Telehealth and remote diagnosis
Business Model Description
Providing remote diagnostic/telehealth services to increase access to healthcare services and reduce the pressure on hospital facilities
Expected Impact
Investments in telehealth models will improve access to healthcare services for the population as a whole and reduce the pressure on healthcare facilities, minimizing the risk of exposure for patients and healthcare workers during viral outbreaks.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Turkey: Eastern Anatolia Region
- Turkey: Southeastern Anatolia Region
- Turkey: Central Anatolia Region
Sector Classification
Health Care
Development need
According to the Sustainable Development Report Dashboard of 2020, significant challenges remain in Turkey's performance on SDG 3 (Good Health and Well-being). This situation is exacerbated by COVID-19
Policy priority
Pharmaceuticals and medical devices are listed as priority investment areas (11th Development Plan and the 2020 Presidential Program). The Ministry of Health 2019-2023 Strategic Plan highlights constraints such as the the inefficient use of information technologies, the limited scale of R&D, inequalities in regional health services and the underemployment of health personnel
Gender inequalities and marginalization issues
60% of healthcare workers in Turkey are women. (17) There is no official data providing a gender-based breakdown of the job categories in the healthcare sector. There are 1.83 doctors per 1000 people in Turkey (18), this is below the OECD average of 3.4.(19) There are currently 19.05 hospital beds per one million people in the country (18). Although the regional breakdown of these indicators are not provided, rural and remote areas have an unequal access to health facilities and personnel.
Investment opportunities
Wide-scale reforms and significant sectoral growth drive investments towards healthcare.The production of high-value added pharmaceuticals and medical devices are marked as priority investment areas by the country. Moreover, the presence of many clinics and hospitals under the internationally accredited Joint Commission International supports prospects for health tourism
Key bottlenecks
The lack of collaboration among scientists and industry & the shortage of opportunities to encourage the private sector to invest in basic research limit scale. Overall, health research and R&D infrastructure development is necessary
Medical Technology
Development need
This subsector was chosen in line with the inequality of access to healthcare services within and beyond Turkey. Regional differences in service delivery can be addressed through business models such as telehealth and health tourism.
Policy priority
Goal #6 listed in the Ministry of Health's 2019-2023 Strategic Plan calls for the contribution of the Turkish healthcare sector to global service delivery and national needs.In line with this, the report notes that health tourism and remote diagnostics are vital areas for service delivery
Gender inequalities and marginalization issues
60% of healthcare workers in Turkey are women. (17) There is no official data providing a gender-based breakdown of the job categories in the healthcare sector. There are 1.83 doctors per 1000 people in Turkey (18), this is below the OECD average of 3.4.(19) There are currently 19.05 hospital beds per one million people in the country (18). Although the regional breakdown of these indicators are not provided, rural and remote areas have an unequal access to health facilities and personnel.
Investment opportunities
Wide-scale reforms and significant sectoral growth drive investments towards healthcare.The production of high-value added pharmaceuticals and medical devices are marked as priority investment areas by the country. Moreover, the presence of many clinics and hospitals under the internationally accredited Joint Commission International supports prospects for health tourism
Key bottlenecks
The transportation and telecommunication infrastructure in certain regions might prevent access to remote diagnostics or health tourism services.
Pipeline Opportunity
Telehealth and remote diagnosis
Providing remote diagnostic/telehealth services to increase access to healthcare services and reduce the pressure on hospital facilities
Business Case
Market Size and Environment
> USD 1 billion
15% - 20%
The global telemedicine market size was estimated at USD 41.4 billion in 2019 and is expected to witness a CAGR of 15.1% during the forecast period. (10)
Indicative Return
> 25%
Cost-benefit analysis of telemedicine business models and previous acquisitions in similar markets point to an IRR range between 21-40% for this investment area. (11)(12)
Investment Timeframe
Short Term (0–5 years)
These investments are not capital-intensive and due to the increased needs emerging from the COVID-19 pandemic, are likely to generate cash-flows in the short-term
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Impact Case
Sustainable Development Need
Well-designed telehealth services will improve patient engagement and monitoring, access to health services and preventive care.
