HEALTHCARE MANAGEMENT EXPORT: TÜRKİYE’S NEW GLOBAL AREA OF STRENGTH

From patient mobility to the export of health system and management capacity

The global health sector has entered a new era shaped simultaneously by demographic change, financial pressure, shortages in the health workforce, digitalization, artificial intelligence, patient safety, and rising service expectations. In this environment, the success of health systems depends not only on clinical capacity, but also on how effectively resources, people, technology, and processes are managed.

The economic scale of this transformation is striking. According to the World Health Organization (WHO), global health expenditure rose from USD 4.5 trillion in 2000 to USD 9.8 trillion in 2022, reaching 9.9% of global GDP [1].

OECD data for 2025 show that hospitals occupy a central position within this economic structure. On average, hospital activities account for 39% of total health expenditure across OECD countries, while in Türkiye the share is 50% or more [2]. This scale reminds us of an important reality: hospital management is not an ordinary administrative function; it is a strategic field of expertise in which human resources, finance, technology, clinical risk, and public responsibility must be managed at the same time.

Türkiye has also built substantial capacity in health tourism. According to USHAŞ statistics based on TÜİK data, the number of international visitors coming to Türkiye for health services increased from approximately 757,000 in 2019, with health tourism revenues of USD 1.46 billion, to 1,398,580 visitors and USD 3.022 billion in revenue in 2025 [3]. This achievement is valuable; however, the value Türkiye can offer internationally in health goes beyond serving foreign patients within its borders.

The new strategic objective should be to preserve the model that brings patients to Türkiye while also building a structure that carries Türkiye’s healthcare knowledge, hospital operations experience, workforce-development capacity, technology, and management model to the world. This approach can be defined as “healthcare management export.”

The global challenge is not only a shortage of hospitals

Across many regions of the world, billions of dollars are being invested in healthcare. New hospitals and health campuses are being built, advanced medical devices are being purchased, and digital infrastructure is being expanded. Yet the health sector has its own distinctive reality: constructing a hospital building and establishing a functioning hospital system are not the same thing.

The physical completion of a health facility does not mean that it is ready to deliver effective, high-quality, and sustainable care. Decisions about which clinical services to prioritize, physician and nurse staffing plans, bed utilization, operating-room capacity, intensive care organization, emergency flow, integration of laboratory and imaging services, management of medicines and supplies, patient admission and discharge processes, quality indicators, revenue-cost systems, and the governance model all need to be designed together.

Millions of dollars can be spent on medical equipment; however, without the right clinical capacity, appropriate patient volume, and a trained workforce, such investments become inefficient. Hundreds of beds can be built; yet without well-designed patient flow and clinical organization, bed numbers alone do not create value. For that reason, in healthcare investments, OPEX, the clinical operating model, and the management system must stand at the center of feasibility analysis, alongside CAPEX.

Why healthcare management is a distinct field of expertise

What distinguishes the health sector from many other sectors is that managerial decisions usually have multiple consequences at once. A staffing decision is not merely a human-resources issue; it can also affect patient safety and continuity of care. A procurement decision is not only about cost; it can influence clinical quality and treatment capacity. Inefficiency in operating-room utilization does not simply generate revenue loss; it may also delay a patient’s access to treatment. Poor inventory management may create financial strain, while simultaneously causing life-saving medicines or materials to be unavailable when needed.

For this reason, the equation facing healthcare managers is multidimensional: patient safety, clinical quality, workforce capability, financial sustainability, efficiency, ethics, regulation, technology, and patient experience. Successful healthcare management does not mean maximizing one of these at the expense of the others; it means balancing all of them around a common institutional purpose.

Professional healthcare managers are not easy to develop

When health systems are discussed, physicians, nurses, technology, and physical infrastructure are usually at the forefront. Yet one of the critical human resources that holds the entire system together is the professional healthcare manager. Being appointed to a management role is not the same as being a professional healthcare manager. Education is an important foundation, but a diploma alone is not enough.

In its full sense, healthcare management develops through the gradual combination of academic knowledge, field experience, institutional memory, understanding of clinical processes, financial literacy, people management, crisis experience, regulatory knowledge, technology, and leadership capability. A hospital is not an organization that can be understood solely through theory. It is difficult to grasp this profession in its entirety without seeing how an emergency department functions at night, experiencing how delays in the operating room affect the whole institution, understanding what happens when no ICU bed is available, managing the clinical and financial impact of equipment failure, balancing the different expectations of physicians, nurses, technicians, and administrative staff, and taking responsibility during crises.

