In this article, Altuğ and İdil explore the legal and ethical dimensions of Turkey’s growing medical tourism industry. Covering topics from accreditation and government support to legal challenges and dispute resolution, the article explores the complexities of this dynamic sector.
Introduction
The rapidly expanding medical and health tourism industry has seen significant growth in recent years. With the increase in the number of health and medical tourists, ethical and legal issues have come to the forefront. These issues encompass, among others, consumer and privacy protection, malpractices, organ trafficking, cross-border complexities, insurance and accreditation of facilities. This article delves deeper into the critical concern of liability arising from damages incurred during the treatment process.
What is medical tourism and health tourism?
“Medical tourism and health tourism” can be broadly defined as the movement from one place of residence (“departure country”) to another location (“destination country”) to acquire health-related services. This is a broad concept that not only benefits the destination country economically but also provides ample opportunities for medical tourists. The term “medical tourism” is often used for receiving medical treatments and procedures in the destination country. In contrast, “health tourism” encompasses a wide range of health services in the destination country, including spas, beauty treatments, rehabilitation, retirement residences and services for the elderly. Globalization allows people to seek cost-effective but high-quality medical services in other countries. According to the Medical Tourism Association, approximately 14 million people worldwide travel to other countries each year to receive medical care.(1). Many countries are investing in medical technologies and qualified healthcare facilities to attract more medical tourists.
The healthcare sector in Türkiye occupies a strong global position. Turkey is a focal point due to its strategic location and proximity to Europe, Asia, the Middle East, North and Central Africa and Russia.
Medical tourism in Türkiye
World-renowned accreditation bodies confirm the quality of services of many hospitals in Turkey. In fact, 38 Turkish hospitals have received accreditation from the Joint Commission International (“JCI“).(2) JCI accreditation means that a medical facility adheres to established and internationally recognized standards. Turkey ranks seventh in the world in terms of the number of hospitals accredited by this organization, guaranteeing high-quality medical treatment.(3) The cost of many procedures in Turkey is 50-70% lower than in Europe, while the quality of medical care remains consistently high(4). Türkiye has transformed into a fully equipped medical center for foreign patients. In the third quarter of 2022, the number of visitors to Turkey for medical tourism was recorded at 880,000.(5)
Foreign patients are usually provided with services such as airport transfers, temporary hotel accommodation until they receive test results and require hospital treatment, accommodation of their relatives during the treatment period , 24/7 translation services and assistance in preparing all necessary documents in their native and local language. Turkish languages.
Incentives provided by the Turkish government
The government has supported health and medical tourism through the implementation of the health transformation program. Most of the facilities in the field of health and medical tourism have been encouraged by the introduction of tax incentives. Government contributions are also offered to cover costs associated with documents, certificates and accreditations required for healthcare facilities to comply with international technical legislation or operate in foreign markets.
One of the recent incentives introduced by the Turkish government is a website developed in collaboration with the Ministry of Health (the “Ministry“) and the Ministry of Culture and Tourism, as well as USHAŞ (International Health Services Inc.). This website is called “Health Türkiye” and can be accessed via the link “https://www.healthturkiye.com/ It provides various information on doctors, hospitals, destination health guides, as well as tourist and cultural information.
Legal considerations for healthcare establishments regarding medical tourism: main challenges
Legal issues often arise in the context of cross-border medical and health tourism. These challenges encompass a range of issues, including language barriers, intermediary mediation agencies, differences in organ transplant regulations, and visa and residency issues. In the legal framework, the transfer of medical records is a crucial concern, often subject to objections. The European Union, recognizing the importance of protecting personal and medical data, has established specific regulations in this regard. Unfortunately, laws governing privacy and data transfer in many medical tourism host countries remain largely unregulated.
The continued emergence of malpractice litigation is due to the lack of an organized international system capable of providing legal solutions for medical tourists. It is imperative to recognize that healthcare facilities must be aware that international patients may be subject to the legal provisions of their home country, unlike local patients. Additionally, the lack of formal medical training in some beauty industry establishments poses a significant risk to patients and is a notable source of disputes within the health tourism sector.
