Health Tourism in Kayseri & the Region IBM Corporate Service Corps Turkey Team 6

Health Tourism in Kayseri & the RegionIBM Corporate Service CorpsTurkey Team 6

Table of Contents • Project Objectives • Executive Summary • Approach – consulting methodology • Findings and action plan for the development of health tourism sector in Kayseri and the region • What is health tourism? • Global consumer behavior and market trends in health tourism • Findings and Hypothesis • Recommendations • Action Plan • Communications and Marketing Strategy for Promotion of Kayseri Tourism • Web Portal • Questions & Answers

Project Objectives Findings and action plan for the development of health tourism sector in Kayseri and the region: Planning for the Development of Health Tourism in Kayseri and the Region which is under the responsibility of ORAN Development Agency Creation of an Action Plan for the Health Tourism Development Strategy to be implemented by the ORAN Development Agency and other stakeholders Communications and Marketing Strategy for Promotion of Kayseri Tourism High level framework for health tourism web portal 2019년 12월 20일 3

Caveats This study does not include: • Analysis on international insurance and legal aspects, due to lack of data, and • Health records management, identified as a challenge during hospital interviews, as it was out of scope of this project’s objective.

Team Introduction Veena Pureswaran from USA Engineering Manager Maxine Watts from Australia Security & Privacy Consultant Monica Tatiana Torres Diaz from Colombia LA Pricing Process & Control Shingo Kato from Japan Software Technical Sales Tadashi Suzuki from Japan IT Architect Changwoo Jung from Korea Solution Architect

Executive Summary Why Health Tourism? Key Recommendations • All studies forecast strong growth through 2015 and beyond for Health tourism industry • Increased demand for healthcare services from countries with aging population • Increasing Medical Tourists to Turkey • Kayseri has significantly invested in healthcare sector • Kayseri has advantages to attract Cappadocia tourists for elective treatments • Establish Kayseri Health Tourism Council (KHTC) • Obtain JCI accreditation and international affiliation • Improve awareness of Kayseri’s medical treatment areas • Focus on Internal Marketing & Buzz Marketing • Create a Kayseri Health Tourism Portal • Continue to keep cost of treatment competitive • Invest in hiring specialized doctors • Offer customized packages for international patients • Develop multi-lingual environment in Kayseri • Invest in elective treatment facilities • Improve connectivity of Kayseri with more direct flights to target regions • Invest in hotel infrastructure • Invest in international food, entertainment, shopping options Key Findings • Kayseri has well funded hospitals but lacks clear ownership and a strategic plan for development of health tourism industry • Kayseri has advantages (cost and specialized doctors) in some areas of medical treatments but lacks specialization in some areas • Kayseri lacks infrastructure (hotels, direct flights, multilingual staff etc) to support international patients effectively • Kayseri lacks awareness of its health services in the target regions 6 6

People we interviewed April, 4th - Secretary General of the Kayseri Chamber of Commerce April, 7th - Mr. Kemal Tekden, the owner of Tekden hospital April, 7th - Mr. Memduh Keskinkılıç, the owner of Alto Tour, a prominent tour operator in Kayseri April, 8th - Kayseri branch of Acıbadem Hospitals April, 9th – Mr. MUAMMER SAK, ARGEUS TURİZM, HEAD OF CAPPADOCIA AREA / TURSAB (ASSOCIATION OF TURKISH TRAVEL AGENCIES) April, 12th - Private dental health clinic called Modern Diş. April, 13th - Maya Eye Hospital in Central Kayseri and met with the Hospital Manager April, 19th - Mr. Mevlut Bilici, Kayseri Province Governor

Table of Contents • Project Objectives • Executive Summary • Approach – consulting methodology • Findings and action plan for the development of health tourism sector in Kayseri and the region • What is health tourism? • Global consumer behavior and market trends in health tourism • Findings and Hypothesis • Recommendations • Action Plan • Communications and Marketing Strategy for Promotion of Kayseri Tourism • Web Portal • Questions & Answers 2019년 12월 20일 8