International professional frameworks also emphasize the wide competency range required in healthcare management. The International Hospital Federation’s 2023 Leadership Model, developed with input from 45 experts across 30 countries, does not reduce hospital leadership to a single managerial skill; rather, it places future readiness, people and culture management, systems thinking, and institutional resilience at the center [4]. Similarly, the American College of Healthcare Executives (ACHE) identifies communication, relationship management, leadership, professionalism, business skills, and knowledge of the healthcare environment as core competency domains [5].

The responsibility carried by a healthcare manager is different from that of many other managers

Poor management in a factory may result in production losses. Poor management in a commercial enterprise may produce financial losses. A wrong managerial decision in a healthcare institution, however, can affect not only finances and operations, but also human health and human life.

WHO patient-safety data underline the magnitude of this responsibility. According to WHO, approximately one in ten patients receiving health services is harmed in some way, and more than half of this harm is considered preventable. Unsafe care is associated with more than 3 million deaths each year [6].

These outcomes cannot be explained by physicians’ or nurses’ practices alone. Patient safety is also the result of correct staffing, medication management, infection control, quality systems, information technologies, communication, organizational culture, and managerial leadership. A systematic review examining the role of hospital managers in quality and patient safety showed that the active involvement of management in strategy, quality culture, the use of performance data, and participation in quality processes is highly relevant to clinical performance [7]. The manager’s desk therefore holds more than a budget; it also holds human life. This awareness is the core ethical responsibility of professional healthcare management.

A hospital is a team game

Another issue that deserves special emphasis in healthcare management is teamwork. No hospital can be managed through the success of a single individual. The best hospitals do not succeed because of strong stars alone, but because of strong systems and teams that can work together effectively.

Consider a patient’s journey through a healthcare institution. The patient first meets the registration officer. A nurse performs the initial assessment. A physician conducts the examination. Then laboratory services, radiology, anesthesia, the operating room, intensive care, pharmacy, blood bank, infection control, biomedical services, technical services, information systems, and many other units may become involved. In the background, procurement, finance, human resources, quality, patient services, and administration continue to work. In most cases, the patient receives the combined output of dozens of professionals.

For that reason, the quality of healthcare is not simply the sum of individual performances; it is determined by how harmoniously teams work with one another. One of the most important responsibilities of a professional healthcare manager is to make this team function well. However, it is not enough for the manager merely to “manage the team.” The manager must also be able to act as part of the team.

A healthcare manager must be able to listen to physicians, understand the realities of nurses on the ground, take the finance team’s sustainability concerns seriously, grasp the constraints of technical teams, recognize patient expectations, and understand the needs of academic structures. The manager must make decisions when necessary, listen when necessary, delegate authority when necessary, and assume responsibility when necessary. A good healthcare manager is not someone who stands above the team, but someone who enables the team to work properly.

Recent systematic evidence on leadership likewise indicates that leadership style is associated with teamwork, communication, organizational learning, and a culture of patient safety [8].

The world is already doing this

Healthcare management export is not a theoretical idea. Leading health institutions around the world have long been transferring their clinical expertise, operating models, educational know-how, and corporate governance experience across borders.

An important example is Cleveland Clinic Abu Dhabi. The institution is based on the partnership established in 2006 between Mubadala and Cleveland Clinic in the United States, with the aim of adapting Cleveland Clinic’s patient-centered clinical model and institutional approach within the local health system of Abu Dhabi [9]. What matters here is not copying an American hospital exactly into another geography; it is the adaptation of knowledge, organizational culture, the clinical model, and the management system to local needs.

Another strong example is Johns Hopkins Aramco Healthcare (JHAH). Johns Hopkins Medicine International states that this collaboration integrates Johns Hopkins’ clinical and management expertise with Saudi Aramco’s health system capacity in order to improve care quality, patient safety, education, and institutional performance [10]. More broadly, Johns Hopkins Medicine International reports more than 25 years of work in hospital planning, clinical program development, operations management, human resources, quality, accreditation, information technologies, and education across different countries [11].

In other words, the world no longer sees health export merely as “bring the patient and treat them.” It increasingly operates through the logic of “take the knowledge, build the system, train the people, and establish long-term partnerships.”Türkiye should translate the areas in which it is strong into the same strategic model.

