Dr Fahrettin Koca – Minister of Health, Republic of Turkey

The Minister of Health of the Republic of Turkey, Dr Fahrettin Koca, provides an overview of the current state of the Turkish healthcare ecosystem, highlighting its opportunities and challenges. He emphasises Turkey’s ambition to become a global leader in medical manufacturing as well as a popular target for health tourism.

 

We will strengthen our healthcare system by making primary healthcare services stronger and more organized

What is your vision for strengthening the Turkish healthcare system? What areas are you focusing on to create a more sustainable and effective national public healthcare system?

The Republic of Turkey’s constitution asserts that state health services indirectly and directly fall under the responsibilities of public service.

As the Ministry of Health, our ultimate goal for Turkey is to provide healthcare for all, to protect every person’s right to healthcare and to administer quality health services to everyone in need.

With the application of a healthcare system, many demands can be successfully met. These demands include and are not limited to: eradicating discrimination throughout the private and public sectors, mobilizing resources that belong to the Turkish society, prioritizing at-risk groups, making centres accessible in remote areas of the country, encouraging citizens to live a healthy and sustainable lifestyle and ultimately maintaining respect for the habits, beliefs and expectations of the people. I believe that when the aid demands are met, we can then have a successful healthcare system.

Human resources will be our biggest strength in creating such a system. Turkey has a young and dynamic population. However, the population is nearing an equilibrium and in order to adapt to the changing demographic structure, we must educate and equip people to successfully meet the expectations of society. For this to occur, the level of education for the majority of Turkish citizens should be on par with global standards. As such, our Ministry will always cooperate with educational institutions.

It is often assumed that we do not require healthcare personnel due to the rapidly emerging medical technology sector. However, the times call for learned professionals who know how to use newly discovered methods and techniques. Essentially, our goals for vocational training will not focus on the quantity but the quality of the education given.

Manpower, duration of service and efficiency of the technology used are factors that are quantifiable. Thus, we shall introduce a service model associated with performance management. This model will consider the level of conformity, efficiency and quality for a result-oriented assessment.

Healthcare should not just fall under a certain sector. We must create a movement geared towards elevating every community member’s health as a whole. This is because even if one provides first-rate healthcare services, as long as any factors that undermine one’s quality of life exists, the expected results will not be achieved. Ultimately, making healthcare services multi-sectoral and allowing them to permeate structures and sectors that are already effective in social life allows us to remove the heavy burden of ensuring a healthy society from healthcare professionals.

It is important to ensure that individuals and civil rights groups (who are the building blocks of society) do not just sit back and play the role of ‘healthcare consumers’. These individuals have the right to engage in law reforms and health guidelines that will be enforced in society as they are the ones most affected by them. This way, a health management model can be formed that represents all of the groups of people that make up society.

A healthy lifestyle begins at home and moves to school, work, transportation, housing, businesses, urban or rural environments and even ultimately international relations. We must ensure avoidance of any addiction and abuse of tobacco, alcohol and technology for a healthy future. We should ensure that measures which delay and prevent the emergence of diseases such as healthy eating and the promotion of an active lifestyle will be adopted and widespread in society. This will only be brought about with the collaboration between health facilities and family health centres.

We will strengthen our healthcare system by making primary healthcare services stronger and more organized. In this way, we aim to reduce the applications to hospitals for problems that can be solved in the first step. To ensure the quality of service, we aim to reduce the population per family physician. Finally, in our rapidly ageing society, we must ensure healthy ageing of our people with an effective chronic disease management system starting from our family physicians.

Our ultimate goal is to decrease maternal and infant death, reduce chronic disease burden and increase immunization. We cannot allow even one single mother or child to lose their lives over a preventable circumstance.

We would like to move to a period where the most modern technology and the most suitable healthcare environment are offered to our citizens. This, coupled with the highest quality of human resources in our City Hospitals that are also in a synergistic relationship with universities, ensures that for any patient these hospitals will be their one-stop centre for examination and treatment. Sooner or later we would like to reduce the need to travel abroad for our citizens’ healthcare needs.

