Between opportunity and equity: navigating medical tourism in Türkiye's public hospitals

Medical tourism has been proposed as a potential means of using available capacity in public hospitals, generating additional revenue, and supporting healthcare investment. However, public-sector participation also raises concerns regarding organizational readiness, resource allocation, and equitable access for local patients. Türkiye, with its extensive healthcare infrastructure and cost advantages, has become an important medical tourism destination where both public and private hospitals provide services to international patients. This study explored institutional stakeholders' perspectives on the provision of medical tourism services in Türkiye's public hospitals.

This study addresses a research gap by providing empirical evidence on medical tourism in public hospitals, a topic that has received limited attention. Focusing on public institutions allows exploration of the tension between economic gains and healthcare equity. A qualitative study was conducted using semi-structured interviews with 13 institutional stakeholders, including Ministry of Health officials, academics, hospital administrators, and medical tourism coordinators. The data were analyzed using inductive qualitative content analysis.

Six interrelated codes were identified: healthcare service quality, access to care, the balance between international and local patients, organizational capacity, financial implications, and equity in service delivery. Participants perceived selected public hospitals, particularly large city hospitals, as having relevant infrastructural and clinical assets. However, readiness was described as heterogeneous and conditional on investment in international outreach, pre-arrival assessment and coordination, trained personnel, translation, travel and accommodation coordination, and post-treatment follow-up. Participants also emphasized risks related to workforce pressure, longer waiting times, preferential access, financial uncertainty, and the possible diversion of resources from local healthcare needs. The study did not establish whether the expected revenues would exceed the full financial and opportunity costs of these investments.

Stakeholders viewed selected public hospitals as possible settings for medical tourism, but physical infrastructure alone was not considered evidence of operational readiness. Public-sector involvement would require hospital-specific assessment of workforce capacity, financing, governance, local patient access, and equity implications. Given the uncertainty surrounding funding sources, net public benefit, and public acceptability, any expansion should be preceded by feasibility, budget-impact, and equity assessments and should initially be considered only in institutions with demonstrable excess capacity.