Approach – Issuebased consulting • Issue based consulting is a particular consulting technique used for solving problems, and consists of 5 stages: • In the Definition stage the consultant helps the client: • Clarify the symptoms causing dissonance; • Define the client’s objective; • Define the barriers that keep the objective from being realized; • Articulate a “vision” for what a satisfying solution might be; • Help scope what that envisioned solution might entail • In the Structure stage, the detailed work plan is developed and the initial storyboard is drafted. This stage involves a focused review of the engagement issues, the development of hypotheses about those issues, and the creation of key questions to test the hypotheses. • In the Data Gathering stage, the consultant determines: • Whatdata are needed and why, • When to keep collecting and when to stop, and • How to extract the data’s important messages for the client. • In the Synthesis stage, the final deliverable is produced and presented. Facts, findings, conclusions, and recommendations can be used to verify the accuracy and efficacy of a compelling story OBJECTIVE Definition Stage ISSUE Structure Stage HYPOTHESIS Data Gathering Stage FACT FINDING Synthesis Stage CONCLUSION Engagement Objective Engagement Objective RECOMMENDATION Recommendation Issue Issue Conclusion Conclusion Hypo Hypo Hypo Hypo Buy-in Stage OBJECTIVE Finding Finding Finding Finding KQ KQ KQ KQ KQ KQ KQ KQ Fact Fact Fact Fact Fact Fact Fact Fact

Issue Diagram Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region • Definition of Major Issues • Strategy: Ownership and Strategic plan for Kayseri to be a Health Tourism city • Offering: Competitive advantage in medical services offered by the city of Kayseri • Infrastructure: Infrastructure development for the city of Kayseri to support a health tourism industry • Marketing: Promotion and Marketing of Kayseri as a Health Tourism Destination Client Objective Engagement Objective Issue 1. Strategy 3. Infrastructure 2. Offering 4. Marketing Hypotheses 2.2 Elective treatments are available in Kayseri 1.1 Hospitals are well funded 1.3 … 2.4 … 3.1 Easy access to Kayseri for international patients 3.4 … 4.1 Neighboring countries are good candidate for target audience 4.4 … Kayseri is a medical city Kayseri is a medical city … … … … … … … … Key Questions

Health tourism, medical tourism - What it is, what it is not Health Tourism is traveling abroad for healthcare services. Health Tourism is usually not emergency or critical care travels: While out of country Expatriate care Occasionally the medical procedure needed is urgent, but more often it is an elective treatment such as cosmetic surgery or dental care. Reasons health tourists go abroad: Real or perceived lack of services at home Limitations imposed by payers or regulatory agencies, certain specialists and/or procedures Treatment protocols, equipment, or services Prolonged waiting periods Lower costs of care Personal reasons Term initially developed by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain healthcare Projected 15% increase in 2011 • In broader sense, health tourism (versus medical travel) includes the leisure aspects typically associated with travel and tourism. “Mini-vacation” options for patients and their friends and/or families are provided at reduced rates through arrangements with travel agencies and airlines.

Strategy Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region There is clear ownership for health tourism in Kayseri Kayseri maintains accurate health statistics Hospitals are well funded Client Objective Engagement Objective Strategy Offering Infrastructure Marketing Issue Hypotheses Key Question and Data Gathering Are top 5 hospitals internationally competitive? (statistics on investors) Stakeholder mapping and interviews Data requests Interviews Internet research

Hospitals are well funded “Kayseri has always had a history of medicine. Over the last 10 years, Kayseri has significantly invested in quality hospitals." — April, 2011, Mevlut Bilici Governor of Kayseri Province “Acibadem is Kayseri's only publicly listed hospital on the Istanbul stock exchange and is well funded.“ — April, 2011, Cemalettin Yilmaz Acibadem Hospital Director As per Istanbul's Stock Exchange website, ACIBADEM has 100,000,000.00 in capital investments Kayseri has significantly invested in the healthcare sector • The Kayseri Health Campus Project • The Kayseri Health Campus project is the first of an ambitious list of PPP (Public Private Partnership) projects and represents the first PPP program adopted for the healthcare sector in Turkey. • Location: Kayseri Province: 2,800,000 people • Beds: No. 1548 of which; • 1,048 general hospital • 200 physiotherapy and rehabilitation • 200 psychiatric hospital • 100 high security forensic psychiatric hospitals • Capacity: Expected access to healthcare services by 10,000 people by day • Estimated cost of investment: 278M USD Source: http://www.scribd.com/doc/33737968/PPP-Health-Campus-Projects

