Health Tourism Regulatory Compliance

Under Article 4(1)(a), an intermediary is an undertaking operated by certificated legal persons (which rules out a sole trader holding the certificate) that advises the patient and companions and arranges the facility, accommodation, transport and transfers. Under Article 4(1)(e), a facility is one holding both a licence under its own legislation and a Ministry authorisation certificate. Two definitions, two authorities, two application files. Our companion note sets out the authorisation certificate procedure end to end, including refusal and revocation.

Two further rules shape corporate planning. Article 5(5) provides in a single sentence, with no qualification after it, that the certificate cannot be transferred, so an acquisition structured as an asset purchase does not carry the authorisation across. Article 5(4) requires a separate certificate for each additional intermediary office or branch opened by the same owning legal person, and bars health tourism activity in an office not authorised that way.

Sub-paragraph (ç) confirms that a facility may accept a patient who applies directly; there is no compulsory intermediation. Sub-paragraph (d) permits remote health services within the framework of the Regulation on the Provision of Remote Health Services of 10 February 2022 (No. 31746), announced through the Portal. Sub-paragraph (e) is the clause that most often needs contractual work: a facility may not procure, from persons or organisations without an authorisation certificate, services that are to be performed by an intermediary. That turns every referral arrangement into a due-diligence question.

Article 6(2) governs the intermediary. Accommodation, transport and transfer must go through travel agencies licensed under Law No. 1618, and the next sentence carries the exception that changes the structure of many groups: those services may be carried out by the intermediary itself where the intermediary is a licensed travel agency. The intermediary must also hold, or contract in, a call capability in at least two foreign languages, seven days a week and 24 hours a day, and its personnel may not work at more than two intermediaries at once. How those duties meet the facility’s own is the subject of our note on the legal position of health tourism intermediaries, including the allocation of responsibility by type of service under Article 6(3).

Inside the facility, Article 7 requires an international health tourism unit covering admission, registration, diagnosis, treatment, invoicing, discharge, interpreting and coordination with intermediaries; at least one staff member must have a foreign language, documented; staff details go to the health directorate through EKİP; and a named responsible officer is assigned to each patient and recorded on the Portal.

This is where the statute bites. Additional Article 11(3) of Law No. 3359 subjects a health institution that fails to keep the records determined by the Ministry, or to comply with a notification obligation, to an administrative fine expressed as a floor amount and, above it, a percentage of the previous month’s gross service revenue. Article 17(7) of the Misdemeanours Law No. 5326 increases administrative fines at the start of each calendar year by the revaluation rate, but its final sentence states that the rule does not apply to proportionate fines. Because these fines combine a fixed floor with a percentage of revenue, the figure to apply should be checked for the year concerned rather than read off the statute.

On price, Article 11 provides that the fee for a health service supplied within international health tourism is determined by the Ministry, and obliges the facility to comply with the procedures and principles in the Ministry’s health tourism tariff; the tariff in force at the time governs and should be checked directly. Article 12 requires a sales receipt or invoice with an annexed itemised breakdown and unit prices, plus certain documents free of charge on request: medicines and consumables charged to the patient, laboratory and imaging results (forensic originals excepted), and outside prescriptions; the intermediary must itemise accommodation, transport, transfer, interpreting and consultancy fees.

On promotion, Article 13(2) requires a website with a foreign-language option, requires the organisation name and titles on it to match the title and ownership name on the authorisation certificate, and requires the facility to publish its accreditation certificate or certificate there. The statutory ceiling sits in the paragraph added to Additional Article 11 of Law No. 3359 on 21 July 2025: a private health organisation may not engage in activity in the nature of advertising that exceeds the limits of promotion and information, and the permitted content is listed exhaustively: address and contact details, working days and hours, the specialty branches in which patients are accepted, the professional and academic titles of the health professionals employed, and health-protective and health-promoting information related to the field of service. Exceeding that, or acting misleadingly or deceptively, carries an administrative fine.

Article 6/1(c), the requirement that the facility take out complication insurance for surgical and interventional procedures performed in an operating theatre, carries no stay note, and the 31 December 2025 date that Provisional Article 1(2) set for that duty has passed.

A stay of execution is not an annulment, and the merits are decided separately. On attacking a regulation, Article 7(4) of Law No. 2577, the Administrative Procedure Law, runs the period from the day after publication, but the same paragraph continues that on the application of such an act those concerned may sue against the regulatory act, the applied act, or both, and that the regulatory act not having been annulled is no obstacle to annulling the act based on it.

The compulsory professional financial liability insurance for physicians is a separate matter and was not affected. Under Additional Article 12 of Law No. 1219, the Law on the Practice of Medicine, that cover is taken out by the private health institution for those working in it, half the premium is paid by the employer, and the following sentence bars deducting the employer’s half from the employee’s salary or other financial entitlements under any name or in any manner, and bars any contract clause providing for it. We set the two covers side by side in our note on complication insurance and physician liability insurance.

Note the limit that follows the escalation rule in Additional Article 11: where there is more than one health institution under the same name and ownership, the sanctions apply only to the institution at which the breach occurred. The same article separates the deciding authorities: governors impose the fines, the Ministry of Health orders the stoppage of activity.

The forum has to be identified first, because the routes differ. An annulment action against a refusal, suspension or revocation runs on the 60-day period in Article 7(1) of Law No. 2577, from the day after written notification under Article 7/2(a). A pre-action application to the superior authority under Article 11 stops the clock, and silence for thirty days counts as a refusal. The trap is in the third paragraph: when the period restarts, the time that ran before the application is counted in. It does not reset. Filing does not by itself suspend the decision (Article 27(1)), and a stay requires both irreparable harm and manifest unlawfulness (Article 27(2)). An administrative fine standing alone follows a different route under Law No. 5326 (fifteen days to the magistrate’s court in criminal matters), while Article 27(8) sends the unlawfulness arguments to the administrative court where administrative-law decisions were issued about the same person in the same act.

The Regulation does not itself name the forum for a decision taken by USHAŞ, which is constituted as a joint-stock company and issues and suspends intermediary certificates under Articles 5(1) and 16(2). Where an intermediary’s certificate is refused, suspended or revoked, that question is worth settling before a time limit runs.