Reading the market correctly A person who travels abroad for care carries a need their own health system has not met: cost, waiting time or access to a particular specialty. A patient seeking rehabilitation at a thermal centre and a patient crossing a border for cancer care have different expectations, but both seek a solution away from home. The global map must therefore be read through people’s needs, the services they buy and how care continues after treatment. Market size depends on the definition used. The Business Research Company estimates the medical tourism market at US$91.98 billion for 2025 and US$109.34 billion for 2026. Its broad scope includes domestic travel and some wellness services, so these figures should not be described as revenue from cross-border hospital treatment alone. The Global Wellness Institute estimates thermal and mineral springs at US$71.7 billion in 2024, US$79.1 billion in 2025, US$87.9 billion in 2026 and US$106.2 billion in 2028. Its wellness tourism estimates are US$893.9 billion, US$978.7 billion, US$1,077.8 billion and US$1,280.6 billion, respectively. The 2025–2028 figures are projections. These categories have different scopes and must not be added together. The US$153.3 billion medical-tourism figure for 2028 is the author’s scenario, applying the report’s 18.4% annual growth assumption for two years to the 2026 estimate; it is not the report’s direct forecast. Growth looks different by destination South Korea recorded 1,170,467 foreign patients in 2024 and 2,011,822 in 2025, a 71.9% rise. Malaysia reported 1.59 million health visitors and RM2.72 billion in health-travel revenue for 2024, compared with preliminary 2025 figures of 1.84 million visitors (+15.7%) and RM3.34 billion (+22.8%). Malaysia’s 2025 figures were announced on 31 March 2026. These countries use different definitions, so the comparison shows change within each destination rather than a league table. Revenue growing faster than visitor numbers does not by itself prove that more complex treatment was provided; prices, procedure mix and per-patient spending also matter. Patients move for different reasons Health travel is not simply movement from wealthier countries to lower-cost ones. Patients may seek affordability, advanced expertise, access to a specific treatment or shorter waits. Dental care and oncology involve different choices: transport and total cost may weigh heavily in one case, while team experience, time to treatment and evidence may be decisive in another. Providers should state clearly which needs they can meet safely. Shared language, proximity, companion accommodation, repeat-trip costs and access to the care team after returning home all matter alongside the initial procedure price. Regional links remain important. In South Korea’s 2025 records, China accounted for 618,973 patients and Japan for 600,009, together about 61% of the total. Malaysia identifies Indonesia as one of its leading source markets. Thermal care, ageing and needs beyond hospitals The GWI’s 2028 estimate for thermal and mineral springs rose from US$97.6 billion in its earlier report to US$106.2 billion in 2025’s report. This is industry revenue, not necessarily international treatment travel. The value of thermal health depends on service quality: medically assessed rehabilitation, trained staff, accessible spaces and measurable outcomes. Calling every thermal stay a treatment distorts patient expectations and sector data. Holiday travel by an older person is different from travel for geriatric assessment or long-term care. WHO says that by 2030 one in six people worldwide will be aged 60 or older, reaching 1.4 billion; this is a planning signal, not a count of potential health-tourism customers. Mobility, post-operative rehabilitation, chronic-care support and independence require coordinated accommodation, nursing, medical, physiotherapy and social services. The 2026 outlook carries travel risks UN Tourism reported a 0.4% increase in international tourist arrivals worldwide in the first half of 2026 and lowered its full-year growth range to 1–2%. This is a general tourism indicator, not a health-tourism growth rate. Flight disruption, higher travel costs and changing security perceptions can also affect care journeys, especially when follow-up visits are needed. Providers need plans for continuing treatment if travel is interrupted. The US$109 billion medical-market estimate for 2026 remains a research projection and should later be compared using the same scope and method. What capacity should be built for 2028? The 2028 US$153 billion figure is a scenario, not a guarantee. Preparation should focus on three things: expertise in defined conditions and procedures, continuity between treatment, rehabilitation and care, and reliable records that connect applications, procedures and follow-up. Digital tools are useful when they deliver accurate information to the right team, reduce unnecessary repetition and support continuity; clinical judgement stays with health professionals. Unsubstantiated claims of “rejuvenation” or “guaranteed recovery” require scrutiny. Cross-border care does not reduce the need for evidence and oversight. Investments must also account for local residents’ access and healthcare workers’ workload. International capacity should be planned alongside domestic health needs so export revenue contributes to the wider system. The 2024–2025 figures show destinations growing at different speeds; 2026 reminds us that travel and economic conditions matter; and 2028 estimates offer a planning scale. A country’s place in the changing map will depend on which patient needs it can meet safely, with which team and with what results. The essential question is: Why should people come to us, and what health need can we reliably meet when they do? Sources and data note Data cutoff: 17 October 2026. Market figures are research estimates, not an official, consistently defined global health-tourism total. Scope and projection periods are retained. Sources: [1] The Business Research Company, Medical Tourism Market Report 2026 (September 2026). [2] Global Wellness Institute, Global Wellness Economy Monitor 2025, Figure 1.11. [3] Medical Korea/KHIDI, international patient statistics, 2024–2025. [4] Malaysia Healthcare Travel Council, 2025 performance announcement (21 April 2026), Bernama MREM. [5] Global Wellness Institute, Global Wellness Economy Monitor 2024. [6] WHO, “Ageing and health” (1 October 2025). [7] UN Tourism, World Tourism Barometer (September 2026).