Stakeholder Relationship Map Kayseri Chamber of commerce Sightseeing Spot/Market/Hotel Associated Stakeholders Other Institutions Travel Operator Transportation Government Agency (ORAN) Patients and relatives Health Tourism Advertising Company Primary Stakeholders Pharmacy Investor Insurance Company Hospital Many Stakeholders and Complex relations Distributor University Pharmaceutical Company Medical Equipment Company 2019년 12월 20일 15

There is clear ownership for health tourism in Kayseri “We are looking to develop new business” “Health Tourism in Kayseri has huge potential” Quote from Interview with Semih Demirtoka, ORAN, Quote from Interview with Alto Tur travel agency, Memduh Keskinkilic Travel Agency ORAN Who has ownership?? Health Tourism Hospital Quote from Interview with Cemalettin Yilmaz, ACIBADEM, “We have an original channel such as International Patient Center. This Center performs the promotional activities abroad”

Kayseri maintains accurate health statistics  Kayseri is now developing statistics about health • The following institutions have some statistics about health tourism in Kayseri: • The ministry of health of Turkey(http://www.saglik.gov.tr/) • Turkish statistical institute (http://www.turkstat.gov.tr/) • We found that the data provided by these agencies are either incomplete or out of date • Kayseri has also some statistics about health: • Statistics Dept. Kayseri Provincial HealthAdministration(http://www.ksm.gov.tr/) • Administration Of Health • Although relatively new, we found that the data is incomplete • ORAN has recognized the importance of statistics and lack of data. 2019년 12월 20일 17 2019년 12월 20일 17 2019년 12월 20일 17

Offering Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region Elective treatments are available in Kayseri Necessary medical treatments are available in Kayseri Client Objective Engagement Objective Strategy Infrastructure Offering Marketing Issue Hypotheses Kayseri is in a good location to attract Cappadocia tourist to Kayseri for health Kayseri provides minimal waiting lists for treatments Sufficient capacity to introduce additional patients Key Question and Data Gathering Dental examination Thermal treatments (Personal opinion, interviews) From statistics, interviews, expertise, success rates, number of operations, time of recovery, aftercare conditions Current waiting lists in UK and Europe Current waiting lists in Kayseri Seasonal occupancy/rates Capacity of hospitals in Kayseri

Kayseri is in a good location to attract Cappadocia tourists to Kayseri for health  Kayseri´s geographical location and airport are advantageous to attract (for health) international tourists visiting Cappadocia • Kayseri is theeasiestwayto get to Cappadocia • Has the closest airport, Turkish Airlines operate 5 flights a day from/to Istanbul to/from Kayseri. • Kayseri to Cappadocia: 75 kms, only 1 hour, compared to 300km from Ankara 300 Km • Cappadocia´s international tourist  number is increasing every year • Turkey tourists: 28.6 million (international without citizen visitors )* • Tourist visiting Cappadocia: 2.18 million, 1.49 million foreigners* • Increased by 30 percent in 2010* 75 Km • Cappadocia’s tourist possible target for Health Tourism in Kayseri • Tour groups, from Europe and most of them above 50 years old (Source: Group Observation) • Tourist stays in Kayseri aprox. 1.6 days (Source : Interviews) (*Source: gototurkey.com, Turkishpress.com)

Treatment Segmentation The following diagram describes the segmentation that was used for the benchmark treatment analysis • Elective (Leisure) • Necessary (Medical Treatment) • Comparing Cities • Orthopaedics • Oncology • Cardiology • Eye • Dental • Medical Spa & • Thermals • Comparison New Delhi World Istanbul Kayseri Kayseri Region Bangkok Turkey

Thermal Spas in Turkey • 1800 thermal springs in Anatolia • 190 thermal resorts in 46 cities Bed capacity is almost 15,000 • 7th richest country in the world when it comes to thermal resources • 10 million domestic guests and over 300,000 foreign guests in 2009 and 1 Million forecast for 2012 Main Turkish Thermals Spas In Turkey Yalova Bolu Canakkale Ankara Bursa Balikesir Eskisehir Sivas Kutahya Bingol Nevsehir Afyon KAYSERI Izmir Van Konya Aydin Denizli Mugla Source: Presentation health tourism destinationfrom Turkish Healthcare TourismDevelopment Council Spas Turkey http://www.allaboutturkey.com/spa.htm Spa Summit 2010

