Do city hospitals really increase bed capacity in Turkey

     Nowadays some roughly argue that although Turkey has been criticised for enormous cost of city hospitals on public finance, Covid-19 crisis has shown their important contribution to increasing bed capacity of the country.
     Yes, every support to the Covid19 fight should be appreciated. But, the contribution of city hospitals to the increment of the bed capacity in the country is quite limited.


     PPP programme
     The construction of these hospitals has been carried out by the well-known Public Private Partnership (PPP) approach. The PPP model enables the private sector to design, finance, construct and operate health facilities for 25 years, and supply certain medical support services such as laboratories and imaging in these facilities for 10 years.
     Forecasted bed capacity of PPPs in healthcare was 42 thousand in 30 hospitals. 19 hospitals with 30 thousand beds were entered into the contract in 2011-2014. Today, 10 hospitals with 13.5 thousand bed capacity are in operation, and ready to deliver health services.  Contracted 9 PPP hospitals are under construction for the time being, and expected to be taken into place in 2020-2021.
     While remaining city hospitals were expected to be tendered out through PPP approach, Ministry of Health surprisingly decided to terminate the hospital PPP programme without proposing detailed justification. Then, these city hospitals with 10.3 thousand beds were taken into the scope of 2020 Public Investment Programme. Consequently these hospitals would be built up through conventional public procurement/public finance approach instead of PPP method.
     Turkish PPP programme in healthcare has intended to expand hospital areas per bed from 30-80 m2 to 150-200 m2 (I’m not sure whether this should be an important priority for the delivery of health services). PPP hospitals also include qualified patient rooms which involve one or two beds with bathroom, toilet, television, refrigerator, and telephone and companion seat.
     On the other hand, PPP city hospitals have mostly been built on the outskirts of big cities, creating a transport problem for the patients. There is rarely public transportation network for (especially old and poor) patients to reach city hospitals.
     New beds? 
     However one should be very careful while appraising the benefit of city hospitals in terms of increasing the number of hospitals beds. Yes, they still modernize hospital rooms like five-star hotel rooms, but slightly increase total bed capacity, because they will largely replace existing public hospitals. Namely, before a city hospital is taken place, former state hospitals operated in the related region were closed.*
     Tables below indicate bed numbers in opened city hospitals and closed state hospitals in two cities, namely Ankara and Bursa. After Bilkent City hospital with 3810 bed capacity had come into service in Ankara, six state hospitals with 3415 beds were liquidated. The same thing has happened in Bursa. The City Hospital with1355 bed capacity has replaced three hospitals with 1074 beds. City hospitals in these two cities have created just 676 new beds (i.e. 15 percent of former bed number).
    Conclusion
    In these hard times, to be able to really raise hospital bed capacity, closed state hospitals should promptly be re-opened to serve against destructive  Covid-19 war.
     Additionally patients would regain state hospitals located in the city centre.

*For this replacement policy, see. interview with the then-Undersecretary of Ministry of Health, (in Tukish).