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10 May 11

Turkish Health Sector Eyes Balkan Market

Turkey has emerged as a key health tourist destination for Balkan citizens unable to access, or pay for, medical treatment at home.

Altin Raxhimi Istanbul

"The treatment here is good," says 76-year-old Milena Stamatovic of her heart surgery at the Acibadem Maslak Hospital (Photo: Altin Raxhimi)

The main entrance hall of the Acibadem Maslak Hospital in Istanbul’s European quarter is crammed with relatives of Turkish pop singer Ibrahim Tatlises, who is being treated here for gunshot wounds, and security guards, anxious to keep the press at bay.

Oblivious to the hubbub on the floors below, 76-year-old Milena Stamatovic, a housewife from a village outside Belgrade, recovers following an operation on her heart.

Stamatovic is far from lonely here; she is just one of fourteen patients on the fourth floor ward who hail from Serbia.

Turkey has emerged as a key health tourist destination for many from the Balkans, as health service provision deteriorated following the collapse of communism and during the conflicts of the 1990s.

In turn, Turkish state-run and private hospitals have aggressively courted Balkan patients, particularly Istanbul, with its hundreds of private hospitals. This has been particularly true of countries that have strong cultural ties with Turkey, such as Albania, Kosovo and Macedonia.

The Turkish health ministry estimates around 58,000 international patients were treated in its hospitals in 2010 alone.
This influx of foreign patients has been matched with the rapid expansion of the private health sector over the past ten years. Today, a third of Turkey’s hospitals are privately run, says Rusen Yildirim, chairman of Turkey’s Health Tourism Business Council who has co-authored an as yet unpublished study on Turkish health tourism with the country’s health ministry.

“We have seen numbers double both from international patients, and those specifically from the Balkans”

Daniel Benevisti, Acibadem hospital group

Of those 58,000 international patients, the majority are German nationals. However, more than 1000 come from Balkan countries, according to figures from a few of the Istanbul-based hospital groups. Daniel Benevisti, a spokesman for the Acibadem hospital group, believes this trend will continue – particularly once the global economy recovers.

“We have seen numbers double both from international patients, and those specifically from the Balkans,” says Benevisti.

At her office not far from the Acibadem Maslak Hospital, Teuta Turku-Gocmen would agree with Benevisti, as she returns to her desk after seeing off a couple from Vushtrri, a northern Kosovan town, who have used her services for fertility treatment at the German Hospital of Istanbul.

Turku-Gocmen is a translator and referral agent for patients, who has been hired by the German Hospital to deal with ethnic Albanians from the Balkans. She acts as a referral service for Albanian-speakers who are unable, or unwilling, to undergo various medical procedures back home - about two dozen patients from Kosovo and Albania monthly.

And booming health tourism in Turkey has spawned an industry of its own back in the Balkans.

In Albania’s capital Tirana, Albert and Ilirjana Zyfi, both aged 42, wait in a residential apartment building on one of the Albanian capital’s busiest streets. The Zyfis are anxious to hear if Sefak Onbasiouglu, an Istanbul-trained doctor, will advise them to pursue fertility treatment in Turkey, as they wish to have a second child now their son is a teenager.

Business opportunities

Onbasioglu, an Istanbul-based orthopaedist, set up the Tirana office in 2005 sensing a lucrative business opportunity in identifying and treating patients from Albania in Turkey for a host of problems, including prosthetic surgeries and fertility treatments.

He says he sends at least 30 patients there every month, including Istanbul’s private Medical Park hospital, for check-ups, medical operations and, a recent trend, plastic surgery. 

The Turkish health tourism industry is worth up to €140 million annually says Rusen Yildirim of the Health Tourism Business Council (Photo: Altin Raxhimi)

Ankara-born Attila Gursel, 42, says the same. Once employed as an architect by a Turkish developer in Tirana, Gursel soon turned his hand to sending patients to Turkey. Before giving up his referral work to concentrate on his regular day job as a manager for Turkish Airline in Tirana, he says he sent Albanian patients to Turkey “in their hundreds”.

The referral business that sprang up somewhat haphazardly with Gursel and others is now far more organised, with major health groups establishing agencies and front offices across the region.

Large Turkish hospital groups like Acibadem and Medical Park have established, or are in the process of setting up, front offices in Tirana and Skopje to refer patients from those countries to their hospital chains in Turkey.

Acibadem, Universal Hospital Group (UHG), which owns the German Hospital of Istanbul, and Medical Park are among the dozen or so groups that cater to international patients, making Turkey a regional hospital hub for the Middle East, Turkic republics of the former Soviet Union and the Balkans, as well as many from western Europe, notably among Turkish migrant communities there, says Rusen Yildirim, who heads the health sector group of the Turkish Foreign Economic Relations Board (DEIK), a lobbying group for Turkish businessmen.