Dr. Fish as an attraction to International Tourists Dr. Fish treatment has become popular around the world. It is a unique treatment that can attract tourists since Turkey has the original one • Open in 2010 • 8 Spas & 17 New openings, Franchises • Services: foot treatment • Price: 10 Euros, 15 min • Testimonials • In Turkey since 1950 • Services: Psoriasis Fishy Treatment (21-14 days) • Packages: Treatment, accommodation, transfers, Catering, Local Excursions • Prices: 21 days USD 3392 • Testimonials UK Turkey Wellness industry cluster market: USD$2 trillion USD 216 Billion

Elective treatments are available in Kayseri region  • Kayseri has the natural resources but needs to improve thermal infrastructure and awareness • BAYRAMHACI THERMAL SPRING : 65km west of Kayseri, two pools for men, and two for women. “..Small Place, frequented by people from the Village, there is infrastructure but not for International tourist..” • TEKGOZ THERMAL SPRINGS : Yemliha district 33km from Kayseri, One pool for men, and one for women. “There is not any hotel or building” • CIFTGOZ THERMAL SPRINGS: 35 km from the city center. Two pools for men, and two for women. “Drinking water available” • YESILHISAR MINERAL SPRING: Yesilhisar Town 82 km from the city center. • ZILE THERMAL: Visited by Develi and Yahyali people. “There is mud, can be an attractive for tourists, is more active than the others” — April, 2011, Mr. Memduh Keskinkılıç, owner of Alto Tour, a prominent tour operator in Kayseri Lack of infrastructure Source: Kayseri City Guide/Mr. Memduh Keskinkılıç, http://www.travelshopturkey.com/hotels.asp?id=301&dest=384

Treatment Segmentation The following diagram describes the segmentation that was used for the benchmark treatment analysis • Elective (Leisure) • Necessary (Medical Treatment) • Comparing Cities • Orthopaedics • Oncology • Cardiology • Eye • Dental • Medical Spa & • Thermals • Comparison New Delhi World Istanbul Kayseri Kayseri Region Bangkok Turkey

Necessary (Medical Treatment) – Benchmarking Criteria The following approach was used to perform the treatment benchmark treatment analysis For each city, a major hospital was chosen to perform the comparative analysis. Treatment comparative analysis is based on the following categories in each city/hospital:

Summary of benchmark analysis of Necessary Treatment in Kayseri Eye capacity Dental Cardiology Oncology Based on this analysis Bangkok is the leader in eye treatment and New Delhi is the leader in all the other treatments Rating Definitions High 0 Low 5 Orthopaedics 2019년 12월 20일 26

Findings on Medical treatments available in Kayseri Necessary medical treatments are available in Kayseri  Kayseri has potential in Cardiology and Oncology treatments but has areas for improvement • Affordable cost for treatments for eye and dental treatments compared with the cities included in the benchmark • High level of specialization in Cardiology and Dental treatments compared to other areas of treatment in Kayseri • Kayseri’s Hospitals have experience with international patients in Cardiology, Oncology and Orthopedics • Overall Kayseri has a better ranking on Cardiology, Oncology treatments • Kayseri’s lack of JCI accredited Hospitals or international affiliations (AHA etc) • Number of specialized doctors are significantly low specially in Orthopedics and Eye treatments • Low awarenessof Kayseri’s treatments • Lack of multi lingual staff in Kayseri’s hospitals • Lack of International Patient facilities, for example, only Acibadem has an International Patient Center in Kayseri         

Kayseri provides minimal waiting lists for treatments  Average Waiting List in UK Kayseri provides no waiting time, only preparation time for treatment “Waiting lists are very long in the Western Europe, such as UK. Meanwhile, most hospitals in Kayseri have no waiting time.” Combined quote from interviews with ACIBADEM hospital,TEKDEN hospital,Moderndis dental clinic, and Governor of Kayseri Province Source: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/index.htm

