“My child’s arm was broken, they said that he needed to have a platinum in surgery, but there was no platinum in the hospital. Today is the 13th day, he still could not be operated on. We went to three different public hospitals and they all gave the same answer: No platinum.”
Nilüfer Aslan, who lives in Adana, says that her child, whose arm is broken and needs platinum, has been waiting for surgery for two weeks because there is no platinum in hospitals.
Nilüfer Aslan, explaining that she got the same answer from every hospital she went to, talks to medical device and material companies and tells that she tried to obtain the necessary platinum for her son, but was unsuccessful.
Due to the crisis in the supply of medical devices and supplies to hospitals in Turkey, it is reported that there are disruptions in health services in some cities.
It is stated that some companies serving in the medical device and material sector have 18 months of receivables from the public.
About two weeks ago, companies in the field of orthopedics, spine surgery and neurosurgery; announced that they cut off the supply of medical supplies to hospitals on the grounds that they could not collect their receivables from the public.
‘The industry is in a terrible state right now’
Yekta Yegen, General Coordinator of All Medical Device Manufacturers and Supplier Associations Federation (TÜMDEF), says, “All of the companies owe loans to banks but cannot pay because they cannot get their money from the public. They sell their houses, sell their cars… The industry is in a terrible state right now.”
After the medical equipment companies announced that they had cut off the supply to hospitals, Minister of Health Fahrettin Koca held a meeting with several associations in the sector on December 8 and announced that they would take steps to solve the problem.
Meeting with Minister Koca, Orthopedics and Spine Surgery Medical Equipment Manufacturers, Importers and Exporters Association (ORDER) President Adem Uyanık describes that meeting as follows:
“We know your troubles, we are aware of everything, we will pay 3 billion TL based on this,” the Minister of Health said at the meeting. We will do 1 billion liras of this through DMO, and the rest through public hospitals,” he said, and sent the order to pay this money as of Friday.
However, this payment order caused another crisis in the sector.
Many medical device and material companies filed a criminal complaint at the prosecutor’s office alleging that some companies were illegally included in the payment order issued by the Ministry, and submitted a petition demanding a stay of execution.
BBC TurkishYücel Denizhan, owner of Denizhan Medikal, spoke to .
“About 920 million TL was ordered to pay special attention to orthopedics, neurosurgery and some large global companies affiliated with certain associations participating in the meeting with the Minister.
“For the first time in history, companies’ tax numbers were written on an official payment order issued by the Ministry, and they issued a payment order saying, ‘Send this much money to these companies,’ which would create chaos in the industry.
“In that document, the tax numbers of global companies that should not receive any money were also included. In the meantime, they also issued payments to companies that did not deserve any money but had strong bilateral relations.”
In the official documents examined by BBC Turkish, it is seen that the tax numbers of the companies to be paid are stated.
The Ministry of Health, which we reached on the subject, did not make any evaluation.
‘Ministry of Health took a step back’
With the growth of the payment crisis in the sector, Kemal Yaz, the Chairman of TÜMDEF, announced that 600 million TL of the 920 million TL payment will be paid “to all sector companies sequentially” through the Uniform Accounting System (TDMS).
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Industry sources spoken by BBC Turkish argue that appeals to prosecutors’ offices and provincial health directorates were effective in this decision, and that the Ministry of Health “stepped back” by accepting the illegal payment order.
Then, sector representatives met with Minister of Health Fahrettin Koca on Tuesday, December 21, and during the meeting, Vedat Bilgin, Minister of Labor and Social Security, and Nureddin Nebati, Minister of Treasury and Finance, were connected remotely via conference method.
According to the statement made by TÜMDEF, as a result of the “very positive” meeting, all three ministers made a commitment regarding the payment to be made to the medical device and materials sector:
“They have clearly stated that payments will be made in December for the allocation of appropriations and the payment of accumulated receivables to the sector.”
According to the statement, sector receivables will start to be paid as of December 27 and the payment terms will be reduced to 90 days.
In addition, it was decided to establish a commission consisting of relevant ministries and sector representatives.
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‘Companies cancel their tenders with hospitals’
Ali İhsan Ökten, Member of the Central Council of the Turkish Medical Association, says that companies can only provide the materials necessary for emergency surgeries, and that many surgeries cannot be performed in hospitals for this reason.
