Even amidst stringent COVID-19 lockdowns in Turkey, a striking scene unfolded in Istanbul’s tourist hubs: foreign men, visibly recovering from hair transplant surgeries, remained a notable presence on otherwise deserted streets. This curious exception, where residents were confined indoors while international patients were exempted from restrictions as early as May 2020, accepting arrivals from thirty-one countries, vividly illustrated how deeply embedded medical tourism had become in the government’s strategic vision for healthcare. This policy stood in stark contrast to the administration’s earlier commitment, under President Recep Tayyip Erdoğan and the Justice and Development Party (AKP), to universalize healthcare coverage for its own citizens. The rapid embrace of international patients, even as domestic citizens were advised to defer non-urgent care, raises critical questions about the evolving priorities within Turkey’s health system and the implications for local access to quality of care.

This analysis delves into the expansion of medical tourism in Turkey and its profound impact on the nation’s universal healthcare system. It posits that the state’s aggressive promotion of the medical tourism sector, a key driver of cross-border healthcare, has inadvertently exacerbated disparities in access to care for Turkish citizens. By creating powerful incentives for healthcare providers to attract foreign currency revenues from international patients, the system’s institutional focus has undeniably shifted away from domestic needs. Resources, including technological investments, provider capacity, and skilled labor, have been increasingly channeled into facilities designed to generate revenue from global healthcare markets. Consequently, while the sector thrives, Turkish citizens often find themselves navigating an increasingly strained public health care system, as providers, driven by market forces, orient their services towards international patient care.

The Health Transformation Program and the Genesis of Private Healthcare Expansion

Turkey has dramatically cemented its reputation as the “hair transplant capital of the world,” a status amplified by pervasive social media narratives, late-night television humor, and the ubiquitous “Turkish Hairlines” phenomenon. Beyond this highly visible cosmetic niche, which also includes globally recognized “Hollywood Smile” dental veneers, the scope of medical tourism in Turkey is extensive. It encompasses a broad spectrum of elective and critical treatments, ranging from advanced cancer therapies and preventative imaging to complex heart surgeries. From high-end hospitals in Istanbul to burgeoning med-spas, a growing number of medical professionals—doctors, nurses, technicians, and even aestheticians—are now primarily serving visitors from abroad. Ironically, this commercial reorientation of Turkey’s healthcare system was facilitated by structural reforms initially designed to achieve universal access for its own population.

Turkey’s strategic pivot towards medical tourism must be understood within the broader context of significant privatization and market reforms that have reshaped its healthcare landscape over the past two decades. In 2003, following a severe economic crisis in 2001 and influenced by policies advocated by the International Monetary Fund and the World Bank, the Turkish government initiated the Health Transformation Program (HTP). This ambitious reform consolidated Turkey’s health system under the General Health Insurance (Sosyal Güvenlik Kurumu – SGK), successfully extending coverage to nearly all citizens. However, the HTP’s universalist insurance framework was intrinsically linked with institutional mechanisms designed to foster private-sector growth. For example, the SGK was reconfigured to act as a purchaser of services from both public and private hospitals. This model envisioned private-care delivery as a complementary force, enhancing public services and broadening access for everyone. Yet, as private providers became structurally dependent on maximizing revenue, the distinction between augmenting and supplanting public healthcare provision grew increasingly blurred.

The HTP reforms undeniably spurred a significant expansion of private hospitals. With the newfound financial stability offered by SGK reimbursements, private hospitals rapidly became a lucrative investment. Public funds began flowing into these private entities, creating a favorable environment for growth. Further reforms by the Ministry of Health eased licensing regulations, encouraging even more investment in private healthcare facilities. Providers were also permitted to levy co-payments from patients, charging up to twice the public insurance rates for standard treatments and as much as three times for “exceptional” procedures. By 2023, the number of private hospitals had surged from 271 to 565, establishing them as integral components of healthcare provision across all Turkish provinces.

The strategic shift towards attracting international patients was a natural evolution stemming from the incentive structures embedded within the HTP reforms. With domestic SGK reimbursement rates subject to caps, providers increasingly sought alternative revenue streams beyond the universal insurance framework. Foreign patients, who typically pay the full price for services out-of-pocket, represented an exceptionally attractive market for hospitals. Many of the newly established private facilities, which emerged in the advantageous post-HTP environment, quickly reoriented their business models in this direction.

