Telehealth and remote diagnosis

November 2021

Indicative Return:

More than 25%

Investment Timeframe

Short Term (0–5 years)

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.

Regions

Central Anatolia Region, Eastern Anatolia Region, Southeastern Anatolia Region

Sector
Medical Technology > Health Care

Direct Impact SDGs:

Indirect Impact SDGs:

Sector
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

Subsector
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.

Market Size and Environment
Critical IOA Unit

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

More than 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
Limited access to internet and telecommunication services might limit scale in certain regions.

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 – Good Health and Well-Being

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

Current Level16.1% (13)

76.2% (13)

Target Level100% (13)

Secondary SDGs addressed

Directly impacted stakeholders

People
Patients, caregivers, healthcare professionals
Gender inequality and/or marginalization
Women, inmigrants or rural population with unequal access to medical services
Public sector
Governments, Public and Private Payers, Social Security Institutions

Indirectly impacted stakeholders

People
Telecommunications network employees
Corporates
intermediary booking organizations, telecommunications networks, internet service providers

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

B—Benefit Stakeholders

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.

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

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)