Stating that there are disruptions in heart surgeries as well as orthopedic surgeries, Ökten states that there is a problem in the supply of medical supplies such as heart stents from abroad.
Nilüfer Aslan, who could not have her child operated on in state hospitals for 13 days due to lack of medical equipment, said, “If my child’s arm is seriously damaged during this period, who will be responsible for it?” he asks:
“In this process, I went to three different hospitals, but the result was the same in all of them. They said that he needed an operation as soon as possible, but they said that they could not do the surgery because there was no platinum in the hospital.
“If it takes any longer, my child’s arm will fuse wrongly. They said the only thing to do in this situation is to break the wrongly fused arm again and insert the sinker.”
‘This is not fair because we pay health insurance to the state every month’
Saying that she is a single mother living on alimony, Nilüfer Aslan says that her only chance is to have her child operated in a private hospital:
“The hospitals said they can’t do anything, they can only have an agreement with the medical professionals and if the materials come, they can take the surgery. I will seek my last right to health, which the state cannot offer, in private hospitals.
“I’ll either take out a loan or beg for money. But that’s not fair because we pay the government health insurance every month.”
Ökten, on the other hand, explains that companies that could not get paid either did not enter into new tenders or canceled old tenders with the hospital:
“Some company officials came to me at the hospital where I work today. They said that they canceled the old tenders and that they could not give more materials under these conditions.”
‘They didn’t think this illegal payment data would be leaked to us’
TÜMDEF has announced that 920 million TL appropriation is planned to be paid only to designated sector suppliers and related companies, among the appropriations sent in the list attached to the letter sent to the Provincial Health Directorates by the Strategy Development Directorate of the Ministry of Health.
In the statement of the federation on the subject, it was stated that “The allocation of special appropriations by separating a certain supply group, in an absolutely unlawful way, has been an act that disrupts public order and discriminates the sector.”
Speaking to BBC Turkish, Denizhan says, “They did not think that these payment data would be leaked to us. Some of our hospital treasurers, who love their country and are conscientious, leaked these documents to us in the middle of the night.”
Denizhan says that petitions have been submitted to provincial health directorates in every province of Turkey regarding the need to stop these payments allocated to certain companies as soon as possible, not to take any illegal action, and to make equal payments to everyone in the medical device sector.
Stating that after this initiative, provincial health directorates and hospital accountancy offices stopped making illegal payments to companies, Denizhan states that they will still use all their legal rights if a payment is made other than the procedures and principles stipulated in the legislation.
‘The industry is waiting for a solution’
TÜMDEF General Coordinator Yegen Yegen says, “The whole industry is waiting for a solution to be produced”:
“It turned out that the companies were ordered to pay according to their tax numbers. These, of course, are not kept secret. After all, the entire medical device industry has receivables, and it is not known how these priority companies were selected.”
So, what kind of crisis is the medical device and material industry in?
Turkey is a country highly dependent on foreign countries in the medical device and material industry.
The increase in the exchange rate adversely affects not only the importer companies of pharmaceuticals and materials, but also the manufacturers in Turkey of products whose raw materials depend on abroad.
Yegen says that in the past, medical device and material manufacturers used to buy the raw material of a product for 3 liras, but now they buy it for 10 liras.
‘One-sided price fixing brought the industry to the point of blockage’
On the other hand, the fees in the Communiqué on Health Practices (SUT), which determines the prices of medical supplies sold by companies to the public, have not been updated since 2011.
ORDER President Adem Uyanık says, “Despite such an increase in foreign exchange and cost, the costs of medical supplies have not been updated for 11 years. One-sided price determination has brought the industry to the point of blockage.”
TÜMDEF General Coordinator Yekta Yegen said, “In the SUT communiqué, it was 3 liras, but the market price was 13 liras. The company brings an imported product for 7-8 liras, how do you expect it to sell for 3 liras?” he asks.
Yegen says that all stakeholder ministries should come together and the prices in the SUT communiqué should be updated in line with the present.
On the other hand, Uyanık states that importers and manufacturers should have representatives in the price determination commission of SSI:
“Allocating 3 billion TL of appropriation was a temporary solution. The Minister said that our receivables from public hospitals will be structured within the next 5 months. We hope that a schedule will be made on the 25th, because there is no sustainable aspect of this business anymore, the supply chain has been broken.
It is stated that at the meeting attended by sector representatives and three ministers on 21 December, it was decided that SUT prices would also be updated.