Even public hospitals eventually became integrated into the HTP’s privatization agenda. Since 2015, the government has championed the construction of public-private partnership “City Hospitals” (Şehir Hastaneleri). These colossal facilities are financed by private consortia and subsequently leased to the Turkish government. While City Hospitals function as public hospitals, their structural design effectively channels investment and profit towards the private sector. The public sector, meanwhile, bears long-term financial risks, including substantial repayment obligations often denominated in foreign currency. These massive healthcare complexes have been promoted by the Ministry of Health as essential infrastructure, intended to both serve Turkish citizens and simultaneously attract a growing number of medical tourists, thereby enhancing Turkey’s standing as a premier healthcare destination.

The rapid proliferation of hospitals in Turkey has also created a new avenue for political patronage, as ownership and construction of these healthcare facilities became increasingly intertwined with ruling party networks. Following the HTP reforms, several private hospital groups with strong affiliations to figures within AKP circles rose to prominence, highlighting the blurring lines between public authority and private enterprise during this era in Turkey. For instance, the Medipol hospital group was founded by Fahrettin Koca, who later became Minister of Health under Erdoğan in 2018. During his tenure, Koca oversaw regulatory adjustments that further expanded opportunities for private hospitals. The opposition Republican People’s Party (Cumhuriyet Halk Partisi – CHP) has consistently criticized state initiatives that provide public financial support for medical tourism to private hospital groups, particularly those with demonstrable links to AKP figures.

Beyond the development of a revenue-generating hospital sector under the HTP, the Ministry of Health also restructured non-hospital services, establishing a more defined regulatory framework for private outpatient clinics and centers (poliklinikler and tıp merkezleri). This expanding ecosystem of smaller, more agile facilities effectively absorbed ambulatory and elective care, which proved particularly profitable for providers. This expansion coincided with a significant increase in overall healthcare capacity. Between 2002 and 2012, the healthcare workforce grew by 56 percent, from approximately 295,000 to 460,000, while outpatient physician visits per capita nearly tripled. The post-HTP surge in personnel and clinical space, coupled with broader marketization trends, incentivized providers to extend their services beyond traditional medicine into aesthetic and elective care, tapping into higher-margin wellness tourism markets.

The cosmetic health care sector in Turkey is vast and has historically operated with relatively loose regulation. In 2016, it was estimated that six out of every ten hair transplant clinics operated illegally. These clinics frequently employed technicians or nurses to perform procedures that, by law, required a physician’s direct involvement; sometimes, doctors merely lent their names for licensing purposes. Despite this widespread informality—and perhaps partly due to the proliferation of a lower-cost, unregulated market—the state indirectly benefited from its economic activity. Nevertheless, the explosion of the hair transplant industry garnered such extensive global attention that in 2023, the Ministry of Health enacted a specific Regulation on Hair Transplant Units to assert greater control over this burgeoning, yet previously underregulated, industry.

However, these regulatory concerns have not diminished the influx of international patients. The Turkish Health Tourism Association estimates that in 2022, approximately one million individuals traveled to Turkey specifically for hair transplants, generating an estimated $2 billion—roughly half of the total health tourism expenditures for the country that year. Cosmetic dental care and plastic surgery also attracted substantial foreign patient expenditures, estimated at $500 million and $400 million respectively. Recognizing this immense profit potential, the Turkish government has thrown its full policy weight behind the export of healthcare services, setting an ambitious target of $20 billion in annual revenues from medical tourism by 2028.

How Health Care Became an Export Strategy

While medical tourism existed in Turkey before the HTP, it was largely an ad hoc phenomenon. As the industry gained momentum, the Ministry of Health gradually assumed a more prominent steering role, elevating medical tourism to a national healthcare priority. This created an inherent tension within the nation’s healthcare system: the same administration responsible for governing healthcare as a public good began simultaneously operating with export-oriented objectives focused on growth and global competitiveness. This fundamental contradiction has ushered in new forms of healthcare inequality within Turkey’s system, as resources and care provision have increasingly been prioritized in high-revenue domains.