The New Paradigm of Health Tourism – Part 13 Behlül Ünver – President, World Health Tourism Platform Türkiye has long aspired to be among the world’s leading health tourism countries. Strong hospitals, skilled physicians, advanced infrastructure, geography and tourism experience support that ambition. As health tourism grows, however, a more important question arises: how much does the economic value it creates strengthen Türkiye’s health system? Incoming patient numbers and revenue are no longer enough to measure success. What matters is how much returns to the system as new capacity, technology, workforce, education and investment. Public healthcare has a different responsibility A large majority of care in Türkiye is publicly provided. According to the Ministry of Health’s 2026 assessment, the private sector accounts for approximately 18 per cent. The public system therefore still carries the main service burden. Public hospitals cannot approach health tourism in exactly the same way as private providers. Their primary responsibility is to safeguard their own citizens’ access to care. The view that “we should treat our own patients first” cannot be dismissed as entirely unjustified. It is understandable when appointments, waiting times or overcrowding are problematic. But ending the discussion there would be incomplete. Properly planned health tourism can become a new resource that strengthens domestic care. The issue is the model, rather than unwillingness I do not believe the public sector is unwilling to participate. Physicians, health workers and managers show substantial motivation to serve international patients, extend specialised care and create value for the country. Daily workloads and public responsibilities mean different methods are needed. Private providers can operate flexibly through individual patient acquisition, digital marketing, intermediaries and international networks. Public institutions need not seek individual patients in the same way. A better approach is institutional models that plan patient groups, funding, treatment areas and capacity through intergovernmental and institutional agreements. For example, government-funded programmes can be developed with foreign health ministries, social security organisations or public funds. Agreements can cover patients funded by foundations and associations. Municipalities, public bodies, large employers and others can support specialised programmes. Public capacity in advanced surgery, oncology, transplantation, rehabilitation and similar fields can serve international patients through such arrangements. In the other direction, specialised operations, clinical training and expertise can be provided abroad. Public health tourism can thereby become an export model for services, education and knowledge. Why should major public hospitals remain outside the system? Türkiye has built substantial public infrastructure, particularly city hospitals. Some have significant capacity in advanced oncology, transplantation, cardiovascular and robotic surgery, neurosurgery, advanced imaging, intensive care, rehabilitation and other specialised treatments. They are also centres of education, research and expertise. I do not believe this capacity should remain entirely outside international healthcare. The objective is to turn planned capacity into economic and strategic value while protecting domestic patients’ rights and access. The new era has already begun Recent measures support more active public participation. The 2025 Regulation on International Health Tourism and Tourist Health places public institutions, universities, private providers and intermediaries within the same regulatory framework. In 2026, an agreement between the General Directorate of Public Hospitals and USHAŞ enabled public hospital health tourism processes to be conducted through intermediaries under USHAŞ coordination. The Regulation on Cooperation in International Healthcare Services published that year also enables more systematic cooperation between authorised facilities belonging to the Ministry of Health and state universities. These are important steps towards professional intermediary support and central coordination, rather than expecting public institutions to market independently. This model has long been needed. A new resource for public healthcare Healthcare represents substantial public expenditure. Through health tourism, some public capacity can also generate revenue. This can be reinvested in devices, infrastructure, staff training, research, technology, employee motivation and new capacity. Health tourism then becomes a financial mechanism that develops the system’s own capabilities. This is where its true public rationale should be sought. Revenue must recognise staff contributions A critical issue is how revenue is used and shared. Physicians, nurses, technicians, coordination teams and administrative staff undertake additional responsibilities when caring for international patients. Within the applicable legal framework, revenue should support institutional investment and the people providing care through a transparent, measurable and fair model. Recognising their work strengthens motivation, quality and institutional capacity together. The public sector’s advantage includes its skilled workforce. Fair value sharing must be a fundamental principle if these people are to participate willingly and sustainably. Domestic patients’ rights must be protected The boundary must be clear: international patients must not worsen domestic access to healthcare. Appointment and surgery waiting times, bed utilisation, access to specialised treatment, patients per physician and satisfaction can be monitored regularly. Dedicated capacity, time slots or organisational models can be created for international services. Health tourism can then produce new capacity, rather than make two groups compete for limited resources. Health tourism should generate new capacity. Public and private sectors can complement one another Growth is a shared responsibility. Private providers offer flexibility, marketing capabilities, rapid decisions and international patient experience. The public sector offers large infrastructure, specialised capacity, teaching hospitals, academic strength and extensive clinical experience. These should be complementary structures. Some patients may receive private care; complex cases may be assessed in public or university hospitals. Joint patient journeys can be created. Agreements can cover specialised care, training and second opinions. The strength of Türkiye’s brand will come from organising all this capacity effectively. Measure success beyond patient numbers International patient numbers and revenue matter. We should also ask how much new capacity was created, how much technology investment occurred, how many professionals received training, how many jobs were generated, which research and innovation projects were supported, and whether domestic care was affected positively or negatively. These questions should form part of assessing real success. We might call this “net health value”: measuring the lasting capacity created alongside income. Greater value alongside growth Türkiye should continue growing in health tourism, with both sectors participating. The objective should extend beyond attracting more foreign patients. We need a model that produces higher value, protects domestic care, creates capacity and supports investment in technology and people. Perhaps the question should become: “How does every international patient coming to Türkiye make its health system stronger?” Properly planned health tourism can help domestic patients access better hospitals, better technology and a stronger system. Perhaps it is time to see public healthcare’s role as a strategic structure delivering high-quality care, education and knowledge between countries and institutions, fairly recognising staff contributions and returning the value it creates to the health system.

The New Paradigm of Health Tourism – Part 10 Last week, we discussed why the same approach cannot serve every health tourism market. Countries and regions have different health systems, needs, cultures and patient behaviours. We argued for different strategies for the Turkic republics, the Middle East, Europe, America, Africa and the Balkans. We must now go a step further. Can we turn our relationships with these different markets into a sustainable international healthcare network, rather than a series of separate activities? I believe “global health corridors” will be an important concept for health tourism in the coming period. From patient corridors to health corridors Health tourism is currently assessed largely through patients travelling from one country to another for treatment. They arrive, receive treatment and return home. The future must be much broader. Patients will not be the only ones moving between countries. Knowledge, physicians, education, technology, capital, investment, healthcare services and expertise will also move. We should therefore understand a health corridor as an organised and sustainable value chain connecting countries’ health systems, alongside patient traffic. What is a health corridor? A health corridor can be understood as a structure connecting healthcare providers, universities, physicians, investors, technology companies, insurers and payment systems in different countries around shared standards and objectives. A patient abroad could receive a second opinion from Türkiye and travel there for treatment if needed. After returning home, follow-up could continue with a partner institution in their own country. Within the same system, that country’s physicians could train in Türkiye, while Turkish physicians could provide services or training there periodically. Joint clinics and centres of excellence could be established. Digital health and AI systems could connect institutions in both countries. Our work would then become a healthcare ecosystem. Why could Türkiye be a hub? Türkiye has important advantages for this model. We stand at the crossroads of Europe and Asia, within a few hours’ flight of the Balkans, the Caucasus, the Turkic republics, the Middle East and North Africa. We have strong aviation infrastructure, substantial tourism and accommodation capacity, a skilled healthcare workforce, modern hospitals and experience delivering care. Yet recognising our geographical strength is insufficient. The challenge is turning it into a strategic advantage in the health economy. Türkiye should aim to become a hub connecting different countries’ health systems, alongside attracting more patients from around the world. I believe this should be an important part of our new vision. Every corridor will need its own approach As we said last week, every market needs a different approach. We cannot therefore establish an identical health corridor with every country. With the Turkic republics, education, hospital management, academic cooperation, joint healthcare investment, pharmaceuticals and medical technology production could feature prominently alongside patient mobility. In the Middle East, advanced treatments, personalised services, family-centred patient experience, rehabilitation, longevity and healthy living programmes could form stronger areas. In Europe, second opinions, waiting-time management, rehabilitation, thermal health, healthy ageing, quality standards, insurance integration and follow-up could take priority. In Africa, corridors could centre on building healthcare capacity, education, hospital management, diagnostic infrastructure, telehealth and technology transfer, alongside patient mobility. In the Balkans, we can strengthen proximity through referral networks, shared training and institutional integration. America requires a different model because of distance. A more selective corridor could develop through second opinions, selected specialised treatments, digital patient navigation, physician and institutional networks, diaspora communities, employer programmes and payment models. There may be one Türkiye, but there cannot be one health corridor model. Establishing a corridor means more than signing an agreement. Agreements between countries are valuable, but do not create a corridor on their own. A genuine corridor must jointly design referral mechanisms, clinical quality standards, patient safety, data security and privacy, payment and financing, complication management, follow-up, education and workforce, digital infrastructure and performance indicators. Patients must know which institution they will attend. Referring institutions must know where and to what standard their patients will be treated. Treating institutions must know how follow-up will continue after the patient returns home. Financing must be determined from the outset. The system must be institutional and sustainable. Only then can we move from an agreement to a functioning system. From health diplomacy to the health economy We previously argued that health diplomacy builds trust between countries. Global health corridors could give that trust concrete form. Health diplomacy starts the relationship; cooperation develops it; corridors turn it into a sustainable system. Such a system brings patients to Türkiye while also carrying its healthcare knowledge, management experience, educational capacity, technology, pharmaceuticals and medical products to the world. We can then view health tourism within a much broader health economy, alongside service exports. A new perspective for HealthTürkiye I believe we must also consider HealthTürkiye’s future role more broadly. Alongside promoting Türkiye’s healthcare institutions worldwide, it could become a strong overarching structure representing trust, quality and coordination in international healthcare relationships. A system connecting the right institutions, international partners, quality standards and patient journeys could significantly strengthen Türkiye’s health tourism brand. Being connected will matter alongside being visible. The future will involve the movement of knowledge, technology, expertise, education, investment and trust across borders, as well as people. A new health economy will emerge. Türkiye has important advantages for this transformation. Yet hospitals, physicians and geography alone will not make us a hub. We must build measurable, trustworthy and sustainable systems that work between countries. Perhaps we should now ask: Will Türkiye be a country where the world’s patients come for treatment, or also a global health hub connecting different countries’ health systems? In my view, this is the central strategic question for the coming period. Türkiye’s new goal should be to build stronger healthcare networks alongside receiving more patients. The real strength in future health tourism will lie in connecting the world through health, as well as producing services.

