Medical case management differs according to the location in question and its peculiarities and subtleties. Different countries present distinct challenges and, on the other side of the coin, boast particular advantages from a medical care perspective. There may also be cultural nuances that need to be considered, along with varying quality of medical facilities and the complexities associated with different healthcare models. The Turkish healthcare sector can be considered complex owing to the variety of different plans and departments involved but, at the same time, is recognised as providing high-quality, affordable care. This is surely part of the reason why the country has seen an influx of patients from other countries, with the Istanbul International Health Tourism Association estimating that tourists arriving in Turkey for medical care rose from 75,000 in 2007 to more than one million in 2018. Here, Faruk Ertuğ, International Assistance Group Supervisory Board Member and General Manager of IAG Core Partner Remed Assistance, and Ece Acar Demirkök, Sales Manager for Marm Assistance, share their knowledge on the idiosyncrasies of medical case management in Turkey.
Proactively managing medical cases
According to Ertuğ, a key element to proactively managing medical cases in Turkey is ensuring there is a good fit between the assistance company’s insured customer (the patient) and the health institution (the hospital or medical centre). He also said that it is crucial that customers are given all of the information they need on where to access help and who to contact in the case of a health problem or emergency, which is not always easy, as he explains: “This can be challenging in the Western European market as insured customers often do not contact their local assistance company before attending a health institution. A lack of local knowledge can prevent them from reaching the most suitable facility for their problem or need and may also result in the loss of valuable time to reach and receive the proper treatment they require.” Demirkök also believes it is imperative that assistance companies’ knowledge remains current and highlighted that this is an ongoing process, as an ever-evolving landscape means the need for ongoing education. She said that in addition to local know how, local presence is also important. “Health regulations change frequently and close monitoring of regulations and legislation in the health system need to be followed up regularly to ensure proactive assistance,” she told ITIJ. Essentially, assistance providers have a duty of care to ensure they are up to date in their knowledge and can, in turn, impart this knowledge to their customers. Assistance companies can also play a role in cost control which, of course, can significantly benefit customers, said Ertuğ: “By applying to the institution by themselves, patients can face higher costs. When assistance companies proactively manage cases on behalf of their patients, they can obtain more effective cost control measures through their referral chain.” A problem here, again, is that customers might not necessarily be in control of selecting a medical facility, as Ertuğ explains: “While we support the view that customers have freedom to select their own health institution, the reality is that customers rarely make this choice themselves. In practice, almost all travellers are referred by other sources – such as by their tour operator and guide, their hotel reception or hotel reception or even by the taxi driver who takes the customer to hospital.”
Challenges and advantages of Turkish healthcare
Sharing his thoughts on challenges associated with medical case management in Turkey, Ertuğ said that economic fluctuations and the knock-on effects on prices can pose difficulties for payers. For example, UK newspaper The Guardian reported recently that inflation in Turkey is approaching 80 per cent which, naturally, will impact the healthcare sector.
Reflecting on challenging cases, Ertuğ noted that the most difficult tend to be exacerbations of acute chronic illness experienced by elderly customers, which can lead to a situation that moves from bad to worse when expatriate citizens choose to receive medical treatment in their home country. “These can cause long hospitalisations and related follow-ups. Problems can arise when our expatriate citizens choose to receive medical treatment for their chronic problems during their travels to their home country. If their health policies do not cover the treatments, the management of the dispute processes between the insured’s assistance company and the health institution may be difficult,” he told ITIJ.
On the other side of the coin, there are also positive elements associated with the country’s unique medical case management landscape. For example, improvements to infrastructure and quality have led to enhanced medical case management capabilties, as Ertuğ articulates: “The development of technical infrastructure and the quality of health institutions both in the public and private sectors in the last 30 years, and the increase in the number of well-equipped health institutions that can treat severe cases in tourism regions, has led to improvements in the management of medical assistance cases.” Ertuğ also noted that improvements in hygiene measures have reaped significant benefits: “In the last 10 to 15 years, more attention has been given to hygiene measures and controls in hotels and food preparation stages. This has resulted in a decrease in the frequency of the most common tourist gastrointestinal diseases,” he told ITIJ.
Demirkök highlighted the multicultural nature of Turkey’s landscape and status as a popular tourist destination and described how this brings about benefits to medical case management: “Turkey is a touristic country which allows all medical assistance parties such as hospitals, hotels, etc to welcome different cultures easily. The hospitals have multilingual staff especially in major cities and touristic places.”
