Competitive advantages of Turkey in medical tourism is presented with a case study about IVF transaction. Cost, quality, succes and safety components are compared between USA and Turkey in that point.

1. Turkey as a medical tourism destination: Cost-advantage, specialization and
subsequent quality improvement in medical tourism hubs
M.Said Yildiz, M.Mahmud Khan , PhD, N.Hikmet, PhD
University of South Carolina
Background
Medical tourism has become an important mechanism of obtaining medical care services
and it is estimated that total value of medical tourism is going to increase in various
reports and studies. Turkey’s market share in medical tourism is increasing with its
competitiveness in different aspects.
Generally Turkey is known as a competitive country in medical tourism with low cost and
high quality service, advanced technology usage in medical care, minimum waiting times,
well trained doctors and high number of JCI accredited hospitals.
IVF is highly available to medical tourism in terms of lower malpractice risk, lesser
hospital visit essentiality and lesser continues care requirement. Turkey is known as one
of the most important destinations of IVF treatments.
Egg donation, surrogacy and sex selection is officially prohibited in Turkey. So Turkey is
an IVF medical tourism destination due to other reasons like cost, convenience, success
rate and quality.
IVF can be considered as mutually beneficial type of medical tourism with minimum
concern of reducing access to health care for the destination country’s citizens. (There is
enough -more than 100- IVF laboratories in Turkey. So access to IVF services is not a
problem) Also medical tourism for IVF doesn’t increase cost of treatment for Turkish
citizens. First and second cycles of IVF is paid by governmental social security agency in
Turkey.
Study Objective
The purpose of this study is to better understand the factors associated with increased
popularity of medical tourism in Turkey with a case study of a JCI accredited hospital’s
medical tourism efforts and accomplishment in IVF treatment.
Competitiveness (Cost comparison between Southeast USA – Turkey)
Turkey
Southeast USA
daVinci Prostatectomy
17,250
102,400
Heart Bypass (CABGx4)
12,250
144,317
Health Valve Replacement
13,750
177,665
Hip Replacement
12,000
100,047
Hysterectomy(Vaginal)
5,000
31,474
Knee Replacement
11,500
IVF Market (Global and Turkey)
65,918
Spinal Fusion
18,000
IVF Cost comparison with other countries
IVF cost
(per cycle)
103,761
Italy
Source: http://www.companionglobalhealthcare.com/employers/comparecosts.aspx
Competitiveness (comparison of treatment choices: country-abroad)
Anadolu Medical Center
It is estimated that at least 20,000 couples receive in vitro fertilization (IVF) care abroad each year. (Peter
Kovacs. Seeking IVF Abroad: Medical Tourism for Infertile Couples Medscape. Jun 14, 2010.)
Turkey is 7th in IVF market. Total number of baby born with IVF is 44.000. Total number of Assisted
Reproduction Centers is more than 120. (2010)
In a report(2008), the fertility industry was being seen to be slated to bring in additional revenue of $1-2
billion by 2012 (http://www.geneticsandsociety.org/article.php?id=4241)
Hospital in United States
IVF (Medical Cost)
2500
12000
Airfare (15-20 percent Turkish airlines
discount for medical tourism patient)
Hotel (located in hospital campus / IVF
package)
Other (Trip expenses 100 USD for a
day)
2500
-
TOTAL
8500
1500
-
2000
$5,504
Spain
$5,600
Norway
$4,523
Sweden
$5,300
Canada
$5,766
USA
$12,146
Turkey
$2,500
-
TURKEY COST INCLUDES
Monitoring, Ultrasonography Exams,
Medical Fees.
Egg Retrieval,
Anesthesia, IVF.
Embryology Laboratory Services,
Assisted Hatching, IMSI,
Blastocyst, Embryo Transfer.
Airport/hospital or hotel/hospital ground transportation.
Hotel and trip arrangements.
24/7 translator assistance.
IVF succes comparison (Anadolu Hospital and USA avarage)
80
12000
70
Competitiveness (comparison of quality indicators)
Data sources and Limitations
Some data like IVF succes, IVF cost and quality indicators for case study hospital were
taken directy from Anadolu Medical Center. Different sources were used for comparison to
USA and world data. Difficulties of reaching same data of same year limited the study.
