KARŞIYAKA AĞIZ VE DİŞ SAĞLIĞI MERKEZİ

REGULATIONS

From the Ministry of Health:

REGULATION CONCERNING INTERNATIONAL HEALTH TOURISM AND TOURIST HEALTH

SECTION ONE

Objective, Scope, Basis and Definitions

Objective

ARTICLE 1 - (1) The objective of this Regulation is to regulate the procedures and principles concerning: the establishment of the minimum service delivery standards for healthcare services providedon an international level within the scope of international health tourism and tourist health, the authorization of healthcare organizations and intermediaries thatare going toconductoperationsin international health tourism services, and the supervision of these operations.

Scope

ARTICLE 2 - (1) This Regulation covers persons who are not covered byLaw No. 5510 on Social Securities and General Health Insurance dated 31/5/2006,orinternational bilateral reciprocity agreements, but have traveled to Turkey from abroad with the purpose of receiving healthcare, or face an emergent need for healthcare services while in Turkey as tourists; and public, university-affiliated and private healthcare institutions and organizations and intermediary organizations thatprovide healthcare services to these persons.

1. The following are not covered under this regulation:

1. Foreign patients and casualtiesfrom such countries as determined by the Council of Ministers, by the order of the Prime Ministry or the relevant Ministry,who, in extraordinary circumstances such as war, disaster, famine and the like, receive healthcare services during their stay in Turkey, or are brought to Turkey from such countries by non government organizations for purposes of treatment, and their treatment expenses paid.
2. Patients brought to Turkey for purposes of treatment from the Balkans and Turkic Republics by non-government organizations approved by the Ministry, the Turkish Cooperation and Coordination Agency (TİKA), or the Prime Ministry Presidency for Turks Abroad and Related Communities.
3.  Patients brought in by the Turkish Coordination and Cooperation Agency (TİKA).

   ç) Citizens of certain countries who are entitled to receive medical assistance under Social Security Contracts in accordance with the international agreement signed by the Republic of Turkey; citizens of the Republic of Turkey; persons who come to Turkey for treatment under international bilateral cooperation agreements.

4. Persons who cometo Turkey for purposes of education, training, or courses, and their dependents for the duration of the education.
5. Persons under temporary protection, refugees, persons who hold the status of asylum applicant or refuge applicant, asylum seekers, stateless persons, victims of human trafficking.
6. Those covered under articles 28 and 44 of Law No. 5901 on Turkish Citizenship dated 29/5/2009.
7. Foreigners of Turkish descent who present documentation of their Turkish descent.

   ğ) Foreigners who receive emergency healthcare servicesupon being brought in by law enforcement officers as part of a judicial case.

1. Persons mentioned inparagraph (2)may receive international health tourism services under this Regulation if they agree to be charged fees within the scope of international health tourism.

Basis

ARTICLE 3 - (1) This Regulation has beendrawn up based on paragraph (c) of article 9, and annex article 11, of  the Health Services Fundamental Law No. 3359 dated 7/5/1987; subparagraphs (a) and (i) of paragraph 1 of article 8, and article 40, of the Statutory Decree Concerning the Organization and Duties of the Ministry of Health and Affiliated Organizations No. 663 dated 11/10/2011.

Definitions

ARTICLE 4 - (1) The meanings of the following expressions that appear in this Regulation are;

1. The Ministry: The Ministry of Health,
2. Directorate General: The Directorate General of Health Services,
3. Directorate: The Provincial/District Health Directorates,

   ç) SATURK: The Health Tourism Coordination Council established pursuant to Prime Ministry Memorandum No. 2015/3

4. International Health Tourism:Any healthcare services and relatedsupport services rendered to natural persons coming to Turkey from abroad temporarily for health purposes, and are not citizens of the Republic of Turkey or areresidents abroad as citizens of the Republic of Turkey,
5. Tourist health: The rendition of healthcare services,to foreigners who are temporarily situated in Turkey for any reason, in cases of suddenly developing diseases and emergencies that occurduring their stayin Turkey,
6. International health tourist: A patientwho is rendered healthcare services within the scope of international health tourism or tourist health,
7. International health tourism intermediary organization: Group A travel agencies that have beengranted operation licences in accordance with Law No. 1618 on Travel Agencies and Association of Travel Agencies dated 14/9/1972, and authorized by the Ministry to conduct operations comprisingthe provision of accommodation, transport and transfer services to an international health tourist andhis/herattendants and other relatives or close associates in his/her company.