Kayseri hospitals have sufficient capacity to introduce additional international patients Kayseri hospitals have sufficient capacity to introduce additional international patients by 50% each year for 5 years Typical occupancy rate is around 50% Source: YATAKLI TEDAVI KURUMLARI CALISMALARI (*1) http://www.acibadem.com.tr/(*2) 2019년 12월 20일 29

Infrastructure Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region Client Objective Engagement Objective Strategy Offering Infrastructure Marketing Issue Hypotheses Kayseri infrastructure can support international health tourism Kayseri is a medical city Food, shopping and entertainment options are available Easy access to Kayseri for international patients Key Question and Data Gathering Number of hospital and doctors/specialists per 1000 people Number of hospital and doctors/specialists per 1000 people Hotel capacity How many different cuisines available?How many restaurants? Opening hours? Multi-lingual staff How many shopping centers? Entertainment options?

Kayseri is a medical city  Kayseri has a higher number of hospitals when compared to other cities in Turkey and any other medical advanced cities in the world. Furthermore in 2014, The Kayseri Health Campus will be completed, number of beds per population will be 3rd in the world • Hospitals • 15 public hospitals, 14 private hospitals, 3595 hospital beds** • 7 hospitals have ISO-9001 certification • Specialists • 2168 doctors, 1837 nurses, 454 midwifes When the Health Campus is completed 4.47 Above Turkey average and same as the world average even in 2007 3% growth YTY • TURKISH HEALTHCAREINDUSTRY REPORT • **Statistics Dept. Kayseri Provincial Health Administration 2019년 12월 20일 31 2019년 12월 20일 31

Easy access to Kayseri for international patients  Direct non-stop flight to Istanbul, Turkey Direct non-stop flight to Kayseri, Turkey Source: http://www.flyhere.com/flight-map, As of April, 15th, 2011 Turkey is a very attractive tourist destination for European countries which is roughly half the distance to travel compared to India but Kayseri needs more direct flights for easier access • Flight • Very limited direct flights to Kayseri international airport • Most travelers can get to Kayseri by taking transfer flight from Istanbul • Visa requirements to Turkey • Top 10 countries visiting Turkey don’t require Visa or can get Visa at the border gates • Out of about 200 countries, • 45% : without Visa, stay up to 90 days • 23% : can get Visa upon arrival at the Turkish border gates • 32% : requires Visa • Get Visa at the border gates • Visa Exempted           Source: http://www.mfa.gov.tr/visa-information-for-foreigners.en.mfa

Kayseri infrastructure can support international health tourism Kayseri doesn’t have enough multilingual staff or information. Infrastructure of Kayseri is adequate for domestic health tourism but lacking for international health tourists • Kayseri Multi-lingual • Hospital: Not enough multi-lingual staff • Restaurant: Menus only in Turkish and no multi-lingual staff • Shopping Center: No multi-lingual staff or announcements • Railroad: No multi-lingual staff or announcements • Roads: Only Turkish signage • Hotels: Only 2 of 21 hotels have multi-lingual staff • Media: Most of TV channels and radio stations in Turkish • Hotels • 1450 rooms and 2796 beds in 21 hotels ( 2 five stars hotels, 4 four stars hotels, 10 three stars hotels) • 3 international chain hotels and others are domestic Hilton City One Novotel Grand Eras Selcuk Nüzhet • Airport • Erkilet Airport is 4km to the city center. • Railroad • 7 hours to Ankara, 6 hours to Adana • Roads • Well prepared inter-connect high-way • Connects Bogazkopru, is 15 km to the city center, with several main highways which come from Ankara, Adana, Nigde • 5 hours to Ankara, 1 hour to Cappadocia 2019년 12월 20일 33

Food, shopping and entertainment options are available  . . . . Kayseri city Cappadocia There are plenty of Turkish food options, however there are limited international cuisine and entertainment options for foreigners • Entertainment • Erciyes Winter Sports Center– during the Winter season – variety of bars, cafes and restaurants • Kayseri city – there are no major entertainment facilities for foreigners – no bars, pubs or live music • Sightseeing • Kayseri city has a number of places to visit including varies mosques, tombs and towers • Cappadocia is within 1hour drive • Food • Kayseri is known for its rich Turkish cuisine culture • One of the unforgeable tastes of Kayseri cuisine is pastrami • Restaurants and cafes are generally open till about 10pm every night • Lack of international cuisines such as Asian, Indian and European • Shopping • There is one major shopping Center – Kayseri Park (10.00-22.00) • Covered Bazaar (10.00-20.00) • Street shops – from carpets to clothes to fresh fish Kayseri Pastrami Kayseri Park

