Regulation on International Health Tourism and Tourist Health ("Regulation") has been published in the Official Gazette dated 13 July 2017 and numbered 30123. The Regulation is published by the Ministry of Health ("Ministry") with a view to regulating the standards of service to be provided within the scope of international health tourism services and the authorization and supervision of health institutions and intermediary institutions that will carry out such services.
Scope of the Regulation
The Regulation covers (i) persons who come from abroad to the Republic of Turkey to receive health services and (ii) those who need health service while in Turkey and (iii) public hospitals, university hospitals and private health institutions and intermediaries that provide health services to such persons1.
Article 4 of the Regulation defines international health tourism ("IHT") as any kind of health services received by a real person coming from abroad for a limited period of time specifically for health purposes. Such persons either must not be a citizen of the Republic of Turkey or be a citizen of the Republic of Turkey but reside abroad.
Requirements for International Health Tourism Health Facilities and Intermediaries
Pursuant to Article 5 of the Regulation, IHT health facilities2 and IHT intermediary institutions3 that fall within the scope of the Regulation are required to obtain an IHT authorization certificate." The Ministry of Health ("Ministry") will suspend international health tourism activities of the health institutions that fail to obtain the IHT authorization certificate. Detailed information about criteria for the authorization of IHT health facilities and IHT intermediaries can be found in Annex 1 and Annex 2 of the Regulation.
The Regulation allows an IHT health facility to accept international health tourists or patients who apply directly to them. In addition, they are also allowed to accept the patients who are sent by an intermediary institution. In the event that an IHT intermediary that is authorized by the Ministry sends IHT patients to an IHT health facility, then it is mandatory to have a protocol between the IHT health facility and the IHT intermediary body and send a copy of the signed protocol to the General Directorate via City/District Health Directorates.
The authorized IHT health facilities are required to register the tourist patients who are to receive health services in the web-based system to be created by the Ministry. Personal health data registered by the international health tourism health facility will be processed in accordance with the Law on the Protection of Personal Data dated 24 March 2016 and numbered 6698, and will be transferred to the central health data system in accordance with the procedures and principles set by the Ministry.
Pursuant to Article 6 of the Regulation, in each IHT healthcare facility, an international health tourism unit ("IHT unit") that is responsible for the acceptance, registration, diagnosis, treatment, billing, discharge, translation and coordination of operations and transactions related to intermediary institutions will be established. In the IHT unit, a doctor / expert doctor is appointed as the responsible manager of the IHT unit and the City/District Health Directorate will be notified of the appointment. Depending on the international health tourism potential, a health professional may be appointed as the assistant manager for the same IHT unit. Those who will be appointed as the IHT unit responsible manager or assistant manger must have the following qualifications:
- Being qualified to practice medicine in Turkey;
- Being proficient in a foreign language;
- Providing documents evidencing at least five years vocational experience in Turkey provided that two of these five years are spent in public or private health institutions.
At the IHT unit, it is required to employ at least 2 personnel –including the responsible manager- who knows a foreign language. It is necessary that one foreign language should be English.
Pricing of Services and Invoicing and Documentation for Payments
Article 5 of the Regulation allows authorized IHT health facilities to provide IHT patients with diagnosis, treatment and rehabilitative health services as well as traditional and complementary medical practices in accordance with the criteria set out in the Regulation. An IHT health facility will also be responsible to provide any other services that the international health tourists will need in addition to the health services to be provided until the time of discharge from the hospital. For such additional services, IHT health facilities will be free to enter into contract with IHT intermediaries and any other institutions and organizations.
Pursuant to Article 10 of the Regulation, pricing of the IHT health services to be provided within the scope of the Regulation will be determined by the Ministry with the opinion of SATURK. The IHT health facilities are obliged to comply with the procedures and principles set forth in the Ministry of Health's prescribed tourism price list.
Under Article 11 of the Regulation, it is obligatory for IHT health facilities to organize sales receipt or invoice according to the applicable laws and regulations in Turkey. In the sales ticket or invoice to be issued, it is mandatory to attach a document showing the detailed breakdown and unit prices of the health services provided to the patient. In addition, if requested by the service recipients, it is obligatory to provide the following documents free of charge:
- For the International health tourism facilities
- A list showing the types and quantities of medicines and medical consumables paid by the patient and used in the IHT health facility
- Laboratory examination and analysis results and X-ray films paid by the patient in and out of the health facility; except for the judicial cases the originals are not given.
- Prescriptions of medicines and materials purchased outside.
- For the international health tourism intermediary institutions
- Detailed breakdown of the fees charged for services such as accommodation, transport and transfer, interpreting and counselling provided to international health tourists, their hospital attendants and other relatives.
Information and Publicity Rules
Article 12 of the Regulation prohibits the health facilities and intermediary institutions that are not authorized within the scope of this Regulation from sharing any information and publicity with potential IHT patients. Promotional activities related to international health tourism must be carried out as follows:
- Promotions cannot be made in Turkish language and in a manner that will create demand within the borders of Turkey. Promotions can be made in English and/or in the languages of the countries in which the services will be promoted.
- IHT health facilities and IHT intermediary institutions can publish information on their websites about the services offered and detailed transportation information with the latest date of update;
- Promotions cannot contain information about health services that are not authorized, not mentioned in the license (lisans) or activity permission document (faaliyet izin belgesi) of the health facility. The information provided cannot be against the professional and ethical rules, and in any case cannot be wrong, misleading and in a manner that will create demand among the citizens living in Turkey;
- Medical information provided in the website and in other promotional devices can only be made by legally authorized health professionals with knowledge and experience in the field;
- In the promotions, patients' stories can be used as a promotional material provided that the patient' s privacy is not violated, the patient rights are observed and a document is prepared evidencing that the patient's consent is duly obtained; and
- The medical procedures and practices already prohibited or not permitted to be implemented in Turkey cannot be promoted.
Supervision of IHT Health Facilities and IHT Intermediaries
Pursuant to Article 14 of the Regulation, IHT health facilities and IHT intermediary organizations will be audited at least once a year by the City/District Health Directorate except for complaints or inquiries.
The system of registration and notification will be established by the Ministry for the evaluation of complaints about international health tourism and disputes that might arise during the application of the tourist health. Regarding the complaints procedure, IHT patients should be informed by the IHT health facility prior to the delivery of health services.
Those who fail to comply with the principles and procedures stated in the Regulation will be imposed administrative fines and penalties s listed in Annex 5 and Annex 6 of the Regulation.
Having regard to the provisions of the Regulation, it can be said that the Ministry of Health has managed not to overburden the IHT health facilities with too much rules and regulations and set forth only the rules necessary for the safety and security of the IHT patients travelling to Turkey to receive health services.
1 This article does not cover the requirements related to the tourist health i.e. foreigners who temporarily stay in our country for any reason and receive health services in case of emergency or sudden illness while in Turkey.
2 International health tourism health facility is defined in the Regulation as follows: Public hospitals, university hospitals and private health institutions and organizations which hold a valid health facility licence and have been granted IHT authorization certificate by the Ministry of Health.
3 International health tourism intermediary institution is defined as follows: Travel agencies which hold a valid Group A operation certificate in accordance with the Law on Travel Agents and Travel Agencies and which are authorized by the Ministry of Health to carry out the activities of accommodation, transportation and transfer services for international health tourists and their accompanying companions and other relatives.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.