   ğ) International health tourism healthcare facility: A public, university-affiliated or private healthcare institution or organization that holds a healthcare facility licence and has been granted an international health tourism authorization certificate by the Ministry.

8. Foreigner: A person not affiliated with the State of the Republic of Turkey by means of citizenship,

ı) Authorization certificate: The international health tourism authorization certificate

SECTION TWO

International Health Tourism

General principles

ARTICLE 5 - (1) The healthcare provider and the intermediary organization shall obtain international health tourism authorization certificates in order to operate within the scope of international health tourism. The Ministrysuspends the international health tourism operations of  those failing to obtain an authorization certificate

1. Diagnostic, therapeutical, and rehabilitative healthcare services, as well as traditional and complementary medicine applications may be provided at the international health tourism facility in accordance with the criteria in this Regulation.
2. An international health tourism healthcare facility may accept an international health tourist who applies directly to the facility. However, in the event that the operations of an intermediaryorganization are needed, a protocol shall be signed with an international health tourism intermediary organization that has been authorized by the Ministry. A copy of the protocol that is signed shall be sent to the Directorate General via the Directorate.
3. It is the responsibility of the international health tourism healthcare facility to provide other servicesthat the international health tourist may need in addition to the healthcare service they are to receive at the healthcare facility from their admission to their discharge.The facility may sign a contract with an international health tourism intermediary organization, as well as with other institutions and organizations, for the delivery of these services.
4. The international health tourism healthcare facility shall register the recipients of healthcare services under this Regulation in the web-based system set up by the Ministry.
5. Personal health data recorded by the international health tourism healthcare facility shall be processed in accordance with Law No. 6698 on Protection of Personal Data dated 24/3/2016, and transferred into the central health data system in accordance withthe procedures and principles set out by the Ministry.
6. The international health tourism healthcare facility and the international health tourism intermediary organization shall send information and documents that are requested by the Ministry.

International Health Tourism Unit

ARTICLE 6 - (1) Within the international health tourism health facility, an international health tourism unit shall be established, which is assigned for international health tourists' admission, registration, diagnosis, treatment, billing, discharge, interpreting and coordination of operations and transactions related to intermediary institutions.

1. In the international health tourism unit, a doctor/specialist shall be appointed as the health tourism unit supervisor and this supervisor shall be reported to the Directorate. According to the potential number of the health tourists, a health professional can also be employed as the international health tourism assistant unit supervisor. Those who will be assigned as unit supervisorand assistant unit supervisor must have the following qualifications:

1. Be competent to perform his/her occupation in Turkey.
   1. To have foreign language skillswith the required proficiency level stated in Paragraph  4 below
2. To have document(s) attesting to skilled professional experience of at least five years, out of which at least two years is executed/performed in a public or private hospital in Turkey.

1. In international health tourism unit, at least two persons including the supervisor who speak a foreign language shall be employed. One of the languages must be English.
2. At least one of the following documents must be provided in order to prove the proficiency of the foreign language.

1. To have a minimum score of sixty-five points out of a hundred either in English or in another language used by the international health tourist, for whom the service will be provided; from the examination organized or held by Higher Education Board (YÖK) or from the Foreign Language Proficiency Examination organized by the Measuring, Selection and Placement Center (ÖSYM) or to have  an internationally valid certificate which is deemed equivalent to this score by ÖSYM.
2. To have a document showing the B2 level (on the European Language Portfolio) language competence in English or in another language used by the international health tourist, for whom the service will be provided.
3. Those with dual-citizenship IDs must have a certificate showing the B2 language level on the European Language Portfolio in Turkish language.

   ç) To have an undergraduate diploma showing that he/she has graduated from the Department of Translation & Interpreting.

