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Executive Summary
Turkey has a population of 80 million, ranking in the global top 20. The population has been steadily rising by around 1.2% per year. The proportion of the population aged 65 and over is lower compared to Europe and the United States (U.S.), however it is expected that this proportion will reach 10.7% by 2026, up from 8.7% in 2017, which will cause an increase in the overall healthcare expenditures of the country in the coming decade.
The Ministry of Health (MoH) at the national level is responsible for the planning of the country’s healthcare policy and is also the largest provider of healthcare services. There are 879 public hospitals operated by MoH, 571 private hospitals, and 68 university hospitals. The total number of hospital beds is 225,863.
Turkey spends 4.5% of its Gross Domestic Product (GDP) on healthcare. According to OECD figures, Turkey’s per capita spending on healthcare has reached $857 which is an increase of 3.5-fold since 2002, when transformation program in healthcare was initiated. The medical devices market has been growing between 5-10% annually in the last ten years, and total market size is 1.9 billion, as of the end of 2018. Even though the number of units of medical devices sold grows every year, it has been declining since 2017, mainly due to the local currency losing value against U.S. Dollar.
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(in U.S. millions)
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2017
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2018
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2019 (est.)
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2020 (est.)
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Total Market Size
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2,284
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1,889
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1,877
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1,854
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Total Local Production
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768
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778
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919
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968
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Total Exports
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429
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494
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543
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597
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Total Imports
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1,945
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1,605
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1,501
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1,483
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Imports from the U.S.
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398
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377
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375
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370
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In September 2013, the MoH launched a project to construct 31 large hospital complexes across Turkey. These new hospitals will physically replace some of the existing hospitals and will renew 20% of total hospital bed stock. These hospital complexes will operate under a public-private partnership (PPP) model where private contractors will build these hospitals and they will receive an annual fee for the services they will render to MoH, , for 25 years. Eight of these hospitals were opened in 2017. The total investment amount that will go into these hospitals will be around $15 billion until 2023.
The medical devices market is imports-dominated, which makes up 85% of the market. This is expected to decrease to a 75%-80% range in the next ten years, as the Government of Turkey plans to incentivize local medical devices manufacturing. Turkey has adjusted its medical devices regulations to match the European Union (EU) regulations, and it is required that devices obtain a CE mark when being imported into Turkey.
Turkey has taken a progressive approach toward utilizing health IT solutions in the country’s healthcare structure. When a patient reports to a medical doctor, all his/her healthcare information is recorded in an Electronic Health Record (EHR). ICD-10 coding is the standard for the description of illnesses in these records. All doctor visits, diagnostics, treatments, and prescriptions are entered in the record. The system produces e-prescriptions, which are fulfilled at pharmacies. This also makes it possible for the pharmacies to claim their receivables from the Social Security Institute. Data collected from across the country is centrally stored at MoH servers. In April 2015, MoH launched a mobile application which makes it possible for every citizen to access his/her health record. In the coming years, MoH intends to use the data collected for forecasting and monitoring trending patterns of illnesses, and to have citizens be more active in managing their individual healthcare processes by allowing easier access to their healthcare records. It will also encourage citizens to use remote monitoring devices to more regularly communicate with their healthcare providers on an as-needed basis. MoH is also working on integrating ‘Clinical Decision Support’ elements into the current EHR systems in order to reduce errors made during diagnoses. Telemedicine is still in its early stages and there are some pilot projects to provide medical support from larger hospitals, to smaller hospitals in rural areas.
Turkey has hosted 750,000 medical tourists from 60 countries in 2016 and had a turnover of $5.8 billion. This is expected to increase to one million patients in five years.
According to MoH figures, there are 1,000 medical device manufactures, 2,300 importers, and 700 companies that do both. Manufacturers are typically small-scale manufacturers of products such as bandages, syringes, orthopedics products, and surgical instruments.
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Market Entry
Medical devices sold in Turkey must be registered by the manufacturer’s own office in Turkey, or through a distributor incorportated in the country. As a result, for a U.S. company to market its medical equipment and health IT solutions in Turkey, it should either open its own subsidiary in Turkey, or find representatives in the Turkish market with strong business development capabilities.
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Current Market Demands and Trends
In general, it can be said that all major categories of medical equipment are present in the market, both in private and public hospitals. At this point, the market is open to state-of-the-art and innovative medical equipment and solutions.