The key to successful outcomes
Ertuğ and Demirkök agree that a local partner is key to successful outcomes for assistance companies. “‘Think global, act local’ may well be the motto of globalisation and applies here,” Ertuğ told ITIJ. “Experienced and well managed local assistance companies create crucial benefits for international assistance companies, as each country has its own culture and healthcare regulations.” He specified the key benefits local partners can provide to international assistance companies:
- The supervision of service providers
- Caring for patient rights
- Taking necessary actions against unwanted situations quickly
- Choosing the right health institution and treatment plan for the patient’s health problem.
In addition, in some cases, the developing health problem cannot be treated in the admitted institution and if necessary, referral to the right treatment institution can be achieved with the best local assistance.” In summary, Ertuğ stated: “Right institution – right treatment – right price. Local assistance support is a sine qua non.”
Demirkök confirmed the essential nature and value of local knowledge, stating: “The local partners are the extended arms of the insurers and assistance companies. Their experience in the field, knowledge in healthcare, and ability to speak the same language, are very important while handling a case.”
Awareness of cultural nuances
Cultural traditions, practices and communication methods will undoubtedly have an impact on medical case management. This applies to any country, but might be particularly pertinent given Turkey’s multicultural nature. Ertuğ articulated the multifaceted importance of understanding and respecting a country’s cultural norms: “While culture is highly applicable to a broad range of issues both within and outside the health sector, health is fundamentally influenced by the cultural contexts,” he told ITIJ. “For this reason, international assistance companies must seek not only to understand the values they attribute to others, but also the daily practices and processes of healthcare institutions.” Ertuğ went on to delve into the subtleties here: “Culture precisely concerns more than what we acknowledge explicitly, recognising it involves the difficult work of scrutinising assumptions, questioning perceived truths and appreciating how shared group values can sharply diverge: for better, when difference helps us creatively to adjust our assumptions; and for worse, when difference leads to misunderstanding and conflict.” Demirkök also recognises the overarching need for cultural awareness: “Like in every other country, there are legal and governmental differences to healthcare systems, pricing, data protection rules, etc. to be considered,” she confirmed.
From the perspective of Turkish hospitals
Looking at what Turkish hospitals might see as the most important ways that international assistance companies can work more effectively to manage medical cases in Turkey, Ertuğ pointed out that the evolution in standards of quality of care will inevitably factor into relationships between hospitals and assistance providers. “Turkey’s healthcare system has undergone significant change since the launch of Turkey’s Health Transformation Program in 2003,” he told ITIJ. “Since then, Turkish health institutions focus on maintaining a certain level of service quality, improved patient experience and cost control. These standards also shape their relationship with assistance companies.”
Highlighting the importance of communication, international assistance companies should ensure a way to establish healthy communication between hospitals and patients while explaining medical indications and procedures. “While most private hospitals make agreements with international assistance companies and insurers, they always prefer to work with reliable, professional and local assistance companies with certain standard procedures in place to ensure that the transactions are smooth and controlled,” Ertuğ told ITIJ. “Health institutions report that they feel more financially secure this way. In addition, they state that assistance companies are very useful both as an independent eye and in terms of establishing healthy communication (in the context of explaining medical indications, overcoming the language barrier among all parties and ensuring that medical transactions and payment processes are smooth and controlled).”
Discussing the role of the international assistance provider in the eyes of the hospital, Demirkök said: “Almost all private hospitals, especially in the Riviera region, have international patient departments which cooperate with assistance companies for insurance procedures. Government hospitals or some private hospitals in non-touristic small cities have agreements with local assistance companies like Marm. On time guarantee of payment checks and approvals are expected from international assistance companies.”
Duty to the patient
In Turkey and beyond, assistance companies have a responsibility to ensure customers have all the information they require to make the best decisions and advocate for themselves. As such, it is important for them to remain up to date on constantly evolving trends and knowledge to be able to present customers with the most salient and useful information possible. This is a cornerstone to providing effective assistance. Assistance companies in Turkey also represent an important bridge in ensuring good communication between medical facilities and patients; for example, in the context of hospitals explaining complex concepts to patients. It is also possible for international assistance companies to help with cost control, resulting in lower costs for customers. As a multicultural country, Turkey is well versed in receiving and interacting with different cultures and this facilitates medical case management, with the indispensable presence of multilingual professionals. In order to further enhance assistance services and ensure successful outcomes, a local partner is key. This sets an invaluable foundation of an accurate awareness of culturally important factors and healthcare regulations that are particular to Turkey and provides important benefits such as helping to quickly resolve situations and advocating for patient rights. Another important factor is for the assistance company to ensure compatibility between the patient and the healthcare facility to make the process as smooth as possible. Ultimately, assistance providers are key to establishing and maintaining smooth relationships between medical assistance stakeholders, while remaining aware of the nuances of Turkey’s healthcare system in order to deliver the best outcomes possible.