It is not difficult to turn our country into a health tourism base with the service model we are going to add to our healthcare system, which has succeeded in keeping the citizen satisfaction rate high for very low costs. This will add to our country’s economy and eventually increase investment rates.

Due to its rapidly developing healthcare system, Turkey has slowly become a global destination for health tourism. Appropriate assessment of this potential will quickly give Health Sciences Departments the chance to provide courses on healthcare tourism. In this way, health professionals from various countries will be educated appropriately. This will lead to a win in both health diplomacy and the overall elevation of Turkey’s reputation in the healthcare sector.

Taking into consideration the geopolitical situation of our country and its influence in the region in recent times, Turkey has been provided with a strong economic opportunity. Thus, in order to take advantage of the said opportunity, we should ensure that vaccines, medicines, and medical devices are made locally. With its favourable geopolitical and central location, Turkey is considered a very attractive market for investors, added to that, if the production of materials occurs domestically then this will increase the likelihood of investors.

 

Given the key measures and reforms implemented in recent years in Turkey, what are the resolutions you plan to implement in the coming months as the new Minister of Health?

The AK Party administered a Health Transformation Program after coming into power at the end of 2002. This program targeted chronic and unresolved problems that have plagued the country for decades, even with intervention. One reason as to why the problems are proving unsolvable is the many interventions that prevent adequate and effective healthcare. Healthcare accessibility is not the main issue. We have made sure that people can now seek treatment without having to worry about financial risks.

Primary care services are recognized and have become available to the public. The satisfaction rate of citizens rose to 75 percent when health services became more accessible. This increase thus propelled expectations the citizens had from these given services. Although providing substantial services that meet high expectations may seem difficult, satisfaction rates have not dropped below 70 percent.

As the state is responsible for healthcare services, the most impactful strategy to enforce would be to establish a sustainable and high calibre system. Thus, ensuring a system that is capable of revamping and enlarging to meet ever-changing demands while also preserving its operation.

We are aware that in the foreseeable future our healthcare system will face a myriad of problems. However, if we do well in our preparations currently then I do not see any reason as to why we cannot sustain our current success.

One of our foreseeable risks is the changing demography. Currently, we are seeing that Turkey’s demography is transforming from that of a developing country to that of a developed country. As of now, our population is young but consequently, we have seen a decline in fertility rate. This means in the future our population will be elderly. In order to be prepared for this future, plans that cater to social and health needs should be cultivated today. Our incumbent health facilities that address acute illnesses today, will in the future be obliged to accommodate chronic diseases. Therefore, we need to take measures to ensure the healthy ageing of our society today. In order to diagnose potential risks at an early stage, our family physicians have conducted a risk screening program that is age and gender specific. Citizens that are considered under the potential risk group have been admitted to what is relatively a “check-up” program. By establishing Healthy Life Centres, we will implement support programs that will allow our people to maintain their health for a maximum period of time.

Previously, Public Healthcare Services were not utilized as much in our country. Our people visit hospitals requesting medical attention for even the mildest of ailments (sore throats, common colds and such). In early periods the government encouraged visitations to these provisional health organizations henceforth triggering a force of habit for the people. Today, what we want to establish is, if our citizens are suffering from any health problems, they first visit the established Family Health Centres before going to the hospital. This place will not only be for those who require medical attention for these centres but will also offer health consultancy and health protection services.

Our reinforcements are aimed at primary healthcare services along with hospitals. We are currently renovating hospital facilities that do not operate at a modern calibre while also building new facilities from the ground up. We have also reduced the establishment age of our hospitals from 43 to 13 years. The hospitals we serve in are spacious and grant patients their privacy. Hospitals that do not align with such criteria are incorporated in the future plans that strive to modernize these buildings. Finally, we are also in the works of increasing diagnostic and treatment facilities.