Turkey imports the following medical equipment and devices from abroad:
- Advanced pre-screening and diagnostics devices
- Advanced point-of-care devices
- Cancer treatment devices
- Wound management devices
- Surgical devices using robotics technologies
- Dental equipment
- Radiation oncology systems
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Market Size
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Healthcare spending (including investment)
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$39 billion (2017)
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… as percent of GDP
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4.5% (2017)
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… of which spent on inpatient services (including long-term care)
and outpatient services
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$23.7 billion (2017)
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… of which spent on pharmaceuticals/consumables
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$6 billion (2017)
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… of which spent on medical devices
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$2 billion (2017)
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… of which spent on investments
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0.3%
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Hospitals, Procedures, Healthcare Professionals:
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Number of hospitals
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1,518
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…Public
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947
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…Private
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572
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Number of hospital beds
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225,864
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… available beds per 1,000
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2.82
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…of which in general hospitals
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84%
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…of which in specialized clinics and rehabilitation centers
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16%
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Number of surgical procedures
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4,931,299
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…of which Phacoemulsification with Intraocular Lens Implantation
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-
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…of which Laparoscopic Cholecystectomy
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-
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Physicians
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149,997
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…of which surgeons
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36,994
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…of which internists
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34,323
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…of which pediatricians
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5,585
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Dentists
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26,674
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Demographics
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Population
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80,810,525
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Life expectancy men/women
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75.3/80.8
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Infant mortality
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9.1 in 1,000
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Percent of population older than 65
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8.5%
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…projection, 2030
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88,000,000
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Annual deaths
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5.2 in 1,000
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…caused by diseases of circulatory system
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39.66%
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…caused by neoplasms
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19.56%
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Prevalence of obesity
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22.3%
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Tips:
- Use any information available from CIA World Factbook or other more recent sources first. Most data from CIA World Factbook is updated as of 2016.
- The UN database has various healthcare statistics on all countries. To find more go to http://data.un.org/Explorer.aspx?d=WHO. Then click WHO Data (World Health Organization). Then click World Health Statistic and explore the different subcategories.
- When using the UN database, notice that for each country they have statistics for past 5 or so years. Pull the latest statistic.
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Registration Process
All medical devices have to be registered with the Device Tracking Syetem (UTS - www.utsuygulama.saglik.gov.tr) operated by the MoH that keeps track of all medical device marketed in Turkey and is also used for post market surveillance of each device.
When registering a device, the following set of information is asked from the manufacturer/distributor:
- Barcode
- Device brand, name, model, label, catalog #
- GMDN Code
- Class
- Device ID
- CE Mark
- Manufacturer’s Name and Address
Following registering of device, if it will also be in the reimbursement system, it has to be registered in the SUT list of Social Security Institute (SSI).
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Reimbursement
SSI is the reimbursement agency of public healthcare expenses. Universal healthcare insurance is in place in Turkey, from which 90% of the population benefits. This makes it relatively imperative for medical device companies to place their products in the reimbursed products list (SUT), which allows it to reach the broader population.
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Barriers
There are no specific barriers targeting U.S. medical device manufacturers. Due to Turkey’s Customs Union with the EU, which obliges European product standards and Turkish Government’s incentivizing local medical device manufacturing, competition will increase in the coming years.
Some of the difficulties in the market are:
- Ministry of Health is the largest customer of medical device companies, as 90% of the population qualifies for free-of-charge healthcare services. These hospitals mostly buy through tenders, where the leading criteria is usually the price of a product. As a result, the price sensitivity of the market is a hardship some U.S. companies must overcome.
- Social Security Institute (SSI), as the reimbursing agency of public healthcare services, has a list of medical devices that are reimbursed. In order to get into this list, a manufacturer must accept the price SSI pays for that device. There are two issues with this list: (1) reimbursement prices have not changed in the last seven years, even though Turkish Lira has since depreciated against the U.S. Dollar. (2) SSI, at its own discretion, sometimes lowers reimbursement prices of a specific device, which the manufacturer and the distributor must adapt to.
- Due to Customs Union with the EU, products that have U.S. Food and Drug Administration approval, but no CE Mark for the EU market cannot be exported to Turkey as well. U.S. companies that have very good technologies, but no CE Mark automatically drop out of the market.
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Procurement & Tenders
Procurement for public hospitals are mostly done through tenders which can be followed at Turkish Public Procurement Authority’s website (www.ekap.kik.gov.tr). However, most information posted is in Turkish, which shows the importance of having a local representative/distributor in the country.
Private hospitals invite companies to bid when they procure medical devices.
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U.S. Commercial Service Contact Information
Name: Ebru Olcay
Position: Senior Commercial Specialist, Healthcare Lead
Email: ebru.olcay@trade.gov
Phone: +90 (212) 335-9223