Regulations established by the Turkish government
The Ministry of Health Tourism mainly uses two concepts. Patients are treated according to different fee schedules based on the following concepts:
Health services provided to people who travel from their place of residence to another location to seek health services (health tourists).
“Patients receiving services within the framework of Tourist Health” for tourists who need to benefit from emergency or unscheduled health services during their vacation.
Although the concepts are distinct, some questions in the field of health tourism remain unanswered. Review of relevant legislation can help identify these issues. In this context, the legislative studies carried out by the Ministry to regulate issues related to health tourism include the Regulation on Private Health Facilities Providing Outpatient Diagnostics and Treatment, the Regulation on Private Hospitals, the Regulation on Health Centers dialysis and the Regulation on International Health Tourism and Tourist Health (the “Regulation), as well as the Directive on health services to be provided in the context of health tourism and tourism health.
The bilateral agreements signed by Turkey should also be considered within the framework of international health tourism legislation. Currently, Turkey has concluded such agreements with more than 50 countries, contributing to the development of health tourism for both parties.(6).
Legal procedure for Follow up in case of dispute
• Responsibility of the medical attendant: In the event of a breach of the duty of care and attention, the acts of the medical attendant, such as neglecting to administer prescribed medications to a patient resulting in harm or failing to monitor vital signs when doing so is medically necessary, will violate the law, and will subject you to criminal liability. Article 506 of the Turkish Obligations Law defines the duty of care and attention between patients and doctors under a mandate agreement.
• Responsibility of the medical establishment: A public law relationship exists between the patient and the administration (public hospital). Pursuant to Article 129/5 of the Constitution, following a wrongful administrative action, legal action seeking compensation may be taken against the Ministry. Whether it concerns service defects or personal faults, the Court of Cassation has established a judicial precedent allowing legal proceedings to be initiated against the administration. A contractual relationship exists between the private hospital and the patient. The Court of Cassation recognizes the existence of a contractual relationship between the patient and the private hospital, generally through a patient admission contract. According to established legal precedents, the hospital bears strict liability in accordance with Article 66 of the Turkish Obligations Law. The resolution of conflicts between a private clinic and a patient must respect the legal provisions described in the mandate contract. Healthcare retainer agreements are essential tools for setting clear expectations and responsibilities between patients and healthcare providers, thereby mitigating potential misunderstandings and disputes. These are legally binding documents that provide a framework for the provision of medical services while preserving the rights and interests of both parties involved. Patients should read and understand these agreements before undergoing any medical procedure in private hospitals.
• Distribution of responsibilities between the intermediary company and the doctor/hospital: According to the Court of Cassation, the intermediary company and the doctor/hospital serving in Türkiye will be jointly and severally liable.
Potential lawsuits
• Material/moral compensation: compensation will be granted in accordance with the Turkish Law of Obligations, which corresponds to the jurisdiction of the place where the illicit medical act took place.
• Tort action: Health tourists also have the option of taking legal action against the hospital/doctor under the tort provisions.
Conclusion
Medical tourism in Turkey is a thriving industry, but it faces ethical and legal challenges that require more legislation and regulation. Issues such as malpractice, consumer privacy, data protection, organ trafficking and alternative medicine require special attention. Sector stakeholders should proactively adopt “preventative law” measures to mitigate inconsistencies and errors, thereby preserving the integrity of the sector. In this context, health tourism companies should establish liability policies or compensation funds to repair damages arising from the legal relationship between intermediary companies and international patients.
In the era of technological advancement, countries around the world are focusing on different healthcare specialties. Turkey, with its favorable position and quality healthcare services, aspires to capture a significant share of the global healthcare market, thereby strengthening its position as a medical tourism hub. With the sector growing exponentially, ensuring ethical and legal standards remain paramount to the continued success of medical tourism in Turkey and beyond.