Turkey entered the competitive medical tourism market later than established healthcare destinations such as Thailand and India, and also behind middle-income contenders like Mexico and Malaysia. Yet, the HTP-driven expansion of its private sector, combined with Turkey’s strategic geographic location at the crossroads of Europe, Central Asia, the Middle East, and Africa, enabled remarkably rapid growth. Initial recruitment efforts concentrated on neighboring Balkan countries, subsequently expanding to attract patients from the Middle East and post-Soviet states seeking advanced treatments. Europeans also increasingly sought out Turkey’s private hospitals for affordable and efficient cross-border healthcare, often finding relief from their own oversubscribed public systems. As these international patient flows intensified, they transitioned from being a marginal presence in Turkey’s healthcare system to an indispensable component of providers’ growth strategies, introducing new axes of differentiation among patients based on geography, mobility, and purchasing power.

Over time, medical tourism evolved from a peripheral concern of the Ministry of Tourism to a central focus within the Ministry of Health’s strategic planning. By the early 2010s, the state had adopted an increasingly proactive role in coordinating medical tourism, a phenomenon described by Volkan Yılmaz and Püren Aktaş as “state entrepreneurialism.” This orientation, however, also recalibrated the Ministry’s internal priorities, as export promotion became inextricably linked with the administration of universal care. This marked a crucial inflection point, as the Ministry of Health began to govern with two distinct constituencies in mind: domestic citizens, entitled to universal coverage, and foreign patients, viewed as vital sources of export revenue. Global branding campaigns, orchestrated by the Ministry of Trade and the Turkish Exporters Assembly, now explicitly invite the world to “Heal in Türkiye,” highlighting its appeal as a premier healthcare destination.

This export-oriented transformation of healthcare was formalized within the Ministry of Health through the establishment of Uluslararası Sağlık Hizmetleri Anonim Şirketi (USHAŞ), a state-owned enterprise. Founded in 2019, USHAŞ was specifically tasked with managing and regulating Turkey’s medical tourism market while promoting Turkish healthcare institutions and professionals on the global stage. In 2022, this export-focused approach extended to domestic providers with the launch of HealthTürkiye, a digital platform managed by the Ministry of Health, which providers could voluntarily join for coordination and promotional activities. By April 2025, a revised regulation mandated that all certified hospitals and brokers involved in medical tourism integrate into this platform, ostensibly to enhance sector regulation and improve international patient care coordination.

Some hospital administrators I consulted interpreted these recent reforms less as a commitment to patient protection and more as an attempt to centralize and redirect financial flows through a state-controlled commercial platform. The Turkish Medical Association (Türk Tabipler Birliği — TTB) has, in fact, initiated legal proceedings against the Ministry of Health concerning its 2025 regulation. Their lawsuit cites multiple legal concerns, including issues of provider autonomy, patient data privacy, price-setting mechanisms, the legitimization of commission-based patient brokerage, and potential manipulation of insurance markets. In February 2026, this simmering conflict escalated into widespread health worker protests. Doctors and dentists explicitly rejected new Ministry of Health regulations requiring physicians treating foreign patients to register with USHAŞ and pay a substantial 120,000 TL (approximately $2,700) authorization fee. They argued that this rule effectively tied medical practice to a commercial license, thereby infringing upon physicians’ professional autonomy. These professional objections and mobilizations underscore the consolidation of an entire ecosystem of commercial actors and transactions under the Ministry of Health’s purview—a development that medical professionals widely perceive as institutionally prioritizing profits at the expense of citizens’ fundamental right to care.

By delegating the organization and promotion of international health care to a state-owned company, ostensibly unencumbered by the typical constraints of public health care administration, the Ministry of Health has effectively recast international health care as an explicitly market-oriented activity. This strategy introduces a fundamental institutional misalignment: the very ministry tasked with guaranteeing universal entitlement now operates within a framework that actively rewards revenue generation and international competitiveness. These dual, often conflicting, incentives have gradually reshaped how vital resources, personnel, and regulatory attention are deployed across the entire healthcare system.

Domestic Ramifications: Access and Equity in Turkish Healthcare

While the expansion of medical tourism has undoubtedly boosted Turkey’s economy and enhanced its international image as a healthcare destination, its growth has had uneven and concerning effects on citizens’ access to healthcare. These repercussions manifest in altered hospital service priorities and significant shifts in the distribution of healthcare workers, as both brain drain and market demands reshape the healthcare labor force. As provider priorities increasingly align with the demands of international patients, local citizens face the prospect of fewer doctors and extended wait times in public hospitals, which often feel neglected.