The New Paradigm of Health Tourism – Part 11 University entrance results have been announced, and young people are making choices that will shape their futures. Medicine, dentistry, pharmacy, nursing and other healthcare fields remain among the most popular professions. This gives us an opportunity to ask a more fundamental question: What kind of workforce does Türkiye want to develop for the healthcare system of the future? Healthcare involves many professions working simultaneously, interdependently and towards a shared purpose. Hospitals are among the most complex organisations. Physicians, nurses, technicians, physiotherapists, dietitians, pharmacists, psychologists, biomedical specialists, engineers, IT teams, healthcare managers and many others belong to the same system. AI, robotic surgery, genomics, biotechnology, digital health, remote care and data analytics are also advancing rapidly. We cannot build the future simply by training more physicians. We must plan complementary health professions together, in the right numbers and with the right skills. Numbers or better planning? For years, Türkiye has debated physician numbers, physicians per population and OECD comparisons. These are important, but total physician numbers alone cannot explain a system’s real performance. We note that our physician density is below OECD averages, while annual consultations and consultations per physician are high. Taken together, these figures raise a question: Is the issue solely a shortage of physicians, or must we also rethink service organisation and the use of our workforce? Easy access to a physician is valuable. Yet measuring success solely by annual consultation frequency may be inadequate. What matters is whether patients receive care at the right level, physicians have sufficient time, unnecessary repeat visits are reduced, primary care is used effectively and other professionals’ skills are fully utilised. I consider recent steps and growing awareness in this area important. A physician seeing many patients in a day may appear highly productive. But if consultation time falls, assessment becomes superficial and patients quickly re-enter the system, a high consultation count cannot be regarded as success on its own. Perhaps we must discuss access with quality, alongside accessibility. Everyone should be able to fulfil their professional role Another aspect of workforce planning is the distribution of responsibilities. Professionals should work where their training enables them to create the greatest value. A physician’s principal contribution lies in clinical decisions, diagnosis, treatment and the patient relationship. Nurses, technicians, physiotherapists, pharmacists and other professionals have their own competencies. Poor allocation wastes capacity and increases staff workloads. The same applies to management. Healthcare institutions are too complex to be managed through clinical experience alone. Finance, human resources, quality, digital transformation, health technologies, investment, international relations, health tourism, operations and strategy each require expertise. Physicians’ participation in management and the clinical perspective in decision-making are valuable. We must also recognise healthcare management as a professional specialty in its own right. A physician’s core value lies beside the patient; a healthcare manager’s lies in ensuring that care is delivered through the right system. Higher education and the healthcare workforce must be planned together We discuss which universities and programmes young people should choose. As a country, we must ask which professions and skills Türkiye will need in ten years. How many physicians, and in which specialties? How many nurses, physiotherapists, technicians, managers, biomedical engineers and data scientists? Which new professions will emerge? These questions are being discussed and partly planned at various levels. Yet we must anticipate transformation now and build awareness. Qualified people from engineering, data science, IT, management and technology will need stronger roles in healthcare. Education planning must therefore extend beyond university admission quotas. The Ministry of Health and the Council of Higher Education, YÖK, should jointly plan the long-term workforce using population projections, ageing, disease burden, regional needs, technology, migration, health tourism and emerging professions. Opening more medical faculties or increasing quotas is insufficient on its own. Education quality, faculty capacity, practical training, teaching hospitals, specialty distribution and postgraduate employment must be assessed within the same system. The question is where professionals work, in which specialties, under which responsibilities and within what service model, as well as how many we have. Health tourism also depends on people Türkiye promises international patients quality, trust and strong clinical outcomes. Growth must not make domestic and international patients compete for the same limited workforce. The economic value generated should fund new capacity, technology, skilled professionals, education, research and infrastructure. Health tourism can then develop the system’s capacity. Our international vision should also recognise workforce development as more than meeting domestic needs. We recently discussed health corridors; movement of knowledge and education could be among their most valuable elements. Türkiye can train physicians and healthcare managers, develop clinical programmes, conduct joint research and export knowledge, alongside receiving patients. Treating one patient provides care to one person. Training a health professional can bring that knowledge to hundreds or thousands of patients over many years. Give young people a wider horizon as well as a profession Türkiye’s transformation in another field offers lessons. Aircraft engineering, space technology, software, defence technology and advanced engineering were once less visible career choices. Investment, institutional development, technology production and ambitious objectives created a new workforce and new role models, alongside products. Selçuk Bayraktar becoming a role model, Türkiye developing its own unmanned aircraft and communications satellite, and sending a person into space demonstrate an important point: When young people receive opportunities, objectives and an ecosystem in which to produce, a generation’s understanding of careers can change. They begin asking “What can I develop?” alongside “Which programme will help me find work?” Why should we not achieve the same transformation in healthcare? The future health professional will work beyond the clinic Türkiye’s young people can become physicians, dentists, nurses and healthcare managers. They can also develop AI diagnostic systems and robotic surgery technologies, establish biotechnology companies, create personalised medicine solutions, research medicines and vaccines, introduce models in genetics and genomics, design systems that interpret health data and develop wearable technologies used worldwide. Healthcare increasingly crosses traditional disciplinary boundaries. Medicine is intertwined with engineering, AI, genetics, biotechnology, data science, robotics and management science. Workforce planning must therefore address how many engineers, scientists, researchers, entrepreneurs and managers Türkiye needs to develop future health technologies, alongside medical students. A country that produces knowledge Türkiye has substantial healthcare experience and a rich historical heritage. Pride in the past alone cannot build the future. Recognising Ibn Sina’s place in this region’s scientific history is valuable. The greater question is: why should future figures of his stature not emerge here again? We now have stronger opportunities. We can access global knowledge and draw on the East’s historical and cultural heritage alongside the West’s scientific research and technology culture. We can combine these with Türkiye’s healthcare experience, engineering capabilities, universities and young population. Our goal should include producing healthcare knowledge, treatments and technology. Young people choosing university programmes need more than information about admission scores, earnings or job security. Perhaps we must offer them a broader horizon. Years ago, developing our own unmanned aircraft and communications satellite, or a Turkish citizen conducting scientific experiments in space, seemed distant goals to many young people. Today, these are realities. Why should we not write a similar story in healthcare? Why should Türkiye not develop healthcare technologies and treatment models used worldwide, alongside training physicians sought after around the world? Why should a new school of healthcare, bringing together the East’s centuries of knowledge and the West’s science and technology, not emerge from Türkiye? And why should the Ibn Sinas of the future not emerge from this region once again?