The name given to the certain type of institution that specializes in hospitalization is “City Hospital” where the buildings are large and integrated. These areas have been planned as the peak level of healthcare and have already begun to operate one by one. A patient will be able to get all the services he/she needs in these health facilities without needing to go to another place. Thus, these facilities are to be the endpoints of healthcare. Consequently, these hospitals facilitate our vision for exemplary treatments. Our objective is to subsume experts and top-grade technology to attain excellent and experienced hospital centres. Therefore, we promote interdisciplinary work between hospitals and universities to enhance our research sector.

Health tourism is also amongst our goals for Turkey. Our country’s position in geographic terms is that it is surrounded by 57 countries with around 1.5 billion inhabitants. Our health services will be affordable without compromising its quality. We plan for Turkey to provide any or all services that are lacking in our neighbouring countries. Our city hospitals will have the facilities to provide the comfort demanded by our patients. Accordingly, these opportunities will prove beneficial to both our patients and the nation.

 

Can you give us any information about the roadmap that you plan to follow in order to realize your country’s potential in health tourism and how Turkey will become a global leader in this field?

According to the OECD health data and European Commission Reports, Turkey places at the highest level for satisfaction and services when looked at the expenses used. These data measures and compare each country’s medical expenses along with satisfaction rates. This is a sign of the sustainability of Turkey’s healthcare system and also shows how high our chances are of competing in the health tourism sector.

In line with the future vision of the Ministry, the centres of excellence that will be established with the cooperation of the City Hospital/university will place Turkey among the giants of international health tourism and health education sector.

With the development of health tourism, we believe that we will provide an important foreign exchange input while increasing employment. This will ultimately contribute to the development of other sectors as well due to the added value brought about by our healthcare sector.

We continue to authorize and govern our facilities in the field of health tourism. As such, 500 health facilities received a Certificate of Health Tourism Authorization. The Ministry of Culture and Tourism and the Ministry of Trade have also provided incentives to health facilities and intermediary institutions that have received health tourism authorization certificate.

We have imposed fixed tariffs on health services offered for tourists. This is to eliminate any concerns tourists may have on fluctuating costs.

We have achieved a significant acceleration in tourism in the last 10 years. However, we have yet to reach our full potential with health facilities, equipment, and healthcare professionals. We founded the International Health Services Corporation (IHSC) in order to uncover our full potential in the health tourism and education sector. Our nation’s resources were deemed more valuable globally when we focused on increasing bilateral cooperation. In due time, by motivating both the public and private sector we aim to make Turkey the ‘poster child’ of health tourism.

To promote our country in terms of health we will open health offices in specific countries and take all precautions for facilitating patient transfer to Turkey. Added to this, we will support health tourism through contracts made with social security institutions and private insurance companies of other countries.

We will also make all of our health institutions (university, private and state) accessible through a single portal. This Health Tourism Portal will allow healthcare personnel to communicate and share files live.

Our thermal resources play a key role in terms of health tourism. These resources will aid in improving physical therapy, rehabilitation and elderly care services. We believe with these improvements Turkey’s standing in the world will be elevated. It is for this reason that, we are developing the necessary legislature and IT infrastructure.

We plan to reach several goals for health tourism in 2023. One of those goals is to provide health services for 1.5 million tourists, becoming one of the top countries for these services and lastly branding Turkey as a spot for health tourism.

 

What are your expectations of the International Pharmaceutical and Life Sciences Companies that are operating in Turkey? Furthermore, what are your thoughts on the cooperation between the public and private sectors to move the Turkish health ecosystem forward?

Almost one-third of the world’s population is centred closely to Turkey’s geography. Additionally, there are many countries in close proximity to Turkey. When considering flight time and route a lot of these countries are again in close vicinity. There are also plenty of easily accessible ports located in Europe, Russia, the Gulf countries, East and finally North Africa. Lastly, Europe and The Middle East are both within reach by land.