The broader trend of privatization, set in motion by the HTP, has been amplified significantly by hospitals’ strategic pivot towards the international patient market. Many private hospitals have developed extensive international patient offices, staffed with multilingual personnel and translators, dedicated solely to international patient care. Larger hospital conglomerates have gone even further, establishing physical recruitment offices abroad. Acıbadem, Turkey’s largest private hospital group, exemplifies this trend, having opened full-fledged hospitals in Serbia, North Macedonia, Bulgaria, and the Netherlands. While high-quality services at private hospitals like Acıbadem are nominally accessible to Turkish citizens, only the affluent professional classes can truly afford the high costs, either through private insurance or substantial out-of-pocket payments.

Meanwhile, as of 2025, eighteen public-private partnership City Hospitals have been constructed, intended to serve both SGK-insured patients and, at least theoretically, the burgeoning demands of medical tourists. For many Turkish citizens, however, these monumental facilities have come to symbolize lavish investment in seemingly endless construction projects rather than meaningful structural improvements to the public system. Undeterred by growing concerns about the marketization of public healthcare providers, the Ministry of Health recently launched USHAŞ Plus, a pilot program designed to integrate twenty-nine public hospitals into the medical tourism framework. In the interim, Turkish citizens, though nominally covered by universal insurance, witness their public health system suffering as private hospitals distort the equitable allocation of healthcare capacity. More than one-third of all hospitals are now private, yet they account for only 6.3 percent of all doctor’s visits, leaving public facilities to bear the overwhelming majority of the nation’s healthcare burden.

As public funding increasingly shifts towards profit-oriented models and private capacity expands, recent data indicate that health outcomes are, at best, stagnating and, at worst, deteriorating. Between 2023 and 2025, the number of treatable mortality cases—deaths avoidable with timely healthcare intervention—increased from 107 to 119 per 100,000 people. Preventable mortality, or deaths that could be averted through primary preventative care, rose even more sharply, from 126 to 168 per 100,000 individuals. Furthermore, declines in infant and child mortality have stalled in recent years, remaining significantly above the figures reported for other developed countries.

Turkish patients themselves are acutely aware of these shortcomings. Their satisfaction levels with healthcare access compare unfavorably with those of patients in other developed countries within the Organisation for Economic Co-operation and Development (OECD). In 2025, only 41 percent of citizens reported satisfaction with access to quality healthcare, a stark contrast to the OECD average of 64 percent and a notable decline from an already lagging 53 percent in the 2023 survey.

Medical professionals, too, have found themselves caught in the crosshairs of a healthcare system that increasingly favors profit-oriented providers. Turkey is currently experiencing a marked brain drain of medical workers to Europe, as doctors seek to escape meager paychecks, overcrowded public hospitals with arduous working conditions, and an alarming prevalence of workplace violence directed at healthcare personnel. Among those who remain in Turkey, many have transitioned from public hospitals to the more lucrative and less strenuous private sector. According to TTB statistics, over 21,000 specialists departed public sector hospitals between 2012 and 2025, leaving numerous clinics and hospital departments across many provinces without vital specialist care. Currently, 27 percent of healthcare workers—and over 30 percent of specialists—are employed in private hospitals that collectively serve only a small fraction of the Turkish population. Even as physicians’ participation in the private sector has stabilized, specialty preferences among top medical graduates continue to shift towards high-income, private sector fields, specifically dermatology, radiology, and reconstructive or aesthetic surgery. As more doctors pursue specialties that are primed for medical tourism markets in major travel hubs, public sector hospitals in underserved areas will inevitably continue to weaken, further impacting domestic quality of care.

The growing perception that the healthcare system is leaving ordinary citizens behind has become increasingly prevalent. An early manifestation of this sentiment emerged with rising anti-refugee sentiment in the late 2010s, fueled by endemic rumors that Syrian refugees were receiving prioritized treatment in public hospitals. This feeling of being sidelined within the healthcare system has persisted and intensified with the growth of medical tourism. This led former Health Minister Fahrettin Koca to publicly refute social media claims asserting that foreign nationals receive preferential treatment in Turkey’s hospitals. However, even in the absence of formalized preferences for foreigners, the establishment of bifurcated intake systems through dedicated foreign patient offices risks the de facto prioritization of international patients who pay higher prices—a troubling global trend recently exposed in the United States organ transplant industry. Opposition politicians have increasingly capitalized on this public sentiment. In press briefings and parliamentary hearings, representatives from multiple parties have explicitly linked medical tourism, chronic appointment shortages with public providers, and deteriorating health outcomes, arguing that state policy prioritizes profit-driven providers even as ordinary citizens struggle to access basic care.