Shared opportunities in medical, thermal, wellness and senior tourism Behlül ÜNVER President of the World Health Tourism Platform 4 October 2026 Europe’s ageing population is giving healthcare cooperation between Türkiye and Germany a concrete agenda. How we sustain the treatment, rehabilitation and care services needed in later life will concern more families and institutions in the years ahead. By considering Türkiye’s healthcare services alongside its thermal resources, coastal living opportunities and accommodation infrastructure, we can develop joint solutions to meet these needs. According to Eurostat, 22% of the European Union’s population was aged 65 or over on 1 January 2025.[1] A projection published by Germany’s Federal Statistical Office in December 2025 forecasts that one in four people in Germany will be aged 67 or over in 2035.[2] Although the age thresholds differ, these two indicators illustrate Europe’s current position and Germany’s approaching retirement demographic. We should prepare our healthcare and care plans for this demographic change now. My proposal is to develop the Türkiye–Germany health tourism relationship within a framework of cooperation encompassing medical, thermal, wellness and senior tourism. Needs range from surgery or specialist treatment to spending several months of retirement in a healthy and safe environment. Jointly planning where, by whom and under which payment arrangements each appropriate service will be provided could create new opportunities for patients and for healthcare and tourism institutions. What longstanding ties can mean for healthcare The longstanding relationship between Türkiye and Germany, family ties and the business activity developed in both countries provide a strong starting point for this partnership. According to the German Federal Foreign Office’s 2025 assessment, approximately three million people of Turkish origin live in Germany.[3] Many families’ lives span both countries. Where to live in retirement, proximity to family and access to healthcare are becoming parts of the same decision. The Turkish community’s linguistic and cultural ties in Germany can make it easier to understand needs and design appropriate services. Partnerships built on this experience should also be open to other people living in Germany. Turkish and German healthcare institutions, universities, insurers and investors can address the needs of an ageing population together. Our existing ties could thus become projects that deliver regular services and allow their outcomes to be monitored. Considering medical, thermal, wellness and senior tourism together Medical tourism covers travel for diagnosis and treatment. Highly specialized procedures, planned surgery and certain rehabilitation services can fall within this field. To help a person living in Germany access appropriate care, a connection should be established between the pre-treatment assessment in Türkiye and follow-up in Germany. Travel should be planned according to the patient’s medical needs and preferences. In thermal tourism, resources and facilities across Türkiye offer a distinct area for cooperation. Thermal destinations such as Afyonkarahisar, Bursa and Denizli also feature in official tourism promotion.[4] Rehabilitation programmes based on a physician’s assessment, appropriate thermal treatments and accommodation can be designed together at these facilities. When developing joint programmes with healthcare institutions in Germany, the scientific basis, clinical suitability and payment coverage of the service should be clearly defined. Wellness tourism can bring together opportunities for movement, nutrition, rest and social participation that support everyday wellbeing. The natural environment, sea and seasonally mild climate of Türkiye’s Mediterranean and Aegean coasts offer opportunities for designing these programmes. We can consider extended coastal stays, accessible walking areas and social activities alongside a living arrangement close to healthcare services. The appeal of the natural environment should be complemented by services suited to each person’s age and needs. Senior tourism should also be considered through the living preferences of retirees and older people. An independently living retiree’s need for seasonal accommodation differs from the care needs of someone who requires assistance with daily life. Regular health checks, rehabilitation, support at home or residential care can be planned according to need. Voluntary participation, the person’s right to make decisions and communication with family should underpin these programmes. Areas for joint work in health tourism Service area Primary need Example of joint work Medical tourism Access to diagnosis and treatment Treatment in Türkiye linked to local assessment and follow-up Thermal tourism Appropriate thermal treatments and rehabilitation Facility and accommodation programmes designed with healthcare institutions Wellness tourism Wellbeing and active living Coastal stays supported by physical activity and social participation Senior tourism Seasonal living and support according to need Extended stays or assisted living with planned access to healthcare and care The table summarizes proposals for cooperation. Service and payment coverage must be defined separately for each programme. Making it easier for retirees to live in Türkiye Some Turkish citizens who have worked in Germany for many years wish to spend a greater part of the year in Türkiye or continue their retirement here. Concern about interruptions to healthcare and care services can make this choice more difficult. It is understandable that someone who does not know how the services available in Germany would continue in Türkiye might postpone their living plans, even with strong family ties and a connection to their homeland. A foundation for addressing this already exists. According to information from Türkiye’s Social Security Institution (SGK), people insured in countries covered by agreements can use contracted healthcare providers in Türkiye with the appropriate healthcare entitlement document and registration procedures. However, coverage can differ between temporary visits and permanent residence, and conditions depend on the person’s insurance status.[5] The use of German long-term care insurance abroad is also subject to rules separate from health insurance.[6] We therefore cannot assume that all healthcare and care services available in Germany can be obtained in Türkiye under the same coverage. An important area for joint work is to make existing entitlements easier to understand and use, while developing solutions for gaps in coverage. My proposal is for SGK, German health and long-term care insurers and service providers to work together to clarify access, service coverage and payment arrangements. Agreements and legal changes needed for broader coverage must be considered separately. The aim is to develop an arrangement through which services compatible with the healthcare and care coverage held in Germany can also be provided in Türkiye. Enabling retirees to choose to live in Türkiye while preserving their protections would be a valuable service for our citizens. Consider a person receiving follow-up care in Germany who wishes to spend the winter months of retirement in Türkiye. If regular medication supplies, check-ups and support at home when needed are planned in advance, a stay of several months can be considered with greater confidence. If daily care is needed, both the provider and its financing must be defined separately. In this example, the solution is to consider the person’s living preferences and healthcare and care needs within the same plan. Providing services jointly in both countries International healthcare already has structures that enable the relationship to begin before a patient travels and continue after their return. For example, a Türkiye-based healthcare group’s Berlin office serves as a local contact point for information, sharing reports, treatment planning and communication after the patient returns.[7] Such offices make it easier for patients to obtain information where they live. Medical services are delivered by authorized healthcare institutions and professionals. In the model we should develop, liaison offices in Germany, partner local healthcare institutions and, where appropriate, joint investments can all play a role. Assessment and follow-up that can be provided locally can continue in Germany, while travel can be planned for treatment, rehabilitation or extended-stay programmes appropriately provided in Türkiye. A person could thereby benefit from a service network across both countries without having to change countries for every service. Information sharing and responsibilities for care must be defined between institutions from the outset. Projects connecting hospitals, thermal facilities, accessible accommodation and care services can be developed in Türkiye, alongside local healthcare partnerships in Germany. Investment decisions should examine the target group’s actual needs, continuity of services and the payment model together. In addition to accommodation capacity, establishing working arrangements for healthcare and care teams will determine whether these projects are practicable. Joint solutions in the short and medium term In the short term, over the next one or two years, there are initiatives we can begin with existing institutions. These could include joint information for retirees about healthcare entitlements, local assessment and follow-up partnerships in Germany, and seasonal accommodation and thermal rehabilitation programmes in Türkiye with a limited number of participants. Each programme should assess healthcare and care needs, service coverage, costs and the person’s experience together. These initiatives can show which models are suitable for expansion. In the medium term, within a three-to-five-year framework, joint rehabilitation centres, assisted-living projects and payment agreements with insurers in appropriate service areas could be considered. A connected structure could provide assessment and follow-up in Germany and appropriate treatment or accommodation in Türkiye. Success depends on institutions operating within their respective authorizations and on older people having uninterrupted access to services. Human resources are also an important area for cooperation. Joint educational programmes, language training and exchanges of institutional experience can be developed in medicine, nursing, physiotherapy, geriatrics and care services. Teams from both countries receiving training together in communication with older people, assistance with daily living and care coordination could provide a concrete starting point. Türkiye’s expertise in healthcare management and service delivery can meet Germany’s experience in the relevant fields through educational and practical projects. Models that comply with professional authorization and qualification requirements should aim to strengthen service capacity in both countries. We can build our joint response to Europe’s ageing population around where people wish to live and the support they need there. Türkiye’s medical services, thermal resources and coastal living opportunities can be considered in projects connected to Germany’s healthcare and care system. Our longstanding ties provide a strong foundation for beginning this work. We should now turn that foundation into services that make a difference in retirees’ and families’ daily lives. Sources The sources were checked on 4 October 2026. [1] Eurostat. Population structure and ageing. Population data for 1 January 2025 and the February 2026 assessment. [2] Destatis. Population projection. The 16th coordinated population projection and the statement of 11 December 2025. [3] German Federal Foreign Office. Germany and Turkey: Bilateral relations. 5 March 2025. [4] Türkiye Tourism Promotion and Development Agency, GoTürkiye. Thermal Springs and Wellness Guide. Presentation of thermal destinations. [5] Social Security Institution (SGK). Yurtdışı. Healthcare entitlements for people insured abroad and retirees residing in Türkiye. [6] Germany’s federal legislation portal. SGB XI, Section 34. Current provisions on using long-term care insurance entitlements abroad. [7] Acıbadem International. Berlin, Germany. The institution’s explanation of the liaison office’s functions.