Telehealth will reduce the demand on crowded facilities, unnecessary admissions and readmissions can be reduced through remote consultations
The Covid-19 pandemic has demonstrated the importance of remote diagnostics and telehealth services in maintaining service quality and continuity despite the pressure on health facilities
Gender & Marginalisation
There are rural-urban disparities in the access to health services and personnel in Turkey
Expected Development Outcome
Improve access to healthcare services and reduce the pressure on healthcare facilities, minimize the risk of exposure for patients and healthcare workers during viral outbreaks (SDG 3)
Gender & Marginalisation
Increase access to medical services for female, inmigrants or rural population
Primary SDGs addressed
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.5.1 Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders
3.8.1 Coverage of essential health services
16.1% (13)
76.2% (13)
100% (13)
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Public sector
Indirectly impacted stakeholders
People
Corporates
Outcome Risks
Inaccurate and unclear reporting/diagnoses, the risks associated with maintaining personal health information in electronic form.
Remote diagnosis might cause reasoning errors, decrease the concept of trust between doctor and patient. (14)
Impact Risks
Execution Risk
Impact Classification
What
Important, positive outcome: access to healthcare services regardless of location and reduced pressure on healthcare facilities.
Who
Remote diagnostics service providers, healthcare institutions and the patients (especially in areas with limited health facilities) are expected to benefit from this investment area.
Risk
Medium Risk (Risks related to data privacy, technology related errors, misscommunication and the (in)accuracy of the remote diagnosis should be considered.)
Impact Thesis
Investments in telehealth models will improve access to healthcare services for the population as a whole and reduce the pressure on healthcare facilities, minimizing the risk of exposure for patients and healthcare workers during viral outbreaks.
Enabling Environment
Policy Environment
(2020 Presidential Programme): 2020 Presidential Programme records that despite the improvements in overall accessibility and resources, there are still regional discrepancies/inequalities in the distribution of healthcare infrastructure and personnel.
(2019-2023 Strategic Plan of the Ministry of Health): The 2019-2023 Strategic Plan of the Ministry of Health notes down telehealth/teleradiology and The Healthcare Information Network among its service-oriented projects and systems
(2019-2023 Strategic Plan): The 2019-2023 Strategic Plan deems developing digital applications for healthcare institutions and professionals to facilitate a more thorough understanding of their responsibilities in line with medical guidelines and rules as essential
Financial Environment
Financial incentives: The Ministry of Industry and Technology and The Development and Investment Bank of Turkey established "The Technology and Innovation Fund" under the Turkey Development Fund to finance innovative tech. based companies/projects with a budget of 350 million TRY.
Fiscal incentives: Companies geographically active or established in the Technology Development Zone will benefit from Institutions Tax Exemption (Kurumlar Vergisi İstisnası), Income Tax Exemption, Insurance Prime Support and VAT exemptions
Other incentives: TÜBİTAK-TEYDEB provide financial support to R&D and innovation activities on a project-by-project basis.
Regulatory Environment
(Regulation): The two bodies regulating this area are The Ministry of Health and the Directorate of Health Information Systems connected to the Ministry of Health
(Regulation): The protection of personal health data are subject to both national and international regulations (international): the WMA Declaration of Lisbon on the Rights of the Patient and WHO's Declaration on the Promotion of Patients' Rights in Europe (continued below)
Continued: Article 23 of the Patients' Rights Regulations, Article 9 of the Code of Professional Ethics in Medicine, Article 31 of the Code of Ethics of Physicials, Article 4 of the Rules of Medical Ethics 'Medical and dental surgeons, and 20th Article of the 1981 Constitution, entitled 'Privacy and the Protection of Private Life' (15)
(Regulation): Decision #663, Official Gazette #28103 sets out the responsibilities of the Directorate of Health Information Systems in governing e-health and health data/information systems.