Türkiye’s invisible capital: healthcare management experience

Over the last 20–25 years, Türkiye has gone through an intense transformation in health. Public hospitals were restructured. Private hospital groups expanded. University hospitals continued to provide advanced care. Large-scale city hospitals entered service. Health informatics became more widespread. Health tourism developed. Significant know-how accumulated in specialized clinical services.

In all these processes, Türkiye did not merely construct buildings or purchase equipment. It also trained a considerable number of healthcare managers, physician executives, nurse managers, quality professionals, biomedical specialists, health-finance professionals, health informatics experts, and hospital operators.

One of Türkiye’s real export potentials lies in this institutional memory and operational know-how. The need in another country is not always a new building. Sometimes it is the effective operation of an existing hospital, the reorganization of operating rooms, the training of human resources, the establishment of revenue-cost systems, the development of a quality and patient-safety culture, or the restructuring of a university hospital’s education, research, and service functions. These are precisely the fields in which Türkiye can export solutions.

The health workforce crisis creates a new field of cooperation

WHO notes that the global health workforce exceeds 70 million people, yet a shortage of around 11 million health workers is still projected by 2030, especially in low- and lower-middle-income countries [12]. This reality opens another strategic field: the export of workforce-development capacity.

Türkiye’s aim should not be to deepen workforce shortages in other countries by attracting away scarce qualified professionals. A more sustainable model is to strengthen local capacity through in-country education, joint specialty programs, nursing-development programs, manager-training tracks, simulation centers, distance education, tele-consultation, and joint clinical programs. In this sense, healthcare management export is also a form of capacity-building partnership.

University hospitals should stand at the center of the model

University hospitals hold a special place in this strategy because they simultaneously treat patients, train physicians, educate specialists, develop nurses and other health professionals, conduct research, implement new treatment methods, and shape the future workforce of the health system.

Contributing to the development of a strong university hospital in another country does not only improve that hospital’s current performance. It also influences the health capacity of that country over the next 20 or 30 years. Türkiye has a major opportunity to develop joint clinical programs, education models, specialty partnerships, research collaborations, telemedicine activities, management-development programs, and shared centers of excellence with universities in Turkic republics, Central Asia, the Balkans, Africa, and the Middle East.

No new model can be built without digital health and artificial intelligence

Healthcare management export should not be understood only as sending people or producing consulting reports. The modern health system has to be digital. Electronic health records, hospital information systems, clinical decision-support tools, patient portals, telehealth, data analytics, performance dashboards, artificial intelligence applications, and the digital patient journey are now core elements of contemporary hospital infrastructure.

For that reason, Türkiye’s healthcare operations experience must be integrated with its health-technology capacity within the same export model. The professional healthcare manager must also be able to transform technology from something merely purchased into a management instrument that improves clinical quality, efficiency, and the quality of decision-making. Hospital management that is not data-driven will become increasingly difficult to sustain in the future.

From health tourism to healthcare ecosystem export

In 2025, Türkiye reached approximately USD 3.022 billion in health tourism revenue [3]. The next step is to turn this economic value into a broader ecosystem. Imagine a hospital model supported by Türkiye in another country: management and clinical processes receive knowledge and consulting from Türkiye; physicians participate in joint education programs; the institution uses Turkish health technologies; medical-device and pharmaceutical companies enter the ecosystem; complex cases are referred or co-managed with reference centers in Türkiye when needed; and joint research and telemedicine services are conducted.

In such a model, we are no longer selling only a single health service; we are creating a sustainable healthcare ecosystem and a long-term institutional relationship. This is exactly where the economic multiplier emerges.

One of the most durable models of health diplomacy

Health is different from other economic sectors. Selling a product to another country establishes a commercial relationship; contributing to the development of that country’s health system creates a long-term relationship of trust that directly touches human life. Jointly trained physicians, educated nurses, established intensive care units, developed cancer centers, or strengthened university hospitals can elevate bilateral relations far beyond economic agreements.

For this reason, healthcare management export is not only an economic activity; it is also an instrument of health diplomacy. In countries where Türkiye has strong historical, cultural, and geographical ties, this model holds particularly high potential. Yet its foundation must not be dominance; it must be joint capacity building. Türkiye should go not to replace another country’s system, but to help that country manage its own health system more strongly and sustainably.

An integrated model for Türkiye

To realize this potential, Türkiye needs an integrated strategy rather than fragmented initiatives. Public institutions, universities, private hospital groups, professional healthcare managers, the pharmaceutical and medical-device industries, health technology companies, financial institutions, investors, and health tourism actors should be able to align within a common framework.