Another significant factor contributing to Turkish citizens’ feeling of being left behind is that the care marketed as “low-cost” to international patients, flush with foreign currency, has become prohibitively expensive for them. Turkey’s ongoing economic crisis, triggered by a decline in the Turkish lira’s value in 2018 followed by a steep plummet in late 2021, has led to rampant and persistent inflation. For Turkish citizens, both rising SGK premiums and private healthcare services are becoming increasingly unaffordable amidst a severe cost-of-living crisis. Moreover, weak regulation of price caps on services has incentivized hospitals to further inflate service prices, often well beyond the state-prescribed SGK reimbursement levels. This situation means that even the middle class, which once could bypass public service wait times by opting for private care, can no longer afford private hospital fees, thereby placing even greater strain on public facilities.

Public facilities have responded to this domestic financial strain by monetizing some same-day, after-hours services for those willing to pay. As domestic healthcare has increasingly become a luxury good, private hospitals have been further incentivized to prioritize profitable specialties highly sought after by foreigners. An international patient coordinator I interviewed in July 2025 candidly explained that in their hospital, although only 10 percent of patients are foreign, “all our profits come from foreign patients … 70 percent of revenue, all the profit.” This stark reality underscores how the marketization that underpinned the HTP now operates through the export logic of state-managed medical tourism, thereby deepening the divides between those who can pay and those who cannot. What began as a project to extend healthcare to all citizens has evolved into a system that extends it to the world while making access at home increasingly unequal. As Dr. Güray Kılıç of the Private Practice Physicians’ Branch of the TTB summarized in a December 2025 panel, “Medical tourism normalizes the idea that those with greater financial means are entitled to better and more advanced healthcare, rendering it acceptable to treat health not as a right, but as a consumer good.”

Turkey’s continued expansion as a global healthcare destination is neither an inevitable outcome nor without significant costs. The sector’s remarkable rise has been largely enabled by reforms that inextricably linked healthcare expansion to market incentives—a strategy that inherently renders the industry vulnerable. The nation’s capricious economy, shifting global healthcare inequalities, and the potential for plateauing foreign demand all expose the inherent fragilities of a healthcare system that prioritizes growth through foreign currency generation over the foundational needs of its domestic population.

The cosmetic sector, a cornerstone of Turkey’s medical tourism success, vividly illustrates both the immense potential and the inherent burdens of a foreigner-facing healthcare model. Social media platforms are saturated with patient testimonials celebrating age- and gravity-defying physical transformations, reinforcing Turkey’s reputation as an affordable aesthetic hub. However, these same platforms that propel the industry can also swiftly undermine it. Stories of botched procedures can go viral rapidly, severely imperiling the country’s international healthcare sector as isolated horror stories come to dominate online narratives. The government has attempted to implement policies to regulate the medical tourism market, aiming to stabilize a narrative of high quality and low prices. Yet, these efforts must confront the uncomfortable reality that the informal market, which is now poised for greater regulation, also plays a crucial role in driving down the prices that attract many international patients.

Simultaneously, medical tourism is transitioning from being perceived as a technocratic growth strategy to a highly contentious arena of domestic political debate. The export orientation of healthcare has generated significant resistance among professional associations and intensified opposition critiques concerning privatization at the expense of public care. As dissatisfaction with access to healthcare has grown and gains in health outcomes have stalled, medical tourism has become a potent symbol of the relegation of Turkish citizens within a healthcare system that increasingly privileges an individual’s market position over their national membership.

A once-premier export has thus become an embattled public good for citizens, leaving them frustrated with an industry that was initially touted as a means to improve economic vitality and healthcare quality for all. As long as global celebrities and influencers continue to travel to Istanbul to renew their hairlines and Hollywood smiles, Turkey’s most visible export will persist in being its capacity to sell the promise of personal transformation to outsiders—all while the collective care system at home gradually frays. If access to care increasingly favors purchasing power over citizenship, the consequences may extend far beyond hospital corridors. Universal healthcare was once a foundational cornerstone of the AKP’s social contract—and its perceived reversal in pursuit of export-led growth risks reinforcing mounting doubts about the party’s capacity to deliver tangible material improvements in citizens’ lives.

Source: Brandeis University