1. The international health tourism unit also provides orientation and guidance services to those who come to Turkey to obtain health services in accordance with international humanitarian agreements and international bilateral cooperation agreements in the field of international social security

Competency criteria

ARTICLE 7 - (1) In order to be granted an International Health Tourism Authorization Certificate by the Ministry of Health in the field of international health tourism:

1. It is obligatory for the health facility to fulfill the criteria set out in the International Health Tourism Healthcare Facility Competency Criteria listed in ANNEX-1.
2. It is obligatory for the intermediary institution to fulfill the criteria set out in the International Health Tourism Intermediary Organization Competency Criteria listed in ANNEX-2.

Authorization Certificate

ARTICLE 8 - (1) In order to obtain a an authorization certificate, the health facility / intermediary organization shall fill in the application form of the authorization document in ANNEX-3 regarding their field of activity and add the application documents stated in the same same annex to the application form and apply to the Directorate with above-mentioned documents.

1. Submitted files are examined by the Directorate whether they meet the competency criteria of this Regulation or not. If the result of the examination indicates lack of any application documents or non-compliance with the criteria, the health facility / intermediary organization shall be notified within seven working days.
2. If the result of the examination does not indicate lack of any application documents or non-compliance with the criteria, the health facility / intermediary organization shall be examined on-site by the team of surveyors formed by the Directorate. On the basis of on site examination, the applications which are determined to be eligible in terms of competency criteria are sent to the Ministry within fifteen business days. If the application is deemed appropriate by the Ministry, An International Health Tourism Authorization Certificate in Annex-4 / A shall be issued to the health facilty and that in ANNEX-4/B shall be issued to the intermediary organization.

SECTION THREE

Tourist Health

Services provided within the scope of tourist health

ARTICLE 9 - (1) Foreigners who are temporarily residing in our country for meetings, congresses, commercial or tourism purposes may benefit from the health services provided in public, university or private health institutions in emerging diseases and emergencies during the time of their stay in our country.

1. Emergency medical services and emergency patient transportation services shall be charged. However, 112 emergency health services ashall be provided free of charge to citizens of the Republic of Turkey who live abroad and have no social security. The income provided by the public ambulance service and the income from the emergency patient transportation are deposited to the revolving funds of the Directorate, which performed the first intervention for the patient.
2. Admission of foreign patients who apply to a health care facility in order to receive emergency health care services and unconditional response to medical emergencies are obligatory. Transactions related to the collection of service charges are made afterthe emergency response and care is provided.
3. Medical treatment expenses as a result of a traffic accident are covered by Social Security Institution according to the applicable legislation regardless of whether the related individual (Turkish citizen or foreign national) has any social security coverage or not andregardless of their nationality. In traffic accidents, the person himself can not be charged for treatment. However, if the person receiving the emergency medical treatment as a result of a traffic accident, has optional travel insurance, then the chargesshall be billed tothe insurance company and be the payment will be collected under the insurance policy.

SECTION FOUR

Pricing and Billing, Informing and Promotion

Pricing

ARTICLE 10 - (1) The cost of the health service provided within the scope of the international health tourism that will be provided within the scope of this Regulation shall be determined by the Ministry in accordance with the opinion of SATURK.

1. The international health tourism health facilities are obliged to comply with the procedures and principles determined in the health tourism price list determined by the Ministry.

Billing and documents to be submitted

ARTICLE 11 - (1) It is obligatory to make out an invoice or prepare billing for those who get service from international health tourism healthcare facilities, within the scope of the relevant legislation. In receipt or invoice annex, a document including the detailed information of the health service provided to the patient and unit cost will be drafted. In addition, it is mandatory to give the following documents free of charge when the person who gets the service demands:

1. International health tourism facility will supply;

1. A list showing the types and quantities of the medicines provided by the international health tourism healthcare facility and paid by the patient.
2.  Laboratory examination, analysis results, and X-ray films executed in the health facility or outside and paid by the patient will be given; however, the original documents will not be given on condition that they are relevant to judicial cases.
3. Prescriptions of medicines and materials purchased from outside.

1. The international health tourism intermediary organization will supply;

1) A detailed breakdown of the fees charged for services such as accommodation for hospital companion or other relatives, transportation, transferring, interpreting, and consultation.