Foreign nationals treated in Turkey*

2008    56,000
2009    72,000
2010    52,000 (analysts blame the dip in 2010 on the economic downturn)
Four out of five international patients seek eye and dental treatments in Turkey.
The rest come for oncology, heart and bone treatments, plus plastic surgeries.
Source: Turkish Foreign Economic Relations Board and Ministry of Health of Turkey

Yildrim says Turkish private hospitals built up their services for foreign patients over the past 20 years and is now worth up to around 140 million euros annually. The Turkish health sector has, he says, targeted three key groups: the US, following Obama’s health care reform programme, western Europeans looking to escape long waiting lists and neighbouring countries, including the Balkans.

“Globalisation helped us see where we are, compared to other medical centres in the world, when our economy opened up. Getting international patients is prestigious for Turkish hospitals, and raises their domestic profile as well,” says Yildirim.

“Several private hospital chains have developed oncology departments, and many come from the Balkans go to such centres because it is a short distance… this has developed especially with the private hospitals,” Yildirim says. “In the 90s, they saw this as a business opportunity.”

These hospitals offer what has been the staple of health tourism, including advanced cancer operations, hip or knee replacements, eye laser treatment and aesthetic, cosmetic surgeries. The treatments are better, faster or cheaper than foreign patients can access at home.

“Our aim is to serve people five hours away from here,” confirms Benevisti, the Acibadem spokesman, as he settles into a cushioned chair at the Kitchenette, a trendy, western pastry shop on Istanbul’s noisy Taksim Square.

Advanced technology

He says Turkey’s private investment in health has led to the introduction of advanced technology that that is prohibitively costly in Balkan countries. Some of the private hospital groups, like Acibadem, offer advanced medical treatment, like ‘gamma knife’ surgery for brain tumours.

Besides, Turkey is competitive on prices, offering many treatments around a third cheaper than in EU member states.

 “Albanians believe that corruption in their health system is high,” says Zamira Sinoimeri, a former deputy health minister of Tirana who now works for the World Health Organization.

“So, for many, rather than paying money in bribes and not get good treatment, they would [prefer to] pay for a private service and get it.”

Patients from the Balkans

  • Universal Hospital Group says it treats about 350 patients from Albanian-speaking areas in the Balkans.
  • Acibadem says it treats a further 600 patients from the Balkans each year.
  • At least 350 patients from Albania are treated in Medical Park hospitals, according to Albaturk, a Turkish health consulting company in Tirana.
    NB: The Turkish health authorities do not keep statistics on Balkan patients treated in Turkey

But it is not just the private sector that is treating Balkan patients. Ankara has treated hundreds of patients from Albania in its state hospitals since the 1990s. These treatments were paid for by the Albanian state.

The Acibadem hospital has struck agreements with most governments of former Yugoslavia who pay to treat patients in need of delicate cancer or heart operations, like Milena Stamatovic. The fact most Balkan citizens don’t need visit visas to go to Turkey, and the national air carrier Turkish Airlines connects all Balkan capitals to Istanbul, has also helped make Turkey the health destination of choice for Balkan patients.

When Turku-Gocmen began working at the German Hospital in Istanbul five years ago, she said she was reluctant to abandon her hairdressing business in a nearby part of town. She had moved from the Adriatic coast 15 years ago, and intended to keep her hairdressing business inside the hospital and work with Albanian patients on the side.

Yet, she found herself so overwhelmed that she now works only as a referral agent and translator for patients from Albania, Kosovo and Macedonia.

EU market challenge?

Some believe that the lifting of visa requirements for Balkan states by the EU - only Kosovo remains behind the strict Schengen visa wall - will reduce Turkey’s booming health tourist market as travel to the West becomes cheaper and easier.

“It will not always stay this way for Turkish hospitals,” says Onbasioglu. “There are new private hospitals in Albania and Macedonia and the service is slowly improving. But it is too early to say whether the visa lifting has had any effect at all.”

The German Hospital in central Istanbul treats numerous Albanian-speaking patients, including fertility care and cosmetic surgery (Photo: Universal Health Group)

And there seems little evidence of any downturn in the number of Balkan patients coming to Turkey for treatment just yet.

Turku-Gocmen flashes me her Blackberry with a sideways look. Many of the Albanian patients at the German Hospital come through her contacts in Albania and elsewhere – her husband is Kosovo Albanian. “One for breasts; one for belly; one for nose… two for belly and breasts,” she says. These are potential customers for cosmetic surgery her contact in Albania had found.

Omer, an engineer with a hospital in Skopje of Macedonia, is sending his son for eye surgery at the World Eye Center in Istanbul.
“The treatment is much better there than the treatment I can get here in Skopje,” he says. “I want to be on the safe side.”

This article was produced as part of the Balkan Fellowship for Journalistic Excellence Alumni Initiative, established and supported by the Robert Bosch Stiftung and ERSTE Foundation.

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