The New Paradigm of Health Tourism – Part 5 Last week, we discussed brand building in health tourism and argued that a true brand is built through trust, quality and sustainability, rather than advertising alone. Once we have established a strong brand, how do we stand out in international competition? By offering lower prices, or by producing greater value? This may be the most critical question facing health tourism today. For many years, Türkiye enjoyed an important price advantage in health tourism. Our strong healthcare infrastructure, skilled workforce and exchange-rate conditions enabled international patients to access quality services at affordable costs. In recent years, however, economic conditions have begun to change. The Turkish lira’s performance against foreign currencies, rising operating and personnel costs, and global inflation mean Türkiye is no longer seen as quite the “inexpensive country” it once was. In my view, this is an important opportunity for Türkiye to enter a new era in health tourism. We must now ask ourselves: Will we compete on price or on value? When health tourism competition is driven solely by price, the race has no end. There will always be another country, institution or provider able to offer a lower price. Price competition may bring patients in the short term, but places serious pressure on quality over the long term. Costs are cut. The workforce is affected. Investment in technology may be postponed. Patient experience may weaken. Most importantly, healthcare gradually begins to lose the value it deserves. Healthcare is not an ordinary commercial product. You can replace a car or upgrade a phone. Mistakes in healthcare, however, often cannot be undone. Sometimes, choosing not to perform a procedure is a far better decision than performing it incorrectly. A healthcare service must be provided for the right indication, by the right physician, at the right centre and using the right method. Success in healthcare is measured by correct outcomes, rather than the number of procedures performed. We can see this more clearly in certain fields today. Uncontrolled price competition affects the entire sector as well as individual institutions. Institutions gradually lose value, services become standardised, perceptions of quality weaken and inappropriate practices increase. International trust inevitably suffers. As trust declines, international patients begin to turn to alternative countries. Competition intended to win through price can therefore lead to market losses over the long term. This is one of the greatest risks in health tourism. Brand value is built over years, yet the wrong approach to competition can destroy it very quickly. International patients today ask more than the price. They also ask: “How experienced is the doctor?” “How are complications managed?” “Will you stay in contact with me after treatment?” “Can I trust this country?” All of these represent value. A patient purchases more than an operation. They purchase trust, experience, quality and an outcome. Perhaps we now need to move towards new services that generate greater added value, rather than trying to offer the same service more cheaply. Global health tourism today extends well beyond hair transplantation, cosmetic surgery and dental treatment. Preventive healthcare, personalised medicine, rehabilitation, wellness, longevity, sports medicine, digital health, genetic counselling and elderly care programmes form a much larger health economy before us. Türkiye’s knowledge, skilled workforce and geographical advantages give us the capacity to become a global hub in these areas as well. “We must now change both our approach to competition and our perspective on health tourism.” We should aim to become the country that creates the greatest value, rather than the one offering the cheapest service. Price competition may make you today’s winner. Competition on value can make you tomorrow’s leader. Türkiye’s true goal in health tourism is to become one of the world’s most trusted, highest-quality healthcare ecosystems, producing the greatest added value. The future of health tourism will be determined by the value created, rather than price lists. This is the approach on which the future of health tourism will be built. Perhaps the time has come to measure success through the value we create, rather than patient numbers alone. In our next article, we will consider what the recently published Regulation on Wellness Services means for Türkiye’s health tourism and the new opportunities it may offer our country.

The New Paradigm of Health Tourism – Part 12 30 August is one of the strongest symbols of this country’s determination to remain independent. Independence usually brings borders, defence and political sovereignty to mind. Today it also involves energy, food, technology and, in my view, an area requiring much more thought: healthcare. Last week, we argued that future health systems require people who produce knowledge, develop technology and bring different disciplines together, alongside more physicians and health workers. Let us take that thought further. A system’s true strength depends on its ability to produce the technology, medicines, medical devices, software and knowledge it uses, as well as on good hospitals and physicians. Dependence in healthcare is more than an economic issue A few minutes in a hospital reveal a vast technology ecosystem: MRI and CT systems, robotic surgery platforms, laboratory devices, intensive care equipment, implants, medicines, biotechnology products, AI software, patient information systems and genetic analysis technologies. Healthcare is deeply intertwined with advanced technology. Importing a large share of these technologies affects the system’s sustainability, resilience and strategic room for manoeuvre, as well as its import bill. The pandemic made this clear worldwide. Having money does not always guarantee access. Sometimes everyone needs the same product at once. At that point, production capacity becomes strategic power. Building hospitals is not enough Türkiye has developed substantial healthcare infrastructure, modern hospitals, skilled physicians, advanced treatments and service experience. We must now ask: How much of the technology inside these hospitals do we produce? Building hospitals alone does not create a health technology country. We must develop their equipment, produce software, analyse data, create AI algorithms, research medicines, develop biotechnology products and, when appropriate, export these systems. I believe our objective must expand from delivering services towards producing technology. Lessons from the defence industry Last week, we discussed how transformation in defence created a new generation, workforce and role models. An ecosystem emerged alongside products. Engineers were trained, companies established, universities engaged, young people became interested and entrepreneurship developed. Technologies once purchased abroad could now be developed in Türkiye. Healthcare needs a similar change in mindset. Why should a robotic surgery system used worldwide not originate in Türkiye? Why should Turkish engineers not develop next-generation imaging? Why should Türkiye not build global brands in AI diagnostics? Why should Turkish biotechnology, genomics and personalised medicine companies not play international roles? Why should new drug molecules, devices and digital health platforms not be developed here? The healthcare sector cannot achieve these objectives alone. Where physicians and engineers meet This may be the critical point for future technology. Physicians understand patients’ problems; engineers understand technology; data scientists interpret data; software developers digitise solutions; biologists and genetic specialists understand molecular mechanisms; managers turn these capabilities into sustainable models. Each is valuable. Real innovation emerges when they work together. Türkiye needs more such multidisciplinary structures in universities and healthcare institutions. Medical faculties should become centres developing products and technology with engineering, computer science, pharmacy, biotechnology, business and healthcare management, alongside training physicians. Universities must do more than award degrees We must reconsider universities’ roles. Success should also be assessed through patents, health technologies, research translated into products, new ventures, participation in international research networks and technologies made available to healthcare. Future universities will turn knowledge into products, technology and economic value, alongside transmitting it. Pharmaceuticals and biotechnology are strategic fields Medicines are a critical part of healthcare independence. Biotechnology medicines, vaccines, personalised therapies and advanced therapy products will account for a larger share of the health economy. Türkiye must expand research and development, molecule discovery, clinical research, biotechnology manufacturing and international regulatory capacity, beyond generic production and packaging. Real strength includes the ability to develop and produce a medicine when necessary, alongside access to it. Who owns the data? Health data is another strategic field. As AI develops, data generates knowledge, research, technology and economic value. Türkiye’s large health system serves millions and offers significant clinical data potential. Managed correctly, without compromising privacy or ethics, it could become a major advantage. If we merely help develop other countries’ technologies using our data, we will miss much of that opportunity. We must protect data while