Informing and promotion

ARTICLE 12 - (1) The healthcare facilities and intermediary organizations that are not authorized by the international health tourism regulations are not allowed to do informing or promotion.

(2) Promotional activities within the frame of international health tourism must be carried out as follows:

1. The promotion can not be done in Turkish or in a way that it would generate demand within Turkey. The promotion can be done in the targetted country language and/or English.
2. International health tourism healthcare facility and international health tourism intermediary organizations will publish the information on the services to be provided within the frame of health tourism and detailed transportation information on the websites, indicating the latest updates.
3. Promotions can not contain information about health services that are not registered on the license, warrant or authorisation, information that is wrong, misleading, against ethical and professional rules and generate demand for the domestic community.

   ç) Informing about the health services on the websites or other means of promotion instruments is to be executed by the members of the health profession who possess information and experience related to the field and are legally capable.

4. Provided that patient privacy and rights are considered and consent of the patient is taken and documented, the promotions can include the stories of the patients.
5. According to the legislation in force, medical operations or practices that are not allowed or banned in our country can not exist in the promotions.

SECTION FIVE

Miscellaneous and Final Provisions

Training

ARTICLE 13 - (1) The certification and vocational course training to be executed in the field of international health tourism are carried out by the joint cooperation of the Ministry and Higher Education Council.

Inspection

MADDE 14 - (1) International health tourism healthcare facility and international health tourism intermediary organization will be inspected at least once a year with regards to the suitability of this regulation, with the expectation of complaint or investigation. In addition to the general provisions of this regulation, the competence criteria and the sanction form partaking in the regulation appendix will be used.

1. The necessary registration and notice system to assess the disagreements that may occur during international health tourism and tourist health practices will be established by the Ministry. On complaint method, the foreigners are informed before the health service presentation by international health tourism healthcare facility.
2. The health tourism facility or mediary organization whose operation is suspended due to the inconsistency with the procedure and principle stated in this regulation is reported to the Ministry of Economy.

Sanctions

MADDE 15 - (1) Those facilities who don't adapt the procedure and principle stated in this regulation will be subjected to the other regulatory provisions which are about judicial sanctions indicated in ANNEX-5 and ANNEX-6.

In case of those who already conduct an existing international health tourism activity

PROVISIONAL ARTICLE 1 - (1) The health facilities and intermediary organizations carrying out international health tourism activities before the publication of this regulation are required to comply with the competence criteria revealed in this document with 1 (one) year and get the certificate of authority from the Ministry. The facilities or firms who fail to get International Health Tourism Competence document stated in this regulation have to stop their activities.

Effect

ARTICLE 16 - (1) This regulation will go into effect following its publication.

Execution

ARTICLE 17 - (1) The provisions stated in this regulation will be executed by the Health Minister.

ANNEX-1

INTERNATIONAL HEALTH TOURISM FACILITY COMTEPENCY CRITERIA

1. Health facility is required to receive a score of at least 85 from the health quality standard assessment carried out before the day of application/inspection. (The health facilities whose quality indicators and health quality standards have not been published are exempted from this criteria. These health institutions have to apply the related set of standard rules within 6 (six) months.)
2. International health tourism unit vested with the 6th article of this regulation has to be formed.
3. The  health facility must have a website infrastructure from which international health tourist is able to get information on the doctor's/doctors', who will provide health assistance, professional history.
4. The health facility is required to have a communication and information transmission system through which the international health tourist can get a detailed information on his/her (patient's) sickness before coming to the health facility.
5. There is required to be an infrastructure for international health tourist through which she/he can render the payment as a deposit to the hospital's account before arriving at the facility.Sağlık tesisi otomasyon sistemi üzerinde, uluslararası sağlık turizmi ve turistin sağlığı kapsamında sunulacak sağlık hizmetleri kapsamında yapılacak tüm işlemleri yabancı hasta modülü üzerinden yapmaları için gerekli alt yapı olmalıdır.
6. An infrastructure is necessary through which patients can do all sort of transactions to be carried out within the frame of international health tourism and tourist health on the foreign patient module which is part o the health facility automation system.
7. The health facility shall, in conjunction with the application, commit to undertake the following issues in writing. Whether these commitments have been fulfilled will be taken into account in all audits to be carried out.