Marketing Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region Awareness about Health Tourism in Kayseri is high for international patients Neighboring countries are good candidate for target audience Turkish workers in European countries are good candidate for target audience Domestically neighboring regions are good candidate for target audience. Turkey is well known for its hospitality Client Objective Engagement Objective Strategy Offering Infrastructure Marketing Issue Hypotheses Turkey is ranked within the Top 20 countries in the Country Brand Index Annual Country Brand Index ratings Interviews and quotes for people How they are promoted? Hits in Google What facilities they have in neighboring countries? Number of visitors from the neighboring countries. Waiting list on their home countries, cost of home countries? What facilities they have in neighboring regions? Number of visitors from the neighboring regions? Demography of current Turkish workers Number of visit from Turkish workers Key Questions and Data Gathering

Turkey is ranked within the Top 20 countries in the Country Brand Index  People Governance Tourism Country Brand Exports Culture & Heritage Invest & Immigration • The world’s perception (brand) of Turkey is average when compared to benchmark countries India and Thailand. • The Country Brand Index is an annual study that examines and ranks 110 country brands, based on Future Brand’s proprietary research methodology (in partnership with BBC World News) Each country is measured in the following areas Sources: http://www.futurebrand.com/think/reports-studies/cbi/2010/overview/ http://www.futurebrand.com/think/reports-studies/cbi/2008/overview/ 2019년 12월 20일 36

Awareness about health tourism in Kayseri is high for international patients Awareness about health tourism in Kayseri is low • Turkey’s health tourism is generally well known compared to other countries • Compared to other cities in Turkey, Kayseri needs to improve the awareness of the city in general and particularly in the area of health tourism • Based on the web search hits result, Netherlands, Germany, France may be potential target customer for health tourism to Kayseri, Turkey Source: http://www.googlefight.com Google Trends Comparison– Istanbul, Ankara, Izmir, Bursa, Kayseri Countries who searched Kayseri Health tourism awareness comparison between Kayseri and Istanbul Source: http://www.google.com/trends Source: http://www.googlefight.com 2019년 12월 20일 37

Neighboring countries are good candidate for target audience  Elimination of visa requirements for neighboring and nearby countries will ease the inflow of medical tourists from these areas • Talks underway for elimination of visas: • Greece, Portugal and Ukraine • Countries that do not need visas: • Syria (as of 16.9.2009) • Albania (as of 20.11.2009) • Libya (as of 24.11.2009) • Jordan (as of 2.12.2009) • Tajikistan (as of 13.12.2009) • Azerbaijan (as of 25.12.2009) • Lebanon (as of 11.1.2010) • Saudi Arabia (as of 10.1.2010, unilateral) • Georgia, Pakistan, Bosnia and Herzegovina • Croatia, Tajikistan, Serbia, Qatar • Russia (as of 19.4.2011) • Visas granted at border: • Belarus, Czech Republic, Estonia, Latvia, Lithuania, Hungary, Moldova, Norway, Uzbekistan, Poland, Slovakia, Tajikistan, and Turkmenistan can obtain sticker-type visas at border gates for stays up to one month. “Following the recent abolishment of visa requirements between Turkey and Syria, Turkey has seen a remarkable increase in the number of patients from Syria, as well as from Lebanon, Iraq and Iran, who seek to benefit from better health services in Turkey. Private and public hospitals and clinics are getting an increase in the number of foreign patients. One private clinic specializing in laser eye surgery in Hatay is now getting 100 Syrian patients each month, in addition to patients from Lebanon, Iraq and Iran who cannot get such treatment at home” Source: International Medical Travel Journal

