ISTANBUL —An estimated 30 million people travel to foreign countries annually for what has been dubbed “health tourism,” spending approximately $500 billion on interventions that are better, cheaper, or both compared to options available at home. Turkey, both the government and the private sector, have been actively looking for a piece of that cake.
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While millions of people have been traveling to Turkey to receive health services, there is a troubling high rate of death among the foreign patients, especially those seeking plastic surgery or interventions related to obesity. A total of 1,538,643 health tourists visited Turkey in 2023 spending more than $3 billion. As of the second quarter of 2024, more than 801,000 people have infused about $1.6 billion to the Turkish economy according to official data.
Compared to other countries, Turkey receives the highest number of foreign patients seeking hair implants, according to the Turkish Healthcare Travel Council (THTC). The list of popular Turkish interventions for visitors follows as such: plastic and dental surgery; oncology, cardiovascular surgery; orthopedic and other surgical procedures; in vitro fertilization (IVF); organ transfer; physical therapy and rehabilitation; pediatrics and internal medicine.
The Turkish Health Ministry granted health tourism certificates to 654 public and private hospitals, 189 medical centers, 2525 private practices and 1299 other medical facilities. There are also 1183 certified intermediary agencies that the foreign patients make deals with for travel, accommodation, sightseeing and the health services they would receive. Most of them offer package deals.
Occasionally stories appear in foreign media regarding some of these patients dying in Turkey, or after they travel back to their home countries. Many of these stories are from the British media since the UK is where most health tourists of Turkey come from and the country is at the top of Turkey’s official 21 strategic target countries for health tourism; followed by Germany, Bosnia and Herzegovina, Bulgaria, Serbia, Kosovo, Romania, Russia, Ukraine, Qatar, Kuwait and Bahrain.
While the actual number of the foreign patients who die or suffers serious complications is unknown, it must be said that Turkey actually does have the necessary facilities and qualified medical personnel to offer quality service.
Abdominoplasty, hair transplant, butt enhancement
Here’s how it works, and what can go wrong:
• Foreign patients arrive after they’ve already picked their operation from a catalogue without consulting a doctor.
• Hospitals discharge the patients early and nearly all agencies have deals with certain hotels for aftercare to save costs.
• Hotel rooms are used as hospital rooms, with nurses walking up and down the corridors. For example, people who had abdominoplasty surgery, a very serious operation, are being discharged the next day to be treated at hotels.
• Patients are being made to travel back home shortly after surgery. Complications from the hastened air travel sometimes begin as late as one to three weeks after the surgery.
• Quality is sacrificed to keep the prices down at every section of the package deals.
• Patients tend to interact only with the agencies, which are pleasant as long as everything goes well. Otherwise, they blame the doctor for the problem.
• Time between the doctor and the patient is severely limited. The agency doesn’t want the customer to skip their services next time and contact the doctor directly.
• Agencies get the lion’s share of what the patients pay. They make deals with the doctors for operations in bulk for less money. Rather than veteran practitioners, this attracts young and inexperienced doctors.
• Doctors perform 30 to 50 operations monthly and make more money with each new surgery. Some work on every day of the week.
• The patients arrive at the facility only hours before the procedure for their examinations. The doctor sees the patient for the first time in the operation room. Serious surgeries are done without consulting a doctor about the risks and patient’s preferences.
• More than one serious operation may be done in a single seance and the risk is too high especially considering some of the patients have obesity. Complications may lead to death when combined with improper aftercare.
• Too many patients are taken to the facilities at the same time which may overwhelm the staff.
Where’s the regulation?
Professor Bülent Saçak, General Secretary for the Association of Turkish Plastic, Reconstructive and Aesthetic Surgery, believes more government inspection and regulation is required for the whole sector. Saçak added that they lack the data to determine if the complications seen after certain operations such as abdominoplasty surgery and buttock augmentation is higher in Turkey compared to other countries.
“At the end of the day, we don’t know how many deaths happened and how many of them are typical and how many are from exceptional circumstances,” Saçak said.
It is not sustainable for the doctors.
Saçak said although the service in question has the word “tourism” in it, the core of the business is health. The agencies promote the services in Turkey with the distinction of low prices to be competitive in the market. But too often, he says, low prices also means low quality. “Patients come and ask for the operation they want to have. However, there should be a consultation; mutual expectations should be discussed [and] an operation is offered only after the risks are communicated,” he said. “It is not normal for a patient to come asking for an operation.”
The agencies currently have the most to gain from the high demand, but it is not sustainable for the doctors who are reduced to work as if they are “intermediate staff or technicians” in this system dominated by the agencies.
Saçak noted Turkey is not alone, and other countries in the region such as Hungary, Poland, Bulgaria and Morocco have both the accommodation and health services that are comparable to Turkey. “We are one of the destinations for the Europeans. However, instead of proving our potential for high-quality, we positioned ourselves solely on the low rates.”
Risks of inexperienced surgeons
General surgeon Professor Ahmet Türkçapar said the obesity surgeries should not be condemned as a whole because they are not as dangerous as commonly believed. Sometimes the procedures save lives since they are mostly performed on patients who have metabolism related problems, and are not merely doing it for aesthetic reasons.
“The problem is the excessive increase in the number of medical faculties and surgeons,” Türkçapar said. “The surgeons cannot gain enough hands-on experience at the animal laboratories. They are forced into operating on people, directly. That’s to say, they practice on the patients, unfortunately.”
Türkçapar said that the Health Ministry of Turkey required that the surgeons who want to perform anti-obesity surgeries to obtain a certain certification, but that hospital managers still assign surgeons with 3-5 years of experience to such surgeries to lower costs.
“Then, the obesity operations are blamed. Why is it done for so cheap? Because cheap labor and materials are being used. The patients are not offered the necessary care, Türkçapar said.
A smear campaign
Doctor Köksal Holoğlu, Chair of the executive board for the THTC, believes the news stories regarding foreign patients dying after being treated in Turkey are part of a smear campaign, which the Turkish authorities should fight against.
Holoğlu said it is impossible to never have any deaths, complications or malpractice suits among the approximately two million heath tourists who visit Turkey each year. Still, there should be an investigation into which agencies and doctors are involved in malpractice, and which are not. He believes up to 20,000 cases annually is normal within such a volume.
Developed countries in Europe are smearing Turkey because they cannot offer such affordable service with such quality, Holoğlu said. “They pick one or two cases out of the 180,000 every month and it becomes news.”
Holoğlu doesn’t agree that the government inspections are lacking; on the contrary, he finds the current inspections “excessive” and the actual problem is unlicensed agencies and medical facilities.
“Ultimately, these businesses are illegal. Anybody can transfer patients whether they have a certificate or not. If they can get a 10% commission from a hospital and 50% from an illegal place, they take the patient to the latter. We report those that we see or learn about.”