also producing knowledge and technology ourselves. The stakes are greater for health tourism Quality treatment alone may be insufficient for lasting global strength. Competition will increasingly ask: who develops better technology, offers personalised treatment, integrates AI most effectively, builds pharmaceutical and biotechnology capacity, manages data securely and prepares professionals for the future? Türkiye must compete through knowledge and technology alongside service advantages. International patients should be able to use Turkish health technology, software and domestically developed devices, and perhaps future Turkish-developed medicines, as well as receive care from Turkish physicians. That would take the economic value of health tourism to a different level. Healthcare independence does not mean closing ourselves to the world Science develops across borders. We will draw on knowledge from East and West, work with international universities, conduct joint research, cooperate with global companies and connect our scientists with centres worldwide. We should contribute knowledge and technology as well as acquire them. A service may generate value within one patient journey, while its technology can be exported to hundreds of hospitals and create much greater, sustainable value. We must arrive at the table with knowledge, technology and products. Perhaps true independence means developing our own productive capacity while remaining strongly integrated with the world. 30 August reminds us of the determination independence requires. Science and technology are new frontiers of that determination. We have seen what is possible in defence, taken our first steps in space and developed a new digital generation. Why not healthcare? Why should Türkiye not become a country producing healthcare knowledge, medicines, devices and technology, alongside a destination for treatment? Perhaps this is one way to carry the idea of independence embodied by 30 August into the future: A Türkiye that creates healthcare technology, as well as uses it.

The New Paradigm of Health Tourism – Part 9 Last week, we considered health diplomacy as one of health tourism’s most important, though invisible, strengths. We argued that it builds trust and a shared future between countries, alongside cooperation. This raises an important question: How do we establish these partnerships? Internationalisation in health tourism does not mean offering the same service, message and model to every country. Becoming global requires a sound understanding of local and regional differences. Every health tourism market needs its own approach. Countries differ in their health systems, incomes, demographics, disease profiles, insurance arrangements, cultures, access to care, waiting times, patient expectations and even healthcare purchasing behaviour. I therefore believe Türkiye must develop health tourism strategies for individual countries and regions. First the market, then the strategy One common mistake is developing a product first and then looking for a market. The right approach begins with market analysis. Which healthcare services are needed? Where do patients currently travel, and why? Which services face capacity gaps at home? What matters most: price, quality, waiting times, technology or trust? Who makes the decision: the patient, physician, insurer or intermediary? Without this knowledge, promotion may fail to produce sustainable results despite substantial spending. Offering every market the same product, message and pricing policy is an absence of strategy. The Turkic republics: A relationship beyond patients Viewing the Turkic republics solely as markets that send patients to Türkiye would mean losing a major opportunity. Shared history, culture, linguistic affinity and mutual trust provide the basis for much broader cooperation. Alongside patient mobility, opportunities include training health professionals, joint academic programmes, hospital management, new healthcare investments, rehabilitation centres, imaging and advanced diagnostics, digital health infrastructure, pharmaceuticals and medical technology. Our approach should therefore go beyond “Send your patients to Türkiye” towards “Let us develop our health systems together.” I believe this will create much more enduring partnerships. The Middle East: Trust, experience and high value The Middle East requires a different approach. The experience of patients and their families, privacy, language, cultural compatibility, personalised service and trust can be particularly influential. Türkiye can develop a strong offering in advanced surgery, oncology, organ transplantation, rehabilitation, health screening, aesthetic procedures, longevity and healthy living. Positioning Türkiye solely as an affordable healthcare destination would be inadequate. We may have a price advantage, but it should not be the foundation of our brand. High quality, trust and an exceptional patient experience offer a more sustainable position in this market. Europe: Value beyond price Our approach to Europe must differ again. European patients may place greater emphasis on quality standards, clinical outcomes, accreditation, data security, continuity of care and integration with their own health system. Waiting times, second opinions, selected specialised treatments, rehabilitation, dental care, thermal health, wellness and healthy ageing offer opportunities. Leading with “We are cheaper” could damage Türkiye’s healthcare brand over time. The right message is: “We offer the same or greater value through strong clinical infrastructure and a comprehensive service experience.” America: Build the right model first America deserves particular attention. The United States is one of the world’s largest and most complex healthcare economies, making a conventional health tourism approach unsuitable. Rather than focusing solely on individual patients, Türkiye could develop partnerships with healthcare providers, physician networks, insurance and payment mechanisms, employer health programmes, referral systems, diaspora communities, second-opinion services and digital health platforms. Distance also means we must select the right patient groups and treatment areas. Different models can be developed for complex surgery, second opinions, specialised treatments, advanced diagnostics, selected elective procedures, rehabilitation and healthy living. Health tourism should also encompass exporting Türkiye’s healthcare knowledge, physician expertise, hospital management experience and digital health solutions to America. Latin America requires its own assessment. Given the geographical distance, training, technology, digital health, academic cooperation and institutional partnerships in selected specialties may offer more realistic models than patient mobility alone. Africa: Build capacity alongside patient pathways Africa holds considerable potential for health tourism. Yet seeing it only as a source of patients is incomplete. In some countries, the more fundamental needs are access to care, trained professionals, diagnostic infrastructure and hospital management capacity. Türkiye can play a stronger role through physician and professional training, hospital operations, telehealth, laboratory and imaging infrastructure, healthcare investment and technology transfer, alongside receiving patients. We should engage Africa to build health capacity as well as attract patients. This approach strengthens health diplomacy and long-term economic relationships. The Balkans: Turn proximity into strategic advantage The Balkans offer Türkiye a different advantage. Geographic proximity, historical relationships, transport links and cultural connections can support faster and more sustainable patient mobility. They also offer opportunities for university cooperation, joint training, physician exchanges and referral systems between institutions. Proximity should mean bringing health ecosystems closer, as well as shorter flights. The real issue is determining the value proposition and partnership model with which we enter each market. One Türkiye, different approaches Türkiye has strong healthcare infrastructure, skilled physicians, quality hospitals, tourism and accommodation capacity, management experience and geographic advantages. We cannot use all these strengths in the same way in every market. We may reach one country through oncology, another through rehabilitation, another through healthcare education, another through hospital operations, and another through AI and digital health. Some countries may be patient markets; others investment, academic or technology partners. Some may combine several roles. This is where strategy begins. From agreements to outcomes Signing numerous agreements is not itself success. Cooperation requires measurable objectives, an implementation plan, responsible people, a financing model and sustainability. Otherwise, it cannot progress beyond signing ceremonies. The strongest countries in the future of health tourism will be those able to build the right healthcare networks with the right partners in the right markets. Last week, we said health diplomacy builds trust between countries. This week, we go a step further. Turning trust into economic and strategic value requires sound market analysis, the right approach, the right strategy and the right partnerships. Türkiye’s next objective should be to match its different strengths accurately with each country’s and region’s real needs. Perhaps this is the new formula for success in global health tourism: Understand every market, develop the right approach for each region, and learn to create together as well as compete.

