Public, private, pay-as-you-go: health care for expats

Normally expatriates have to pay a small fortune to be adequately covered in case of illness or even for a routine visit to the nearest hospital. Turkey is different, and health care is much more affordable: By rule of thumb, health care and medical treatment are less expensive than in the United Kingdom and definitely more affordable than in most parts of continental Europe.

Has lower cost compromised higher quality?

Not any more. Turkish health care reforms must be put into the wider picture of a country that had to recover from a serious economic crisis early in the new millennium. Over the best part of the last decade government efforts have focused on improving public health care whilst attracting investors to open private hospitals. Today, in 2010, we can say that private health care is one of the finest available in Europe, while access to and general provision of public health care is constantly improving.

Expats speak up

Mrs. L. from Kuşadası on Turkey’s Aegean coast told me she had had a heart attack in January 2010. She had no insurance.

She went to a private hospital in nearby Aydın as that was the only hospital with a heart surgeon available. She arrived at 10 p.m., and the treatment on arrival was fast and efficient in the operating room. In her own words about her stay in intensive care for 36 hours: “The nurses treat you like a piece of meat. My one main criticism would be lack of TLC [tender, loving care] with regards to the hospital’s nurses.” She observed that Turkish patients in similar circumstances had their extended family stay to look after them and to do what the nurses do not. Cost: Nearly TL 6,000.

Mr. and Mrs. W. from the same resort told me that about their experience when Mr. W. had a stroke two years ago. He went to the devlet hastanesi (state hospital). Commenting about his treatment I was told, “It was fine.” The hospital was also very clean. They said that “the biggest problem was missing follow-up care,” and that Mr. W. “would really have benefited from some therapy after he came home.” Cost: Four days hospitalization, treatment, drips, meals, bed and also meals for spouse: TL 146.

Where to begin

Let us talk about non-expatriates, aka holidaymakers, first. It is strongly advised to take out travel insurance that includes repatriation provisions. Most likely you will still need to pay upfront for minor charges, but since travel insurance is intended to cover emergencies we must be prepared to buy aspirin or other non-emergency medication ourselves, anyhow. Be advised, though, that travel insurance ceases to cover you or your family once you decide to become a resident or start to work in another country.

The transition from visitor to resident

Have a number of visits made you fall in love with Turkey? Then travel insurance will no longer be sufficient to take care of your medical and health-related needs. Either because you were offered a job in this country or because you bought a property and enjoy retirement over here, you have become an expatriate.

What are your options?

I would strongly advise against staying uninsured as whether young or old, working or retired, with a family or single, an accident can happen at any time; a stray dog may cross your path or a health problem may arise which you were not aware of, or you simply need to consult a doctor for advice. As my example from Kuşadası above, without being properly insured one treatment alone can set you back TL 6,000.

Details: How much to pay?

The basic decision is whether you want emergency cover only from a Turkish insurer (usually taking care of all costs) or a combination policy where you usually pay a 20 percent excess but can use it for nearly all medical problems. Be advised that for many conditions a one-year waiting period applies.

Examples: A leading Turkish insurer will charge you and your family (one adult, one child) TL 2,040 per calendar year for a combination of 100 percent cover for emergencies, but 80 percent cover for all non-emergency treatments, with a one year waiting period for more serious treatments as well as for maternity cover.

A policy with emergency-only cover, without reimbursement for non-serious medical treatment, will set you back TL 539 per year (One adult).

A single visit to a private hospital for minor treatment with one follow-up visit will cost anything from TL 90-150 or more. State hospitals charge similar amounts.

Make sure you have an English-speaking broker and that the insurance policy is available in English, too. Insurance brokers can be easily found via the Internet or your local yellow pages where available in print. Word-of-mouth from fellow expats may be helpful, too, but remember each case is different.

For those of us who really want watertight cover: Keep your travel/expat insurance from back home for the duration of your first year here in Turkey, but take out Turkish health care simultaneously and after one year, drop the former plan as you will have now served the necessary waiting/exclusion periods for the latter.

The wider picture

An expert friend of mine, who for many decades worked in the domain of health but due to the sensitivity of his current brief has asked to remain anonymous, explained that the present government successfully streamlined the health care system firstly by uniting all previous institutions active in this area under the one roof of the Social Security Institution (SGK). The website www.sgk.gov.tr has limited information available in English. Secondly, it divided health care providers from the health care buyer groups.

Ready for a UK-style family doctor approach?

The greatest obstacle according to my interview partner is how to allocate enough funds to afford the money so that the new Family Physician (Medicine) System may be established. This is provisionally planned for the end of 2010 and to be rolled out over a number of years; all of the country will be involved and the system will focus on preventive measures.

When it comes to state hospitals, I was told that for the last two to three years quality matters, accreditation measures and internal controls by local administration in hospitals have become integral to performance points, which in return increase the revolving fund incomes of personnel working at those institutions.

Talking about medical tourism, I heard that Turkey does not have long operation waiting lists and that the costs are very affordable. Talking about careers in the medical profession, I learned that there are some obstacles for foreigners to practice medicine in Turkey alongside Turkish nationals.

A final comment

Over the last few weeks expatriates reacted in panic due to a number of newspaper reports about a proposed new law which would require all foreigners to sign up under Turkey’s relatively new Social Insurance Universal Health Insurance law. It was said that every month, a premium of TL 182 would need to be paid to the relevant Turkish authority. The reading of the already translated legal document, in particular pages 45-46, Article 60, defuses the time bomb that once read “Turkey is becoming too expensive for expatriates.” (http://www.sgk.gov.tr/sgkshared/dokuman/SOCIAL_INSURANCE_AND_UNIVERSAL_HEALTH_INSURNCE_LAW.pdf )

The law that I mentioned above implies that if reciprocal agreements exist, those who live (and work) in this country “may” benefit from the new scheme, which has already been available to all Turkish citizens since 2008. Having mentioned that, please check the SGK or your embassy website for details as and when they are made available.