(Regulation): The Personal Data Protection Authority in Turkey is responsible for the protection of personal data and raising public awareness about data privacy
Marketplace Participants
Private Sector
Telemedicine service providers such as Acıbadem University, Memorial Hospital, Medical Park, Yeditepe
Government
Ministry of Health, The Directorate of Health Information Systems, the Personal Data Protection Authority, the Social Security Institution
Multilaterals
The Development and Investment Bank of Turkey, commercial banks, MDBs such as EBRD
Non-Profit
TEMDEC- Telemedicine Development Center of Asia, Istanbul University (started the national Telemedicine Project in 2000), Continuing Medical Education and Research Center of Istanbul University (ISTEM), Turkish Association of Endoscopic Laparoscopic Surgery (ELCD)
Target Locations
Turkey: Eastern Anatolia Region
Turkey: Southeastern Anatolia Region
Turkey: Central Anatolia Region
References
- (1) SDG Index & Dashboard, 2020, https://dashboards.sdgindex.org/profiles/TUR/indicators
- (2) 11th Development Plan http://www.sbb.gov.tr/wp-content/uploads/2020/03/On_BirinciPLan_ingilizce_SonBaski.pdf
- (3) 2020 Annual Presidential Program, http://www.sbb.gov.tr/wp-content/uploads/2019/11/2020_Yili_Cumhurbaskanligi_Yillik_Programi.pdf
- (4) 2019-2023 Strategic Plan of the Ministry of Health, http://www.sp.gov.tr/upload/xSPStratejikPlan/files/Anobg+StratejikPlan2019-2023.pdf
- (5) Sustainable Development Goals Evaluation Report http://www.surdurulebilirkalkinma.gov.tr/wp-content/uploads/2020/03/Surdurulebilir-Kalkinma-Amaclari-Degerlendirme-Raporu_13_12_2019-WEB.pdf
- (6) Swiss Chamber of Commerce, 2015, https://www.tr-ch.org/wp-content/uploads/2015/06/Turkey-Pharmaceuticals2015DT.pdf
- (7) Bioizmir, http://bioizmir.deu.edu.tr/en/
- (8) PwC, "İlaç Sektörü Vizyon 2023 Raporu, https://www.pwc.com.tr/en/publications/industrial/pharma/pdf/ilac-sektoru-vizyon-2023-raporu-eng.pdf
- (9) Acı Badem Hospital, news on HERA's grant support, https://old.acibadem.edu.tr/haber/mobil-uygulama-heraya-kanadadan-destek
- (10) Grand View Research Telemedicine Industry Analysis, https://www.grandviewresearch.com/industry-analysis/telemedicine-industry
- (11) Kouskoukis and Botsaris, 2017. Cost-Benefit Analysis of Telemedicine Systems/Units in Greek Remote Areas. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691845/
- (12) Private Equity News, 2020. Idinvest sells German telemedicine start-up delivering 40% IRR. https://www.penews.com/articles/idinvest-sells-german-telemedicine-start-up-delivering-40-irr-20200724
- (13) SDG Tracker, 2020, https://sdg-tracker.org/
- (14) An Overview to Ethical Problems in Telemedicine Technology, Article 2013, https://www.sciencedirect.com/science/article/pii/S1877042813037609
- (15) Telehealth Legal Background, https://e-saglik.gov.tr/TR,7190/uap-ipu-yasal-dayanaklari.html
- (16) Ministry of Health, 2018. https://tr.euronews.com/2020/04/05/koronavirus-turkiye-de-hangi-bolgede-kisi-basina-kac-yogun-bakim-yatagi-dusuyor
- (17) Anatolian Agency, 2020. https://www.aa.com.tr/tr/sirkethaberleri/saglik/saglik-sektorunde-kadin-paneli/656192
- (18) Trading Economics: OECD Health Data, 2018. https://tradingeconomics.com/turkey/medical-doctors
- (19) OECD, 2017. https://www.oecd-ilibrary.org/docserver/health_glance-2017-52-en.pdf?expires=1615450933&id=id&accname=guest&checksum=75ABA90B65E377ACA91EBA3E9CEBA6B2
- (20) Turkis Statistical Services, 2021. https://cip.tuik.gov.tr/#