1. Will inform about all the transactions to be provided within the scope of international health tourism and tourist’s health and the consent form written in the language of the international tourist will be signed by the international tourist and the doctor who is giving the health service.
2. The clinical and laboratory findings of the patients, the diagnosis of the disease, the progress of the disease, the results of the examinations and the results of treatment and treatment, the epicrisis given by the health facility after the treatment and the patient's needs after discharge should be prepared in the patient's own language and delivered to the patient.

ANNEX-2

INTERNATIONAL HEALTH TOURISM INTERMEDIARY ORGANIZATION COMPETENCY CRITERIA

1. To have Group A travel agency business certificate dated 14/9/1972 and numbered 1618 as per the Law on Travel Agents and Travel Agents Union.
2. To certify that it has signed a protocol with at least 3 health facilities with international health tourism authorization certificate. This protocol will enter into force after the mediator receives the international health tourism authorization certificate.
3. To have an infrastructure that can serve 24/7 in order to answer possible calls. (It is necessary for one foreign language to be in English.)
4. To employ at least 2 staff members who know a foreign language except the staff to answer the calls, (It is necessary for one foreign language to be English.)
5. Having at least one of the following documents for foreign language proficiency;

1. Having a score of at least 65 out of 100 in the Foreign Language Assessment Exam conducted by OSYM in English or  in the language of the international health tourists to be served or having a document with international validity which is accepted by OSYM as equivalent to this point,
2. To have a document showing the B2 language level in the European Language Portfolio, either in English or in the language of the international health tourists to be served.
3. Those with dual citizenship IDs must have a certificate showing the level of B2 in Turkish in the European Language Portfolio.
4. Having a certificate that showing the graduation from the Department of Translation and Interpretation at the undergraduate level.

1. The intermediary will commit to undertake the following issues in writing. Whether these commitments have been fulfilled will be taken into account in all audits to be carried out.

1. To have a web site supporting at least 3 languages in Turkish and English compulsory, to have necessary explanations about the topics that international health tourists might want to get information on this website, to provide detailed information about these health facilities by publishing the health facilities that they are in agreement with.
2. Making travel insurance covering international travel to the international health tourist,
3. Investigate the health facilities that are suitable for the health service that the international health tourists want to receive, to deliver the medical information of the health tourists and 1 or documents to the health facility,
4. To provide detailed information about the health facilities that can provide health services to international health tourists.
5. To provide information about the service cost and payment conditions to the international health tourists by getting information from the health facilities related to the health service fee that international health tourist will take,
6. Providing information to international health tourists such as travel, passport, city transportation, communication, consular operations in our country.
7. To ensure that those arriving with international health tourists come to our country, stay in our country and return to their country,
8. To deliver the international health tourist to the international health tourism facility which will serve, communicating with the international health tourism unit in the facility and deliver the tourist to this facility and getting the tourist from the facility after discharge,
9. To act in accordance with the Law on the Protection of Personal Data dated 24/3/2016 and No. 6698 on all kinds of information obtained by international health tourists during its activities.

j)     To keep all the documents related to its activities for the periods specified in the relevant legislation.

k)     Get informed consent by providing detailed information about international health tourists and services to be provided to them. (Information may also be provided in electronic form.)

ANNEX-3

ANNEX-3/A

AUTHORIZATION CERTIFICATE APPLICATION FORM

1. APPLYING FACILITY/INSTITUTION

   (1)  Name of facility / institution:

   (2)Tax Office No:

   (3)Address:

   (4) Postal Code:

   (5) City:

   (6) Country:

   (7) Phone:

   (8) Fax:

   (9)Web address:

2. REPRESENTATIVE OF APPLYING FACILITY/INSTITUTION

(1) Name of representative:

(2)Surname of representative:

(3)Address:

(4) Postal Code:

(5) City:

(6) Country:

(7) Phone:

(8) Fax:

(9)E-mail:

1. REQUESTED DOCUMENT

   □	1. INTERNATIONAL HEALTH TOURISM HEALTH FACILITY AUTHORIZATION DOCUMENT
   □	2. INTERNATIONAL HEALTH TOURISM INTERMEDIARY COMPANY AUTHORIZATION DOCUMENT
   (*) Mark your request with the (X) sign.

