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Positioning Turkey in Medical Tourism Hub

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Content Turkey As MT destination Key drivers to support the MT Factors impacting MT GCC as potential market for Turkey MT.

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Who is going where for Medical Tourism. Source: Healthcare Special report - EIU 2011 and Dubai Medical Tourism Research 2012 Source: Mint.com on the Global Medical Tourism Info graphic

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Turkey As a competitive country There are 28 hospitals, 3 Genetic Diagnostic Center, independent laboratories, more than 4,000 beds and over 2,000 physicians. Health care affiliations and collaborations with a prestigious providers; John Hopkins, Harvard Medical International, Mayo clinic, Houston Memorial, and Sloan-Kettering Cancer Center. High Medical capabilities and expertise in the level of liver and kidney transplantation, Bone marrow transplantation, Robotic surgery and Cardiology and cardiovascular surgery. * Turkish Accredited hospital association.

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Medical Tourism Market Segmentation - Positioning of Destinations Centers of Excellence quality focus USA Singapore Germany UK Switzerland Korea Value Offering (Quality + Price mix Low cost) India Czech Republic Hungary (for dental and spa) Bulgaria Jordan Belgium (in respect to Germany & US) Tourism driven value proposition (supported by tourist infrastructure and popularity of the destination) Thailand Turkey South Africa Greece Spain and Portugal Location centric value offering (focus on 1-2 nearby countries) Malaysia (Indonesian patients 70%) Taiwan (Mainland China patients 80%) Poland (Russia, Scandinavian nations) Canada (US patients 80-90%) Mexico (US Patients - >90%) Costa Rica (US Patients - >90%) Niche services positioning ( specific treatments ) Cuba (for ophthalmology) Philippines (spa treatments & therapies) Japan (Radioactive therapies for cancer)

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Medical Tourism The Approach Understand target markets for MT Identify priority health services Health facilities and hotel tie ups Marketing of identified health services in China Marketing of identified health services in China Medical Tourism Tourism, travel and visa support Price benchmarking with other destinations

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To support Medical Tourism Continuous government support of the industry Systematic collaboration of the MT stakeholders Insurance company promotion of medical tourism Multiple surveys of patients experiences at facilities. support in investment promoting quality care or a cluster of facilities within an attractive location. Strong marketing & branding strategy to promote Turkey as tourism hub especially in the GCC.

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Medical Tourism support a Country Economically ; tourism revenues Produce foreign exchange Improves the health services Increase access to health care. Attract brains from other countries

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Reasons to travel for healthcare involve a lot of factors for patients and payers Source: Healthcare Special report - EIU 2011 and DHA Overseas Treatment Survey 2012 Expertise of the doctors or surgeons involved, and the quality of aftercare. Ease of travel, including the possibility of combining treatment with a holiday;. Familiarity with the country, language and the healthcare system; Risks for the patient, which range from quality concerns in the healthcare system to general risks, such as terrorism. Cost, both for the treatment and for the stay. The perceived value from treatment abroad considering the quality of health system in the home country and malpractice. The waiting time for the procedure in the home country compared with the medical travel location. The availability of after care services post surgery The availability of information on quality/cost and the experience surgeons.

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Important factors to Consider 1. Medical; Are we using innovative evidence based techniques? Do we have strong credentialing system for our providers? Is our quality standard comparable to competitive countries? Complication rates. Infection control. Medical errors.

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Cont/factors 2. Financial; Cost for uninsured patients / procedures Cost of complications is carried by home country in case of infection. Decreased access to specialized services for citizen Decreased training resources Coercive use of medical tourism by insurance companies Shortage of nurses / physicians.

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Cont/factors 3. Ethical Infrastructure development may be focused on industry rather than local needs Infrastructure costs may be passed on to local population in form of increased taxes or reduced services Emphasis on high tech care. Brain drain from public to private sector

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Cont/factors 4. Legal; Are we protected against substandard care by: Professional licensing & credentialing system. Institutional policies. Legal remedies. Care provided in MT country may not meet tourist home legal standards Disclosure of risks, benefits. Credentialing of professionals. Access to legal remedies. Limitations of medical liability.

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50% of 6 mn medical tourists go to South East Asia and C&E Europe for treatment Source: Various market reports incl. estimates from Deloitte Medical Travel Report 2 mn 4 mn 6 mn

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Industry Drivers: Factors that have lead to the rise of Medical tourism Source: Healthcare Special report - EIU 2011) Government policy Around 50 countries have now identified medical tourism as a strategic national industry. Developments in information technology - The Internet has enabled patients to research options beyond national borders, and expanded international marketing opportunities. Lower air fares -The advent of economic airlines and a drop in airline fares have made medical travel more affordable. Increasing foreign investment - it impacted the provision of healthcare services by leading to improvements in quality and efficiency and investment in health care. Internationalization of the medical workforce - As healthcare systems expanded, more immigrant healthcare workers get employed. This has given medical staff valuable international experience, and has allowed Western patients to become familiar with dealing with foreign medical staff. Internationalization of medical training and accreditation - This prompted some harmonization of medical training, and the spread of English as an international language had impacted highly on health system. The rise of facilitator firms this have supported the MT; such as arranging accommodation and acting as a mediator with the hospitals. These agencies also act as a channel for governments and hospitals to promote medical services.

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GCC As potential Market for Turkey Arabian Gulf citizens spend an estimated Dh91.8 billion a year for treatment abroad with medical tourism picking up in countries such as India, Thailand and Singapore. Where GCC people mainly going? - Germany - United Kingdom - India - Thailand - Singapore - USA It is projected that GCC health market to grow at an annual rate at a CAGR of 11.4% to USD43.9 billion by 2015 from an estimated USD25.6 billion in 2010 Some experts estimate health spending to grow to USD 60 billion in 2025 with growth in inpatient and outpatient market due to increased disease prevalence coupled with rising healthcare cost/inflation

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GCC Population has grown considerably over the past 5 years 18 CAGR:2.2% The GCC population expanded at CAGR of 2.2% to 41.6 million during 2008-2013. The expatriates make up to 49% of the regions population.

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GCC Population is expected to rise to over 50 mn in 2025 19 By 2025, the population in GCC will reach 50 million. The vast majority will be under the age of 25. Growth in GCC is largely due to increasing number of expatriates in the regions developing economies. Source: International Database- Census bureau

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NCDs a % of total for cause of mortality % Overweight out of total population % Obesity out of total population % at risk from raised blood pressure 66% 71%56%69%72%79% 33% 28% 83% 71%69%76% 21%33% 42% 35% 33%34%29% GCC Health Indicators and Risk Factors 71% 79% 33% 37% WHO: Non communicable diseases country profiles 2011

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Factors Related to Treatment Abroad The general atmosphere in the destination country (language, hospitality, religion, customs and traditions) Political environment and security The entertainment side of the trip and the possibility of a vacation along with the treatment Availability of brokers and health offices Geographical closeness of the destination country to GCC Affordability of treatment abroad Quality of healthcare services Physicians experience Lack of health insurance Availability/Access of information about treatment Previous successful experiences of patients traveled abroad

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Thank You Laila@hbb.ae