Turkish government is considering raising limits of reimbursement for private hospitals

BMJ 2009; 338 doi: (Published 23 February 2009) Cite this as: BMJ 2009;338:b770
  1. Max Hotopf
  1. 1London

    Private hospitals in Turkey may soon be allowed to increase the rates that they charge the health department for treating publicly insured patients because they are facing severe financial problems.

    All Turks can use state national health insurance to pay for part of the cost of treatment in the private sector with a Ministry of Health tariff paying set amounts for defined procedures. But in July 2008 the Ministry of Health introduced regulations that limited the private sector to charging individuals no more than an extra 30% above this level. The Ministry of Health is now considering raising that ceiling to 70%.

    The private hospital sector in Turkey is labouring under $3bn (£2.1bn; €2.1bn) of debt after a recent rapid expansion, which saw the number of private hospitals rise from 250 in 2006 to 373 in 2008.

    Reşat Bahat, chairman of the Private Hospitals and Medical Associations Organisation (OHSAD), said that one fifth of the country’s private hospitals faced closure, and others had serious problems. “Some 60% of private hospitals are in trouble. Some of them are unable to pay their debts,” he claimed

    Filiz Çevirme, general coordinator at OHSAD, said the Minister of Health was indicating that it was likely to raise the level of the supplement to 70%, which would bring considerable relief for many, but not for all, private hospitals.

    There are three classes of private hospital in Turkey—A, which are the equivalent of high quality Western hospitals; B, which have fewer facilities, but still offer some luxury; and C, which are more or less the equivalent of public sector hospitals, with long queues and open wards. Private hospitals in Turkey cover the gamut of acute care, including, in a few cases, organ transplants.

    Dr Çevirme said that, before the ceiling was brought in, C hospitals typically charged supplements of 30-50%, B charged 100%, and A could charge from 150-300% of the money paid by the state insurer.

    She said that the effect of the 30% ceiling had been to make private medicine more affordable for the burgeoning middle classes, but that the dozen or so A class hospitals had refused to take state patients because they could not afford to offer their services at the price that the state was prepared to reimburse.

    It has left B hospitals losing money in many cases. She said: “The B and C hospitals have become very crowded and the A hospitals are empty.” By limiting the price of private health care, it has also had a disastrous impact on healthcare insurance.

    A 70% ceiling will give respite to some of the B group hospitals, but will still not be enough for the A class hospitals. Acibadem, the leading A hospital group, claims that the state payment is typically a fifth of treatment costs. The limit means that its eight hospitals focus exclusively on the wealthiest million Turks.

    The rise in the reimbursement will be welcome, but still leaves many expanding groups in trouble. Worse affected are groups like Medicana and Medical Park, who have invested heavily in huge, new, class A hospitals over the past two years, but who have not yet built a medical reputation sufficient to woo the wealthy.

    Private operators say the Ministry of Health is concerned at the growth in private hospitals over the past three years, and is worried by the number of doctors and nurses being poached. The ministry is limiting the number of licences granted for new private hospitals.


    Cite this as: BMJ 2009;338:b770

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