    

2. APPLICANT'S DECLARATION AND SIGNATURE

We commit that we accept all the terms and conditions of the Regulation on International Health Tourism and Tourist Health and fulfil our obligations, we will pay the administrative fines ceased after the audits to be made by the Ministry within 30 days at the latest,  we will be liable for the consequences of delays and erroneous transactions arising from the non-concurrent submission of additional administrative and technical documents requested in connection with the application and we will accept records of all kinds of work and processing to be carried out by the personnel assigned on behalf of the Ministry and the person / persons declared as representatives in this application form, We undertake to provide any kind of facilitation during the examination of the criteria of competence certificate of personnel working for the Ministry.

We confirm that using the certificate of facility/institution before completing the certification transactions about the document we applied and getting the rights to use the certificate, will be considered as illegal and we are aware that our certification application will be affected because of the above mentioned matter.

Within the framework of the information provided above, we request the evaluation of our International Health Tourism Authorization Certificate application for our legally owned facility / establishment in accordance with the provisions of the Regulation on International Health Tourism and Tourist Health.

Name                   :

Date                     :

Signature             :

Seal                      :

NOTE: Please add the Application Documents in ANNEX-3/B to this form.

ANNEX-3/B APPLICATION DOCUMENTS

Documents to be submitted by the health facility:

1. Copy of license / provisional license and activity permit certificate of the applicant organization issued by the Ministry,,               |
2. Book of authorized signature of the person(s) with representative and binding authority of the applicant organization (Notary certified),
3. Document, showing that the applicant organisation obtained a minimum score of 85 points on the last healthcare assessment.
4. Language proficiency documents and monthly premium and service documents of personnel in accordance with the Article 6 of the Regulation, indicating the required level of language proficiency and the number of personnel

Documents to be submitted by the intermediary organization:

1. Copy of operation license of a Group (A) travel agency in accordance with the Law No. 1618 Concerning Travel Agencies and the Association of Travel Agencies.
2. Copies of protocols signed with 3 healthcare facilities with International Health Tourism Authorization Certificate,
3. Trade Registry Gazette containing registered articles of association of the company, specifying health tourism agency as the main field of activity,
4. Trade Registry Certificate indicating the person(s) authorized to represent the company,
5. Book of authorized signature of the person(s) authorized to represent legal entity,
6. TR Identity Number and criminal record statement of the person(s) authorized to represent the company,
7. Tax Registration Certificate,
8. Previous year-end’s balance sheet approved by Certified Public Accountant,
9. Language proficiency documents and monthly premium and service documents of personnel, in accordance with ANNEX-2, indicating the required level of language proficiency and the number of personnel

ANNEX-4/A

Republic of Turkey

MINISTRY OF HEALTH

GENERAL DIRECTORATE OF HEALTH CARE SERVICES

INTERNATIONAL HEALTH TOURISM AUTHORIZATION CERTIFICATE

Within the scope of the Regulation on International Health Tourism and Tourist Health,

……………………………………………………………

has been entitled to perform international health tourism activities in accordance with the general principles of the Regulation and Competency Criteria for Healthcare Facilities associated with International Health Tourism.

On Behalf of the Minister;

Undersecretary

Document No :

Document Date :

ANNEX-4/B

Republic of Turkey

MINISTRY OF HEALTH

GENERAL DIRECTORATE OF HEALTH CARE SERVICES

INTERNATIONAL HEALTH TOURISM AUTHORIZATION CERTIFICATE

Within the scope of the Regulation on International Health Tourism and Tourist Health,

……………………………………………………………

has been entitled to perform international health tourism activities in accordance with the general principles of the Regulation and Competency Criteria for Intermediary Organizations associated with International Health.

On Behalf of the Minister;

Undersecretary

Document No :

Document Date :