For example, a 500- or 1,000-bed university hospital project in another country should not be seen merely as “hospital management consulting.” The same project is also an education project, a technology project, a pharmaceutical project, a medical-device project, a research project, a health tourism project, a workforce-development project, and an investment project. If the right model is established, a single hospital can become a long-term health corridor between Türkiye and the partner country.

We should measure success with new indicators

Türkiye naturally measures its health-tourism success through patient numbers and revenue. These indicators should remain, but additional indicators should also be developed to measure the new strategy: In how many countries is a Turkish healthcare management model being applied? In how many foreign hospitals are Turkish healthcare managers taking operational or advisory roles? In how many countries do Turkish universities have clinical education partnerships? How many foreign health workers are we training? In how many countries are Turkish health technologies being used? How much do these projects contribute to Turkish pharmaceutical and medical-device exports? How many joint centers of excellence have we created? In how many countries have we contributed to the development of sustainable local health capacity?

One more indicator must be added: How many professional healthcare managers capable of working internationally are we developing? Because, in the end, the core capital of healthcare management export is still people.

Not buildings, but systems; not position, but leadership capacity

Technology will become more important in healthcare. Artificial intelligence will be used more widely. New hospitals and new devices will continue to emerge. Yet technology will not eliminate the need to manage health systems. On the contrary, as systems become more complex, the importance of professional management will increase.

The healthcare manager of the future will understand the clinical system, manage finance, use technology, interpret data, develop the workforce, protect patient safety, manage crises, and build strategy. All of this will be achieved not alone, but as part of a strong team. Because healthcare management is not a position; it is a responsibility.

If thousands of people enter a hospital every day, if hundreds or thousands of health professionals are working there, if large financial resources and advanced technologies are being managed, and if human life stands at the end of every decision, then the management of that organization cannot be left to chance.

One of the important assets Türkiye has built over the years is this experience. Now is the time to systematize that experience, develop professional healthcare managers, and turn it into a model that can be carried to the world.

Patients should continue to come to Türkiye. At the same time, Türkiye’s healthcare knowledge, technologies, universities, and professional healthcare managers should also reach the world. Türkiye should be positioned not only as a country that treats patients, but as a global actor capable of building health systems, training people, producing technology, and exporting healthcare management.

One of Türkiye’s next major areas of transformation in health will be the shift from health tourism to healthcare ecosystem export. At the center of this transformation will be well-trained professional healthcare managers who can assume responsibility, build teams, and at the same time know how to be team players.

Behlül Ünver

President, World Health Tourism Platform

References

1. World Health Organization. (2024). Global spending on health: Emerging from the pandemic. https://www.who.int/publications/i/item/9789240104495

2. OECD. (2025). Health at a Glance 2025 - Health expenditure by provider. https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en/full-report/health-expenditure-by-provider_e3cf1a7d.html

3. USHAŞ. Health Tourism Data (TÜİK-based 2019-2026 series). https://www.ushas.gov.tr/saglik-turizmi-verileri/

4. International Hospital Federation. (2023). IHF Leadership Model 2023. https://ihf-fih.org/what-we-do/ihf-leadership-model/

5. American College of Healthcare Executives. Healthcare Leadership Competencies. https://www.ache.org/about-ache/resources-and-links/healthcare-leadership-competencies

6. World Health Organization. (2023). Patient safety - Fact sheet. https://www.who.int/news-room/fact-sheets/detail/patient-safety

7. Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of hospital managers in quality and patient safety: a systematic review. BMJ Open, 4(9), e005055. https://pubmed.ncbi.nlm.nih.gov/25192876/

8. Althobaiti, F. M. (2026). The effects of leadership on patient safety culture in health care: a systematic review. BMC Nursing, 25, 125. https://pubmed.ncbi.nlm.nih.gov/41507881/

9. Cleveland Clinic Abu Dhabi. Who We Are / About Our Partners. https://www.clevelandclinicabudhabi.ae/en/about-us/who-we-are

10. Johns Hopkins Medicine International. Johns Hopkins Aramco Healthcare. https://www.hopkinsmedicine.org/international/health-care-consulting/emea/johns-hopkins-aramco-healthcare

11. Johns Hopkins Medicine International. Global Collaborative Health Care Consulting / Hospital Design and Development Support. https://www.hopkinsmedicine.org/international/health-care-consulting/

12. World Health Organization. Health workforce / Health workforce education and training. https://www.who.int/health-topics/health-workforce