A series of debt crises among university hospitals in Turkey has raised the question of whether a new balance needs to be struck between providing affordable health care and supporting the rising costs of medical institutions.
After failure to repay a 250 million Turkish lira ($66 million) debt on schedule forced Akdeniz University Hospital, famous for its organ transplants, to stop providing medical service, several other hospitals came into the spotlight for their unmanageable debt ledgers.
Namely, the Istanbul (Çapa) Medical Faculty and Cerrahpaşa Faculty of Medicine and their hospitals have accrued a total of TL 600 million ($159 million) in debt, with payments to vendors delayed by four years.
University hospitals receive TL 42 ($11) from the Social Security Institution (SGK) for each patient examination, a fee set based on the cost analysis conducted 10 years ago. Apart from this fee - which covers examination, and laboratory and all other testing - patients are not charged any additional fees.
All other expenses for faculty of medicine hospitals, including personnel expenses, operational costs, investments and maintenance, are being covered by the hospitals' circulating capital funds, unlike state hospitals that receive additional funding form the Ministry of Health and the SGK.
Because the vast majority of patients who come to university hospitals are also suffering from medical conditions, the cost incurred by the facility of almost every patient goes above the standard fee.
Security and food services at the facilities, which are operated by subcontractors, are also covered under the university budget.
In addition, salaries in the Health Practice Statement (SUT) have not been raised for 10 years, so despite increases in the cost of living, income for medical personnel has remained the same.
A solution to the persistent debt will likely include a multifaceted approach, necessarily raising the standard fee for patient examinations, and perhaps requiring a debt forgiveness program to allow heavily-indebted institutions to continue to provide services.
Besides decreasing the quality of medical services provided, the debt burden has also hurt the quality of education the university hospitals are able to provide.
Istanbul Medical Chamber President Dr. Selçuk Erez said these institutions are struggling to provide their students with international-grade instruction, threatening the qualification of these graduates to work in medical institutions abroad.
"Ten years from now, they will not accept our graduates because we have not already complied with international university standards," Erez warned.
"In a certain way, [the university hospitals] have to be operated in such a way as to respond to a certain need, but they cannot," he said.
Turkey is among the countries that recorded the biggest improvements in universal health care between 2000 and 2016, according to a Bill & Melinda Gates Foundation-sponsored study published by the medical journal Lancet. The World Health Organization (WHO) has also noted that Turkey's investments in healthcare contribute to longer life expectancy and less mortality rates in the country.