Domestic patients from regions around Kayseri are a target for medical treatment  Distribution of Hospitals in TR-72 Patients from neighboring regions of Sivas, Yozgat, Nevsehir and Aksaray come to Kayseri hospitals for Necessary medical treatment and will continue to bring a significant inflow of patients to Kayseri hospitals . . . . . However, concentration of specialized treatment is in Kayseri. Most patients from these regions come to Kayseri hospitals for necessary medical treatment. Kayseri hospitals also serve the neighboring regions of Nevsehir and Aksaray Most patients in these regions are referred to specialized treatments by their physicians-- For example, family of heart surgery patient from Aksaray: “We were referred to this Kayseri hospital for cardiac surgery by our physician in Aksaray due to the lack of same level of specialized surgery in Aksaray. I can stay at the hospital until the patient is able to travel back to Aksaray” Source: www.kayseri.gov.tr

Turkish workers in Europe are a good target audience  Turkish workers from Germany, Bulgaria, France, Netherlands and UK are a target audience for necessary and elective medical treatments Germany, Bulgaria, France, Netherlands and UK have the top number of people of Turkish origin, more than 75% of Turkish people living outside Turkey *An average of 900,000 Turkish workers traveled back to Turkey each year in 2008- 2010 **“Summer months and holiday season are very popular for Turkish workers in Europe to travel back to Turkey. Patients coming from these countries are not only Turks but also people in those countries that have heard about the medical services in Turkey” Source: *OECD Study on Inflows of Turkish workers to Europe **Team Interviews

Foreign tourists already visiting Turkey are a potential target for elective treatments  Countries that have significant tourist inflow to Turkey are a good target for elective treatments Germany, Russia, UK, Bulgaria and Iran are consistently the top 5 countries with tourist inflow to Turkey, constituting almost 50% of tourist inflow to Turkey Source: Turkey Ministry of Culture and Tourism

Countries with significant waiting list for necessary medical treatment are a potential target  • United Kingdom, Ireland and Canada are countries with the longest waiting lists for availability of medical treatments and surgeries. • Of these countries, patients on the United Kingdom waiting lists are prime candidates for treatment in Turkey because of the proximity to Europe and ease of travel to Turkey • For example, average waiting time in UK: Source: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/index.htm

Countries where medical care is expensive are a potential target for necessary medical treatment  Average of 50% savings for treatments in Turkey compared to other European countries (80% savings compared to treatment costs in US!) Cost multiplier relative to Turkey Source: healthinturkey.org

Summary of Findings - Issue Diagram Health Tourism in Kayseri and the Region Findings and action plan for the development of health tourism sector in Kayseri and the region Kayseri is in good location to attract Cappadocia tourist to Kayseri for health Turkish workers in European countries are good candidate for target audience Neighboring countries are good candidate for target audience Awareness about Health Tourism in Kayseri is high for international patients Domestically neighboring regions are good candidate for target audience. Easy access to Kayseri for international patients Food, shopping and entertainment options are available There is clear ownership for health tourism in Kayseri Necessary medical treatments are available in Kayseri Elective treatments are available in Kayseri Kayseri provides minimal waiting lists for treatments Kayseri infrastructure can support international health tourism Turkey ranked within the Top 20 countries Brand Index Kayseri maintains accurate health statistics. Turkey is well known for its hospitality Sufficient capacity to introduce additional patients Kayseri is a medical city Hospitals are well funded Client Objective Engagement Objective Strategy Infrastructure Offering Marketing Issue Hypotheses                  

SWOT analysis of health tourism in Kayseri • Strengths • Affordable cost for treatments • High level investments were already made and new project (PPP and Ski Center) is in progress • Kayseri is a medical city • Kayseri has advantages to attract Cappadocia tourist for health treatments • Kayseri provides minimal waiting lists for treatments • Kayseri hospitals have sufficient capacity to introduce additional international patients • Neighboring countries do not require Visas • Kayseri has more specialized doctors than the regions near by • Kayseri has more specialized doctors compared with benchmark countries for Cardiology and Dental treatments • Opportunity • Increased demand for healthcare services from countries with aging population • Shortage of supply in National Health Systems in some countries • Demand from countries with underdeveloped health systems • Decreasing cost of international travel • Being a EU Candidate (Patient immobility in EU) • Numbers of uninsured in developed countries • Increasing Medical Tourists to Turkey • Weakness • Low coordination between the stakeholders in the industry. There is not clear ownership for health tourism in Kayseri • Kayseri does not maintains accurate health statistics • Kayseri doesn't have enough multilingual staff, information nor entertainment for International people • Low awareness of Kayseri as an international medical destination • Kayseri does not have JCI accredited hospitals • Number of specialized doctors are significantly low especially in some treatment such as orthopedics and eye • Threats • Strong competition from countries like Thailand, India, etc. • Some of the developing countries in the region want to attract medical tourists too • Possible conflicts in neighboring countries