Foreign Visitors for Medical Purpose to Turkey
(Tourist declared health reasons in custom)
60
CLINIC QUALITY INDICATOR USA DATA
Urinary Tract Infections (UTI) (per 1000 catheter days) Medical
Major Teaching hospitals pooled mean(1) (lower is better)
Catheter related blood stream infections (per 1000 catheter
days) Medical Major Teaching hospitals pooled mean(2) (lower is
better)
Patient Falls (Per 1000 Inpatient Days) mean in hospitals over
500 beds in 2007, Massachusetts(3) (lower is better)
Pressure Ulcer (Per 1000 Inpatient Days) Among community
hospitals in the Healthcare Cost and Utilization Project, the riskadjusted rate of this indicator(4) (lower is better)
Prophylactic Antibiotic Selection for Surgical Patients in US
National data (April 2011-March 2012) (higher is better)
Prophylactic Antibiotic Received Within One Hour Prior to
Surgical Incision (higher is better)
Prophylactic Antibiotics Discontinued Within 24 Hours After
Surgery End Time (higher is better)
2,4
ANADOLU HOSPITAL DATA
(2011)
2,2
Competitiveness (accredited and affiliated high quality hospitals)
•Hospitals with high quality levels has significant cost advantages
•Turkey has the highest number of JCI accredited hospitals in the world. (28 hospitals, 3
Genetics Diagnostic Centers, independent laboratories, over 4.000 inpatient beds and 957
ICU beds, 179 operating theaters and 2.000 physicians employed)
•Affiliations and collaborations with prestigious medical centers like; Harvard Medical
International, Johns Hopkins Medicine International, Mayo Clinic, Houston Memorial,
Sloan-Kettering Cancer Centre…
•Turkey has capabilities & Expertise in high level medicine including Liver, Kidney and
Pancreas Transplantations, Robotic Surgery, Bone Marrow Transplantations, Cardiology
and Cardiovascular Surgery…
Anadolu
40
1,8
USA
0,7
30
4,76
5.18
0,6
0,6
20
10
.
0
< 35 age
98
35-37 years
38-40 years
41-42 years
> 42 years
100
Source: SART https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
98
99,4
Conclusion
97
97,3
(1, 2) http://www.cdc.gov/nhsn/PDFs/dataStat/NHSN-Report_2010-Data-Summary.pdf
(3) http://www.qualitymeasures.ahrq.gov/content.aspx?id=27680
(4) http://www.qualitymeasures.ahrq.gov/content.aspx?id=38513
(5, 6, 7) http://www.baptisthealthmadisonville.com/quality-indicators-data
Source: Turkey Statistics Agency – TUIK Data Bank http://www.tuik.gov.tr/
50
Cost of medical services in Turkey is only about 30% of the costs in Western Europe and the USA but
the high demand for IVF services is not due to cost-advantage only; the success rate of IVF is found to
be higher in Turkey than in the USA. Therefore, after correcting for the success rate, the cost-advantage
per successful case becomes even higher. Over the last few years, quality indicators of Turkish hospitals
(especially accredited ones) are showing significant improvements implying that Turkey is moving
towards creating significant comparative advantage in medical tourism.
Competitiveness of Anadolu Hospital (case study)
•209 bed, 59 ICU bed capacity,
•136 doctors (internationally experienced and English speaking) 384 nurses.
•36.336 total inpatient, 136.997 outpatient visit, 3358 surgeries (2011),
•On campus hotel for medical tourism patients and dedicated International Patient Department,
•Joint Commission International (JCI) accredited and Johns Hopkins Medicine affilied
•ESMO-European Society for Medical Oncology (Certificate of Excellence)
•Integrated Management System ISO 9001-2008, ISO 14001-2004, OHSAS 18001-2007,
An embryology lab with advanced technologies. Chief of IVF department is an American Board of
Obstetrics and Gynecology certificated and USA IVF licenced Yale University professor.
Team is composed of experienced and English speaking members.)
References
BIRDAL, Erginer, Medical Tourism Research 2011, Ministry of Health of Turkey, 2011
INHORN M.C, GÜRTIN Z.B, Infertility and Assisted Reproduction in the Muslim Middle East: Social,
Religious, and Resource Considerations FVV in ObGyn, 2012, MOnOGraph: 24-29
KOVACS P, Seeking IVF Abroad: Medical Tourism for Infertile Couples. Medscape. Jun 14, 2010.)
SAROJINI N, MARWAH V, SHENOI A, Globalisation of birth markets: a case study of assisted
reproductive technologies in India Globalization and Health 2011, 7:27
TRAM Tourism Research and Marketing Report on Medical Tourism (http://www.tramresearch.com/MedicalTourism.PDF) (06.12.2012)
YILDIRIM, R Turkish Accredited Hospital Association Presentation, Medical Tourism in Turkey, March 1213, 2010 – Chicago, http://www.medicaltourisminturkey.org/docs/Day1S2RusenYildirim.pdf (06.12.2012)