The New Paradigm of Health Tourism – Part 17 Behlül Ünver – President, World Health Tourism Platform Global health tourism is growing. Definitions and methods vary, but international research organisations estimate the medical tourism market at approximately USD 34–38 billion in 2025 and forecast continued double-digit growth. Different estimates show that sector boundaries and measurement methods are not fully standardised. Türkiye is an important participant. According to TÜİK, it reached approximately 1.5 million health tourists and USD 3 billion in healthcare export revenue in 2024. The figures and ambitions are substantial. Yet we sometimes overlook a fundamental point: A major market share requires a substantial organisation. Patients do not arrive by themselves Strong hospitals, skilled physicians, competitive prices, aviation links and tourism infrastructure make the sector attractive. It is tempting to assume patients will naturally come. In practice, patients must learn about and trust the country, find the hospital and physician, understand treatment and price, decide to travel and often secure their family’s confidence. Their doctor, insurer, government or intermediary may also be involved. This requires a serious operation. Expectations must be balanced with the budget, team and time devoted to achieving them. Expectations and investment belong together We sometimes see high targets paired with limited marketing budgets, small teams, unclear markets, no local partners or sales network, inadequate digital infrastructure, unprepared physician communication, undeveloped treatment packages and inconsistent prices. Months later, the question is: “Why did patients not come?” We should ask how much we actually invested for the market share expected. As expectations rise, organisation, workforce and investment must grow too. Costs extend beyond advertising Google advertising, social media, fairs and websites matter, but represent only the visible part. Real costs include international teams, call centres, multilingual staff, local representatives, physician communication, digital marketing, CRM, intermediary relationships, insurance agreements, treatment packages, legal processes, secure records, interpretation, transfers, accommodation coordination, follow-up and sometimes complication management. Health tourism is a business model. Entering a country and acquiring patients are different Institutions target Germany, the United Kingdom, the United States, Iraq, Uzbekistan, Azerbaijan or Saudi Arabia, then send identical materials everywhere. Decision-makers vary: individual patients, insurers, state funds, physicians, diaspora communities or local agencies. Market entry requires understanding healthcare, payments, behaviour, competitors, prices, flights, regulation and trust relationships. This takes time and money. Health tourism is a team sport Physicians, nurses, coordinators, interpreters, finance, IT, legal staff, transfer teams, call centres, intermediaries and often a local contact all contribute. Putting the entire department on one person’s shoulders while setting million-dollar targets is unrealistic. Teams need a shared objective. If clinical information, sales promises, prices and representatives’ explanations conflict, problems begin before arrival. Speed also requires investment Patients may approach Türkiye, India, Germany, Spain, Thailand, South Korea and other destinations simultaneously. While one provider takes three days to review a file, another may respond within three hours. Competition includes speed. File transfer, clinical opinion, pricing, responses and answers must be organised through designed processes. Not every patient is profitable Revenue alone cannot demonstrate healthy growth without acquisition costs. We must know advertising, commission, transfer, interpretation and staffing costs, acquisition time, repeat visits, referrals and which treatment groups generate real economic contribution. Otherwise, high numbers may produce little profit. Acquisition cost should therefore be a key indicator alongside patient volume. Patience is part of investment Trust, recognition, physician relationships, insurance agreements and government cooperation take time. Satisfied patients referring others build a brand over years. A three-month campaign differs fundamentally from a five-year market strategy. The latter reflects a serious health tourism approach. Türkiye’s opportunity remains substantial Approximately USD 3 billion in 2024 healthcare exports is important, yet Türkiye’s infrastructure, workforce, tourism capacity and location suggest considerable room for growth. USHAŞ’s 2024 annual report expressed a USD 20 billion health tourism revenue target for 2028. That transition requires new markets and agreements, public and private institutions, universities, intermediaries, insurers, digital infrastructure, airlines and, above all, professional teams. Are we genuinely ready to invest what our desired share demands? Targets and budgets, expectations and effort, revenue and organisation are interdependent. Discussing large figures is easy; building the system that delivers them is harder. The decisive difference may be between those who see an opportunity and those who manage health tourism as a real business model.

The New Paradigm of Health Tourism – Part 8 In recent weeks, we have considered health tourism through trust, value, branding, artificial intelligence and wellness. Yet we have not discussed the often invisible but critical element that enables all these areas to succeed: health diplomacy. Health tourism grows through trust between countries, as well as through hospitals. What is health diplomacy? Diplomacy usually brings politics, embassies and international relations to mind. Today, however, health has become one of countries’ strongest diplomatic tools. When a country shares healthcare knowledge with another, provides training, develops joint projects, builds hospitals, educates health professionals or offers support during crises, it is also building trust. Health tourism and health diplomacy have different roles. Health tourism brings people to a country for treatment. Health diplomacy encourages countries to choose one another as partners. The former involves patients; the latter involves long-term strategic partnerships. These partnerships underpin sustainable success. Building trust. In health tourism, trust must be built with ministries, universities, hospitals, insurance systems, physicians, investors, local authorities and international organisations, as well as patients. Once established, it naturally supports patient flows. In our discussions across different countries, we found that lasting cooperation never emerged from the first meetings alone. Trust came first, followed by knowledge sharing and then joint projects. This is the essence of health diplomacy. Health diplomacy in a new era. Countries will increasingly become partners that train professionals together, establish joint hospitals, develop digital health systems, create AI solutions and set up research centres, alongside sending and receiving patients. This is the new meaning of health diplomacy. Health diplomacy extends beyond patient transfers. Many countries still view health tourism mainly in those terms. Genuine health diplomacy means establishing joint university programmes, training physicians, creating shared research centres, exchanging hospital management systems, developing digital health infrastructure, planning health investments together and showing solidarity in times of crisis. This is where diplomacy truly begins. Who conducts health diplomacy? Many people think only of foreign ministries. Yet health ministries, universities, hospitals, civil society organisations, professional associations, academics, healthcare managers and the private sector are all actors. Why does Türkiye have an advantage? Türkiye’s strengths extend beyond its hospitals. Its location, workforce, healthcare infrastructure, tourism experience, cultural affinity, historical ties with many countries and humanitarian approach constitute significant diplomatic power. Long-term healthcare partnerships, particularly with the Turkic states, the Balkans, the Middle East, Africa and neighbouring regions, can contribute substantially to economic, academic and social relationships, alongside health tourism. Health diplomacy is particularly strong where shared history, culture and mutual trust exist. From this perspective, the Turkic states, the Balkans, the Middle East and Africa are areas for long-term strategic partnership, as well as markets. Türkiye should become a country that exports healthcare knowledge, management, education and technology, alongside healthcare services. How should HealthTürkiye position itself? HealthTürkiye should carry a vision of health diplomacy that shares knowledge, delivers training, establishes quality standards, develops joint projects and builds trust, alongside promoting Türkiye to international patients. Strong brands add value to their ecosystem as well as promoting themselves. Perhaps countries’ true strength in the future will be measured by their contribution to humanity’s health, as well as the size of their economies. To the extent that Türkiye combines its healthcare infrastructure, skilled workforce and culture of international cooperation with health diplomacy, it can become an influential actor in global health policy as well as health tourism. Health diplomacy builds lasting trust and a shared future between countries. In my view, health diplomacy is the invisible backbone that sustains health tourism. Türkiye’s true leadership in global health may therefore depend on the trust it builds, the cooperation it develops and its vision of health diplomacy, alongside the healthcare it provides. In our next article, we will consider why international cooperation in health tourism has become a strategic necessity.