Recommendations • Establish Kayseri Health Tourism Council (KHTC) • Board members from hospitals, hotels, travel operators, ORAN, Ministry of Health and Ministry of Tourism, Kayseri province Governor’s office etc. • Representation from Kayseri Council (KHTC) in Turkish Healthcare Tourism Development Council (THTDC) • Responsible for collecting and maintaining accurate health statistics • Own short/mid/long term action plan for health tourism in Kayseri with measurable checkpoints • Hire subject matter experts with medical background to validate top treatment areas • Hire subject matter expertsin healthcare consulting to continuously asses and provide feedback on health tourism action plan • Monitor PPP Health Campus project and alignment with health tourism roadmap for Kayseri • Obtain membership with the health tourism Association (MTA http://www.medicaltourismassociation.com) • Invest in a Common International Patient Center (CIPC) for small and medium size hospitals to network and promote treatments to patients • Investigate training and hiring health tourism facilitators to coordinate between CIPC and patients • Obtain JCI accreditation and international affiliations for leading hospitals in Kayseri • Continue to keep cost of treatment competitive • Offer tax support as needed to compete with benchmark countries • Invest in hiring specialized doctors in areas where specialization is low, for example, orthopedics and eye • Offer customized packages for international patients • Investigate facilities in Kayseri that can be combined with tour programs in Cappadocia Strategy Offering

Recommendations • Develop multi-lingual environment in Kayseri • Short training courses with certifications and exams for conversational proficiency for doctors, nurses, travel agents • Also staff in restaurants, shopping centers, hotels, airports, TV channels etc • Signage in multiple languages, for example, Turkish with English translation • Invest in elective treatment facilities • Spas, Hamams, hot springs in the area need to be improved significantly to be attractive for international tourists • Improve connectivity of Kayseri with more direct flights to target regions • Must offer direct flights to cities in Germany, UK, France, Russia Bulgaria, Jordan, Azerbaijan, Syria • Invest in hotel infrastructure to accommodate additional international patients and their families • Invest in international food, entertainment, shopping options for families accompanying international patients • Improve awareness of Kayseri’s medical treatment areas • Advertise Kayseri’s hospitals in Cappadocia via stands offering free health checks, free eye checks, free information kits to make facilities visible to tourists • Combine health checks and elective treatments in Kayseri with travel packages to Cappadocia • Promote Kayseri’s hospitals in international forums, congress, fairs in target markets and create partnerships with healthcare services in those countries • Include Kayseri in existing Turkey health tourism websites, for example, healthtourism-tr.com, healthinturkey.org • Internal Marketing • Educate doctors, travel operators, insurance companies etc about importance of health tourism and align their roles to grow health tourism in Kayseri • Buzz Marketing • Facilitate word-of-mouth discussions, reviews using online forums, social networking tools • Create a Kayseri Health Tourism Portal to enhance awareness, establish a brand and provide international patients quick information on health tourism Infrastructure Marketing

5 Year Action Plan Phase 3 Expansion Phase 2 Stabilization Phase 1 Initialization • Continue to keep cost of treatment competitive • Offer customized packages for international patients • Develop multi-lingual environment in Kayseri • Improve connectivity of Kayseri with more direct flights to target regions Growth of Health Tourism Industry in Kayseri • Invest in hiring specialized doctors in areas where specialization is low • Invest in elective treatment facilities • Invest in hotel infrastructure • Invest in international food, entertainment, shopping options • Buzz Marketing to facilitate online word of mouth information • Establish Kayseri Health Tourism Council (KHTC) • Obtain JCI accreditation and international affiliations for leading hospitals in Kayseri • Improve awareness of Kayseri’s medical treatment areas using recommendations provided • Internal Marketing to educate primary stakeholders • Create a Kayseri Health Tourism Portal 2011 - 2012 2012 – 2014 2014 – 2016

Health Tourism in Kayseri & the Region IBM Corporate Service Corps Turkey Team 6