Meri Istiroti, group coordinator of Liv Hospital Group, shares the hospital’s success story since its beginning in 2013 to becoming a leading private healthcare institution dedicated to service, quality, and innovation. She also offers her insights into the Turkish healthcare system and the delicate balance that exists between the public and private sectors.


Since this is the first time we are meeting Liv Hospital, can you briefly introduce the hospital and its scope of services?

I have been in the health management industry for over 28 years and have opened 16 projects in my career, Liv Hospital in Istanbul being my 14th. My mission for the Liv Hospital was to create a more competitive hospital, leveraging specialty the services that chain hospitals cannot provide. Once a group begins to grow as a chain, it is difficult to maintain a certain degree of quality. Liv Hospital operates at a boutique level in terms of service, patient satisfaction, and clinical results. We started our first hospital here in Istanbul and expanded our presence to Ankara and Karadeniz. We are part of MLPCare Health Group which consists of the Medical Park and Liv Hospital brand.

In total, MLPCare Health group have 31 hospitals in the group across 18 cities. It is the largest healthcare group in Turkey, however, we work separately in medical disciplines and marketing strategy. Liv is not a public hospital; we are only in partial agreement with the government reimbursement system in the oncology and radiology intervention areas. We work on a sophisticated level in choice disciplines; for example, our stem cell department where we provide research data of the field is unique in Turkey. Liv Hospital is a pioneer not only in this area, but also in cancer, brain, spine, and specialized tumor treatments. We have also been licensed by 52 clinics as a subspecialist in these areas.


You carried a very successful track record in the healthcare management industry before joining Liv Hospital six years ago. What was the challenge you identified at the moment that convinced you to embark on this new adventure?

The reason I joined Liv was to help launch the new hospital line which could offer more therapeutic services in Turkey. This was very difficult because the industry was already being dominated by brands like Memorial and American hospitals. It was forecasted that Liv Hospital would not survive in this harsh environment; however, not only have we survived but we have thrived. Our marketing strategy is built on medical results. The building is beautiful, but in the future, newer and more aesthetic hospitals will be built. However, what does not change is the operational culture and medical achievement.

I joined the project in 2012 while the hospital was under construction. Six months later, the hospital was finalized and the name Liv was chosen, which stands for Leading International Vision. Knowing we wanted to operate in the medical tourism segment, we selected a name which would be memorable to international patients. We started to receive patients in January 2013 and launched our services to international patients one month later. Since then, Liv Hospital has been very popular in dealing with multidisciplinary, high-risk cases; we are not only operating in the simple segment of aesthetic services. We decided to tackle high-risk cases from countries where diagnosis may not be done properly or treatment is not possible due to a lack of infrastructure.


What are a few of the key accomplishments realized by Liv Hospital since its foundation in 2013?

After three years of operation, we opened the Istinye University Hospital; a goal we had set from the beginning. In 2016, our academics created the medical faculties of the hospital and this year we are welcoming our third generation of students in the medical school. Our primary areas are in health sciences, nursing, and medical studies, however, we have over 30 faculties in total.

Liv Hospital also strives to be a pioneer in priority diseases areas. Liv Hospital is also accredited by the Ministry of Health and every year we go through a screening program to ensure our operations are up to par. We are the only hospital to achieve disease-based accreditations, the first in robotic surgery, and we are moving forward to finalize this high standard in other areas as well.


Under the current healthcare system, patients can visit private hospitals and have the costs reimbursed by the government. Do you see this sustainable in the coming years?

To sustain the system, the current dynamics will have to change. Over the past seven years, the government has not increased the payment contribution of the system from the public; neither the university, public or private hospitals. However, the government has established a standard premium of price difference between public and private hospitals. Through SGK, 70 percent costs in private institutions are reimbursed, the difference being paid by patients out of pocket. Under the new guideline, private hospitals can charge up to 200 percent difference from the rate in public institutions. As the aging population increases and GDP growth slows, the out of pocket patient expenditure will need to increase to sustain the healthcare system.

In Turkey, total health expenditures account for slightly over five percent of the country’s GDP. It is critical how the new government will handle this five percent GDP expenditure to healthcare, which will need to increase to meet the inevitable needs of elderly care. I feel it is important to focus on decreasing the volume of patients visiting public hospitals by leveraging online systems; similar to what is being done in England, Israel, and other western countries. They are using digital technologies for diabetes and cardiac patients; following up using wearable technologies to avoid emergency visits to the hospitals. Digital solutions are a valuable tool to lower costs which cannot be overlooked.


Liv Hospital is a first-in-class user of digital health solutions with many initiatives being implemented in the hospital. What have you done to bolster this area in the group?

We have been very successful in implementing digital technologies with the healthcare solutions we offer in the hospital. Our position for the future is not to treat only the patients that come to Liv, but to continue the care outside of the hospital. This will aid in preventing emergencies, monitoring patient conditions, and improving their quality of life.


What are your partnership strategies for pharmaceutical or medical device companies to bring technology solutions to the patients of Liv Hospital?

We aim to collaborate with some technology partners to become an educational hub. These companies bring R&D initiatives to the field of medicine and we have many skilled clinicians which we can assist in these efforts. On the training side, Liv Hospital clinicians could act as proctor tutors to educate international physicians on the most cutting-edge technological advancements. We are also creating an artificial intelligence program in the university hospital in conjunction with the engineering faculty. This will be the first time in Turkey a medical oncologist is running AI programs under an engineering faculty. Our engineers have many AI programs in development which will guide doctors to formulate more individualized treatments for our patients.


What message would you like to deliver about Turkey as a medical tourism destination?

We know Turkey has many political issues domestically, but medically, the investments placed here and the capabilities of the physicians in Turkey are exceeding many markets in the world. Turkey is a strong hub that can serve a large geographic scope; including Chinese and African patients. When compared to Germany, Korea, and India, Turkey is the crossroad of the world. Turkey is not the cheapest medical provider, but it is the optimal location for the quality and medical success valued against the price of treatment.


Having worked in the industry for 28 years, what would you highlight to our international audience as your proudest achievement?

As a graduate of psychology, I started my career with no intention to join the field of medical management. My achievement is not only in building new brands and healthcare projects, but I have been working as the leader of the health committee for various organizations such as TUSAP Healthcare Platform, Foreign Economic Relations Board of Turkey (DEIK), and Turkish Healthcare Travel Council (THTC). I have been working on the brand of Turkey from all angles to promote the country in this meaningful sector. From 1990 to 2000, people with high economic status were travel abroad particularly to the United States, Germany, and Israel. In my last thirteen years, when starting my career in this industry in 2005, this slope reversed. People with this high socioeconomic status in Turkey are not traveling for care in other markets; they have a trust in the Turkish healthcare system.