Even for just logistic reasons, we can all see how ideal Turkey’s location is when it comes to production facilities. Many other countries have their own production facilities and investments here in Turkey. Likewise, products manufactured in Turkey are consumed both domestically and internationally. Any advancements in the aforementioned markets will broaden and strengthen trade in Turkey in the coming years.

For investors, Turkey is an attractive market because of its relationship with other countries. The element that makes Turkey an ideal market area is the fact that products are manufactured domestically. Currently, Turkey holds the most stability in the region. All of the countries around us have the potential for development and the ongoing market capacity allows for the said potential to play a role in the possible expansion.

We do not want to remain as a country that only manufactures and packages common chemical drugs. We will steer towards building high-tech medical devices, pharmaceuticals and biotechnology products. We have identified this as one of our objectives.

54 percent of pharmaceuticals and 100 percent of the high-tech medical equipment is acquired from foreign countries. Ultimately, such an external dependency does not seem to be sustainable.

We contrive to produce medicine and devices inside Turkey. Strategically, we want to build relationships with countries that already have these technologies. Establishing such communication, and our own production line within our borders we aim to meet the needs of both the domestic and foreign market. On the other hand, we do not want these production lines to just manufacture exact copies of existing products, we would eventually like to create new products.

The Research and Development facilities work to transfer “know-how” systems, design and improve technology. This will ensure advanced products will be designed and eventually produced.

I believe it is important to form business partnerships where both parties have mutual gain. It is also important to share how cost-effective products were manufactured in their respected facilities and ensure that both the parties will benefit once the products are sold in the developing markets.

The pharmaceutical industry for Turkey falls under the top five most important areas for economic development. Our approach involves the cooperation of private sectors, university and state sectors to domestically produce and export medicine.

Currently, with the support given to the Pharmaceutical Sector, we have been able to make high-value-added products by promoting domestic production, increasing export capacity and, adopting an R&D venture ecosystem. We do not make any distinction between a domestic and foreign company that produces in our country, as long as they support us we will also support them. At present, we are currently not equipped in our companies’ partnerships and industrial collaborations. However, we are working towards improving this aspect in the future.

Presently, we do not have support or encouragement towards investing in any medicine or medical device that is either not currently in production or has been found to be unsatisfactory. We are trying to make Turkey’s Pharmaceutical and Medical Device Industry fall under a regional management and have a shared service centre. In this period of creating a support mechanism for the company, global company investments become an important element to us. Following these investments, it will be ensured that the current account deficit will be closed by creating a structure (ecosystem) in which the firms will be used effectively. Through the help of Global Clinical Research investments, we expect to increase the number of clinical studies carried out by 25 percent annually. This will be done through investments and projects from global firms.

Implementations on pricing policies, licensing and reimbursements processes have been made in order to evaluate the production of pharmaceuticals and medical devices. The R&D’s work in Medical Treatment Products is considered an “Advanced Treatment”. These products cater to the nation’s needs and will be supported in terms of reimbursements and pricing practices.

 

Minister, do you have any final words you would like to direct towards Pharmaceutical Executive and Pharmaboardroom.com readers?

With the current policies implemented in the healthcare sector in our country, Turkey has gained a reformist structure which has been modelled in many other countries. In addition to having an accessible and comprehensive healthcare system, we are constantly implementing reforms we consider to be necessary in order to assure quality service.

Due to its advantageous geographical location and infrastructure, Turkey is a very attractive candidate for investments in the health sector. Owing to designing our health ecosystem as an open system instead of a closed system, we have ensured the efficient use of both domestic and foreign products. Therefore, we do not restrict healthcare services to just citizens of Turkey, we also make sure that everyone is able to access the healthcare that they require. A pleasant working relationship with foreign companies and convenient economic structure provides a beneficial environment for potential investors to invest. This factor also supports various domestic companies that would like to invest in foreign countries.

We invite everyone who wants to cooperate in the health sector to our country, and we welcome the invitations of those that want to collaborate in their own countries. Lastly, I would like to send my regards to your readers.

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