulfilled at the pharmacies. This also makes it possible for the pharmacies to claim their receivables from the Social Security Institute online. Data collected from all across the country is centrally stored at the MoH servers. In April 2015, MoH launched a mobile application which makes it possible for every citizen to access his/her health record through this application. For the coming years, MoH aims is to use the data collected for effectively so that they can do forecasting and trending patterns of illnesses in Turkey, to have citizens be more active in managing their healthcare by accessing their healthcare records, and if there is need, to encourage citizens to use of remote monitoring devices to communicate with their healthcare providers on a more regular basis. MoH is also working on integrating ‘Clinical Decision Support’ elements into the current EHR systems in order to reduce errors made during diagnoses. Telemedicine is still in its earlier stages and there are some test projects done to provide medical support from larger hospitals to smaller hospitals in distant parts of the country.
Imports of U.S. origin is about 12% of the total imports market in Turkey. The rest are mainly from the European Union, predominantly from Germany, Italy, United Kingdom, France and the Netherlands, and China and India. There is also an emerging group of medical device and equipment manufacturers in Turkey, which are active in the manufacturing of disposables, orthopedic devices and tools, surgical and cardiological tools; like stents. There are close to 100 healthIT software development companies.
Unit: USD (millions)
Total Market Size
Total Local Production
Imports from the U.S.
Turkish medical device directives have been aligned to those applicable in the European Union (EU):
Per the directives listed above, medical devices have to have CE Mark in order to be registered and marketed in Turkey. They should have Declaration of Conformity and EC certification given by a Notified Body authorized by the EU.
Medical devices that will be sold in Turkey have to be registered in the Turkish Medicines and Medical that is operated by Turkish Drugs and Medical Device Agency under the Ministry of Health. If the manufacturer has a subsidiary in Turkey, medical devices, in question, can be registered under this entity’s name. If they are represented by a distributor in the country, this distribution company has to file in the registration under its own name.
Turkey has Customs Union Agreement with the EU which provides that products exported from an EU country are not levied any imports tax when passing through Turkish customs. Countries that have Free Trade Agreement with Turkey also benefit from the same application. Products exported from countries not falling into either of these groups are levied imports tax at varying amounts. This is not a trade barrier but an extra factor that U.S. companies have to take into consideration when they are establishing their pricing strategies in Turkey. Turkey also sometimes pursues protectionist approaches in favor of some of its local industries (lately for furniture industry which has had negative impact on hospital beds imported to Turkey) which results in sudden increases in the tax rates it charges on related imported products. A rather recent development in the market is a push by the Government for companies to partially or completely locally manufacture medical devices in return for purchase guarantee in public procurement. This action mainly targets capital products but as healthcare purchases create a sizeable portion of Current Account Deficit of the country, Government has decided to implement this approach in the coming years.
EXPOMED Eurasia (http://www.expomedistanbul.com/en/)
March 30-April 2, 2017
Tuyap Fair and Congress Center, Istanbul/Turkey
HIMMS Summit, Turkey
Best Prospects :
U.S. Commercial Service Contact Information
Senior Commercial Specialist – Medical Sector Lead
U.S. Commercial Service, Istanbul
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