This article gives an overview of the leading market indicators and the key drivers which will shape the Turkish medical technology market in the coming years. It is based on the inputs of policy makers, hospital managers, care providers and the MedTech industry.
Macroeconomic trends and market outlook
Since 2013, politics took center stage, when the government smashed wide spread protests in May 2013 and allegations about corruption are daily news in the social media. Just as the Turkish economy appear set to rebound, the country also appears set for a return of political uncertainty.
The Turkish economy has gained momentum in 2013 after 2 years of decreasing growth. Experts expect economic activity to further to grow 5% for 2014. Unemployment rate remains at around 8 to 9%. About 17% of the population lives below the poverty line. Inflation remains high at around 7% in 2013 but decreases. Public deficit is uncomfortably high at 7%.
In a nutshell one can state that Turkey has digested the economic turmoil in the world economy of 2009 and 2010 quite well and the economy gains momentum. All this comes at a cost, which is high inflation. The challenge will be to manage that growth without allowing the economy to overheat resulting in a rise in inflation or cause a worsening of the current account deficit.
This is why some experts remain cautious about the long term recovery and growth of the Turkish economy. They suspect that GDP growth will be based mostly on domestic demand and not on increased exports which will further widen the current trade deficit. Their scenario is that GDP growth will remain below 4 percent in the next 3 years, causing a higher unemployment rate than expected.
The Health Care system
In 2014 the Turkish health care system is still facing a series of challenges.
The key challenges are the poor referral mechanisms in Turkey, mainly linked to the underdeveloped primary care network and the overconsumption of care by both patients and care providers.
- The recently introduced “family doctor” system hasn’t completely solved the pressure of ambulant patients in hospitals.
- Poor referral systems in primary care, impacts on the effectiveness, costs and clinical outcomes of the patient pathways.
- Overconsumption of pre hospital or ambulatory services driven by the patient.
- Overconsumption of care services organized by the hospitals to generate additional revenues .
- The substantial deficit of the healthcare system cannot be sustained.
- Staff shortage in spite the increasing efforts in training and education.
- Staff shortage in hospitals.
- Lack of management skills in public hospitals: Introducing and extending public hospital governance structures that aim to grant autonomous status to public hospitals.
Most of the changes will be situated in the secondary care networks. The government aims at further expansion of capacity and infrastructure and at improvement of management skills.
- Centers of excellence: Several institutions (Acıbadem, Florence Nightingale, Memorial, Dunya Goz, …) are specializing in oncology, cardiovascular diseases and ophthalmology.
- Private sector: Growth in health care tourism driven by the private sector (one expect over 1Mlln foreign patients by 2015.
The healthcare reform and government policies:
- Harmonization with the EU standards.
- Strengthening of the HC infrastructure so more and better facilities and equipment.
- Negative effect due to the yearly reimbursement adjustments leading to reducing margins and even impacts demand.
- Plan to move to a DRG-based system for the reimbursement of inpatient care. It is envisaged that the GHIS will purchase inpatient services from all hospitals based on DRG groups.
- Increasing number of beds and hospitals.
- Privatization will remain an important vehicle to improve the HC infrastructure.
- The government aims to standardize licensing criteria and accreditation systems to improve healthcare accessibility and quality.
- An initiative to boost E-health and homecare services will be implemented by 2015.
The economic growth, the demographic evolution, other socio-economic changes and the recent healthcare reforms result in a very dynamic healthcare landscape.
For the coming 3 years Turkey’s hospital spending will yearly increase by 6 to 8% and places Turkey among the most attractive growth markets. Although the local ‘medical equipment industry’ is substantial, 85% of Turkey’s medical equipment is imported. The local manufacturers provide attractively priced, ‘good enough’ products and are partially subsidized by the government.
Low cost entrants of medical disposables have taken a substantial position in the market. The yearly reimbursement adjustments, bringing ASP’s down have a negative effect on the margins and on the market growth.
The Health Transformation Program had and has a positive impact on the market opportunities.
The infrastructure is growing and so the related investments. The government wants to increase the number of acute beds by more than 10% by 2015.
The PPP program creates new hospitals. 18 new hospitals are in pre-building or building phase. The growing privatization leads to more HC capacity. More than public hospitals, private hospitals use CPO’s to manage procurement centrally.
Creation of centres of excellence specializing in Oncology, cardio vascular and ophthalmology will lead to attractive opportunities in specialized diagnostical and surgical equipment and devices.
New regulations are in line with EU standards and make Turkey an increasingly attractive grow market.
Capital Equipment & Medical devices
The hospital building programs and increasing privatization lead to CAGR of over 10 to 12% for capital equipment for the coming 3 years.
The increased demand for HC and the wider access to hospital care and improved medical insurance coverage results in CAGR of 6 to 9% for medical devices for the next few years.
The creation of specialty centers (Oncology, cardio-vascular, ophthalmology) will generate an attractive segment for specialized equipment and devices.
New regulations are in line with EU legislation. As a potential future EU member, Turkey is aligning its own legislation relating to medical devices so as to reflect EU regulations and directives. The systems are not yet identical, but Turkey increasingly complies with international procedures, quality and safety standards, such as GMP, GHP, ISO, and CE marking.it will make its local products more competitive and create export opportunities.
Consumables & Disposables
The market is expected to grow at at least 5% for the coming 3 years.
The low cost entrants from China, SE Asia and Pakistan have occupied a substantial share of the business. New regulations will limit below quality standard products.
On the other hand local manufacturers manage to offer ‘good enough’ products at attractive prices and are favored by government policies.
The market for hospital pharmaceuticals is around 8 Blln € in 2013.
The increased demand for HC and the wider access to hospital care and improved medical insurance coverage results in CAGR of 10 to 14% for the next few years.
55% of the drugs are generics (30% of value).
2 large distributors account for more than 70% of the market.
If you are looking for more detailed information per country on healthcare markets, care provision data, socio-demographics and macroeconomic information, please consult TforG’s World Healthcare Scan online business intelligence platform, covering more than 40 countries and 13 specialisms.
About Bart Van den Mooter
Bart is the founder of TforG and works closely together with over 50 global companies such as Abbott, Baxter, GE, J&J, Medtronic, Philips, Stryker and Covidien. In this function, he spends a lot time with Key Opinion Leaders and Health Policy makers in Europe and in Emerging Markets.
He graduated at the Polytechnic University of Leuven with a Master of Engineering and has an MBA (Flanders Business School).