Last week, we discussed trust in health tourism and concluded with these words: “The winners in the future of health tourism will be countries where international patients can confidently say, ‘I trust this country,’ rather than simply those with the largest hospitals.” What, then, is the next step once trust has been established? The answer is clear: Building a brand. Yet building a brand in health tourism is often misunderstood. The word “brand” first brings to mind advertising campaigns, social media activity, trade fairs or promotional films. These are only its visible face. Advertising makes you visible; what protects your brand value is the service quality you deliver consistently over the years. A true brand means people choose you without hesitation, as well as recognising you. To become a brand in health tourism, you must first build trust. Promotion without trust may attract short-term interest, but cannot secure lasting success. We can see this particularly clearly in hair transplantation. Türkiye succeeded in becoming one of the world’s leading destinations in this field over many years. However, increasing competition, differences in quality and uncontrolled growth have made protecting that strong brand perception more important than ever. Our work in different countries over the years has shown me an important truth. Not every part of the world views a brand in the same way. In the United States, a brand is assessed through institutional strength, legal safeguards, academic achievement and a reputation built over many years. In Europe, it is built on quality standards, accreditation, scientific output, patient experience and transparency. In the Turkic states, the Middle East and many African countries, it gains strength through trust, relationship management, sincerity and keeping promises. There is no single model of brand building. Every region has different expectations. Success in health tourism therefore requires good healthcare and an accurate understanding of the target market’s culture, expectations and decision-making dynamics. One of Türkiye’s greatest advantages is its unique geographical position alongside its strong healthcare infrastructure. Like a diamond carefully set by a master jeweller, our country sits at the intersection of Europe, Asia and Africa, giving it a natural advantage as a health tourism hub. Yet good service alone is no longer sufficient in international competition. We must turn it into a strong national brand. A strong national brand supports strong institutions, which in turn support strong physician brands. It therefore directly enhances the brand value of healthcare providers. As the national brand grows stronger, so does the brand value of healthcare institutions. A true health tourism brand is created through successful treatment and the experience a patient has throughout the entire journey. Every point of contact is part of the brand: the first telephone call, the airport welcome, treatment, discharge and follow-up after the patient returns home. A brand is therefore not a logo. Nor is it an advertisement. Nor a slogan. A brand means fulfilling the promise completely, every time. Global health tourism is entering a new era in which competition on price is giving way to competition on value. The winners will be countries that offer the greatest trust, the strongest experience and the most sustainable quality, rather than simply the lowest price. This should be Türkiye’s objective. Building a health tourism brand means earning a lasting place in people’s minds and hearts, rather than merely increasing promotion. And we should remember: A brand is a building’s foundation, not its roof. No brand can stand for many years without a solid foundation. In our next article, we will consider whether competition in health tourism is really shaped by price or by value. The New Paradigm of Health Tourism – Part 4 Behlül Ünver President, World Health Tourism Platform

The New Paradigm of Health Tourism – Part 16 Behlül Ünver – President, World Health Tourism Platform Last week, we asked why patients choose Türkiye. We considered trust, first contact, digital reputation, family, insurance, the patient’s own physician and uncertainty after treatment, alongside prices, hospitals and doctors. Another often invisible but important actor is the intermediary. The familiar description “a company that finds patients” is no longer sufficient. International patients need more than a referral. They want the right institution, clinical assessment, an understandable plan and price, travel arrangements, communication in their language, support in Türkiye and continuity after returning home. Future intermediaries must manage the journey. Intermediation or patient navigation? “Intermediary” suggests a link between two points. The journey now includes dozens of contacts. Enquiry, records, referral to the right specialty, second opinion, explanation of options, pricing, travel, accommodation, interpretation, admission, tests, treatment, discharge, review, return home and follow-up all require coordination. Patient navigation may therefore become a more important concept. Patients are finding their way through an unfamiliar system; this is where good intermediaries’ responsibilities begin. The right patient must reach the right institution Appropriate matching differs fundamentally from choosing the highest commission. Hospitals and physicians have different competencies. A patient may need a university hospital, a specialist centre, a public hospital clinic or multidisciplinary assessment. Some may be treated at home without travelling. Trust begins here. True professionalism means showing patients the right option. Sometimes saying “You do not need to travel for this treatment” builds a stronger long-term relationship. Clinical and commercial decisions must remain distinct Intermediaries and hospitals conduct economic activity, but physicians must determine treatment and medical assessments must establish whether surgery is necessary. The intermediary’s role is to enable access to appropriate assessment. Unnecessary procedures, misdirection and unrealistic promises can damage trust far beyond one institution, reaching a country’s healthcare brand. First contact is already part of healthcare Patients often speak to an intermediary before a physician. Even the first WhatsApp message matters: tone, requested information, record protection, response time, clear answers and promises about care and prices signal the coming experience. International patient representatives need terminology, understanding of patient psychology and cultural differences, awareness of clinical boundaries, crisis escalation skills and communication competence. Sometimes a call-centre worker creates the first impression. Discuss responsibility alongside commission Commercial sustainability matters, but the central question should be which responsibilities an intermediary accepts. Does support end at the hospital door? Do records reach the correct institution? Is clinical information conveyed accurately? Are price and scope clear? Who manages complications? Does follow-up continue at home? Without answers, debating commission alone means little. A good intermediary can operate as an external extension of a hospital’s international patient department. Each market also needs its own intermediary model Family relationships and personal contact may matter more in the Middle East; insurance, data security, transparency and follow-up in Europe; institutional connections in the Turkic republics; government, fund or major organisational agreements in some African countries; and physician networks, employer programmes, digital second opinions and selected treatments in America. Success depends on understanding the market as well as reaching patients. A different model for public hospitals Public hospitals need not conduct individual marketing like private providers. Programmes with governments, social security organisations, health funds, foundations, associations, municipalities, major companies and international organisations may suit them better. Intermediaries can organise groups, document flows, travel, interpretation, coordination and post-treatment communication. Public providers can then maintain their core service organisation while benefiting from professional external coordination. Technology will also change intermediaries AI and digital health can support file classification, specialty matching, multilingual communication, follow-up, appointments, satisfaction analysis and identification of journey problems. We may soon see structures very different from conventional medical tourism agencies. Patient navigation platforms, international second-opinion networks, digital follow-up centres, insurance–hospital integration and AI-supported matching will make the difference between professional and unprofessional providers more visible. Patient data is entrusted to us Intermediaries handle passports, medical reports, images, diagnoses, laboratory results, genetic and financial information. Data security is everyone’s responsibility throughout the chain. A medical file cannot be treated as an ordinary sales document. Health information is entrusted to us. This understanding is essential to professionalisation. Winning a patient or building a country relationship? With trust, intermediaries can become connections between physicians, insurers, public institutions, employers and even countries’ health relationships. Referrals can develop into long-term cooperation, where commerce and health diplomacy meet. Alongside patient numbers, we should ask: How many patients reached the right centre? How many journeys were managed throughout? How many problems were resolved before harm occurred? How many patients received follow-up at home or recommended Türkiye? Above all: Did the patient feel recognised as a person entrusting their health to the institution? I believe this will distinguish future intermediaries. Finding patients may become easier. Earning trust will never be automatic.