Evaluation of the Private Hospitals Regulation Published in the Official Gazette No. 32798 Dated January 30, 2025

The Private Hospitals Regulation dated 2002, which was amended 45 times in total and consisted of 69 articles, 12 additional articles and 20 temporary articles, was repealed by the new Regulation published in the Official Gazette No. 32798 dated January 30, 2025 by the Ministry of Health. The Private Hospitals Regulation dated January 30, 2025 has 54 articles and 14 temporary articles.

Article 5/3 of the Private Hospitals Regulation dated January 30, 2025 includes the regulation regarding the minimum number of beds among the basic features required for opening a private hospital.

On the other hand, the provision in Article 10 of the repealed Regulation, “Private hospitals operate in independent buildings. In no case can there be any workplace for another purpose in the part of the building used as a hospital and a section within the hospital cannot be rented to third parties or transferred in any way to operate for another purpose” is regulated in Article 5 of the new Regulation.

In addition, in the Regulation dated January 30, 2025, unlike the repealed Regulation, private hospitals are required to obtain an accreditation certificate from the Turkish Health Services Quality and Accreditation Institute (TÜSKA) within three years at the latest from the date they are licensed, and a regulation has been introduced stating that an information sign stating “This hospital does not have a TÜSKA accreditation certificate” will be hung in a place visible to patients in hospitals that cannot obtain an accreditation certificate.

Article 5

(3) Private hospitals shall be opened with at least one hundred patient beds, excluding observation beds. Private hospitals may be allowed to be opened with at least fifty patient beds, in accordance with the planned number of physicians and service needs according to the health service regions determined by the Ministry.[1] The total number of intensive care beds in private hospitals cannot exceed 30 percent of the total number of patient beds based on the license.

(7) Under no circumstances may there be any other workplace within the hospital building, and a section within the hospital cannot be rented to third parties or transferred in any way for purposes other than those listed in the sixth paragraph.

(8) Private hospitals must obtain an accreditation certificate from the Turkish Health Services Quality and Accreditation Institute (TÜSKA) within three years at the latest from the date of their licensing. In hospitals that cannot obtain an accreditation certificate, an information sign stating “This hospital does not have a TÜSKA accreditation certificate” and in accordance with the standards specified in Annex-14 must be hung in a place visible to the patients. The Ministry reports these hospitals to the Social Security Institution every January.

It should be noted that, according to the Temporary Article 1 of the Regulation, private hospitals licensed and operating before the date of publication of the Regulation must also obtain an accreditation certificate from TÜSKA within three years at the latest.

Temporary Article 1- (1) Private hospitals licensed and operating before the date of publication of this Regulation must obtain an accreditation certificate from TÜSKA within three years at the latest.

The Regulation dated January 30, 2025, unlike the repealed regulation dated 2002, introduces restrictions on persons authorized to open and operate private hospitals by including the provision that ‘‘Persons convicted of crimes listed in Article 28 of Law No. 1219 and crimes committed against sexual immunity, individuals banned from public service and legal entities that have these persons in their partnership structure are not allowed to open private hospitals. These persons cannot take over the licenses of licensed private hospitals and cannot take part in the partnership structure of legal entities that have private hospital licenses in their name.’’

Article 7- (1) Private hospitals are opened and operated by individuals or private law legal entities.

(2) Private hospitals are not allowed to be opened in the names of individuals convicted of crimes listed in Article 28 of Law No. 1219 and crimes committed against sexual immunity, individuals banned from public service and legal entities that have these persons in their partnership structure. These persons cannot take over the licenses of licensed private hospitals and cannot take part in the partnership structure of legal entities holding private hospital licenses.

(3) No new private hospital licenses shall be issued for five years on behalf of real persons and private law legal entities whose licenses have been cancelled.

(4) In the event of a change in the partnership structure of private law legal entities in whose name a private hospital license has been issued, this change must be notified to the Directorate within one month at the latest. However, the notification obligation is not required for private law legal entities offered to the public.

It should be noted that the Temporary Article 3 of the Private Hospitals Regulation dated January 30, 2025 stipulates that Article 7/2 of the Regulation shall not apply to private hospitals licensed or granted preliminary permission before the effective date of this article.

Temporary Article 3- (1) The conditions specified in the second paragraph of Article 7 of this Regulation shall not be sought in private hospitals licensed or granted preliminary permission before the effective date of this article.

Article 8

(3) As a result of the plans announced by the Ministry, a planning conformity certificate is issued for those whose requests for a change in special centers, units, medical devices, specialist physician staff or bed capacity are deemed appropriate for the opening of new hospitals and existing hospitals.

(4) It is mandatory to obtain a preliminary permit within two years at the latest for changes in hospital, special center, unit, medical device and bed capacity for which a planning conformity certificate is issued. The planning conformity certificates of those who cannot obtain a preliminary permit within this period are cancelled.

(5) The planning conformity certificate is not transferable.

Article 9

(1) It is mandatory to obtain a preliminary permit for private hospitals;

a) Before opening,

b) Before starting renovation works in case buildings constructed for other purposes are requested to be converted into hospital buildings,

c) Before starting construction of additional buildings in a licensed hospital building, provided that they comply with the planning in Article 8.

(2) Applications for preliminary permits for private hospitals are made through the EKİP system together with the documents in Annex-13.

(3) If the Directorate[2] determines that there is no deficiency or non-compliance upon submission of the information and documents in the application document, the relevant document is sent to the Ministry within ten working days at the latest. If the application is deemed appropriate by the Ministry in the evaluation to be made, a preliminary permit document is issued within thirty days at the latest. If there is a deficiency or non-compliance in the application document, this situation is notified to the applicant in writing through the Directorate.

(4) Preliminary permit documents cannot be transferred. However, if licensed and active private hospitals with a preliminary permit issued for the purpose of moving transfer their licenses, the current period of the preliminary permit is preserved and the preliminary permit is allowed to continue in the name of the new license holder.

(5) The number of beds and polyclinics of the private hospital and the special medical device spaces subject to planning are specified in the private hospital preliminary permit document. The hospital preliminary permit document is issued in accordance with the capacities specified in the planning conformity document. The hospital is licensed with this capacity. Building and medical device space investments exceeding the capacity specified in the preliminary permit project do not grant the hospital the right to additional beds, staff and devices.

(6) Those who are granted permission to open a private hospital by the Ministry must obtain a preliminary permit document within two years at the latest from the application date.

In addition, the Temporary Article 5 of the Regulation stipulates that if the hospitals with a preliminary permit on the date the Regulation enters into force are not put into operation by 25/3/2026, their permits will be canceled.

Temporary Article 5- (1) If hospitals with medical device, unit and center rights that were granted preliminary permission within the scope of planning before the date of entry into force of this Regulation are not put into operation by 25/3/2026, the permissions granted will be cancelled.

The Regulation dated 30 January 2025 defines the license by replacing the phrase “compliance with the regulation” in the repealed Regulation with the criterion “compliance with the provision of health services”.

Article 4- (1) In this Regulation;

g) License: The document issued by the Ministry, which shows the compliance of private hospitals with the provision of health services, is issued in the name of the hospital owner at the opening and includes the name, address and number of beds of the hospital.

Article 10-(1) It is mandatory to obtain a license within three years from the date of issuance of the preliminary permit. The preliminary permit of those who cannot obtain a license at the end of this period is canceled. However, those who cannot apply for a license due to not completing their building at the end of the licensing period and who have a foundation-based visa obtained from the relevant local administration are given an additional two-year period.

(2) License applications are made through the EKİP system by private hospitals that have completed their buildings in accordance with the preliminary permit, together with the documents in Annex-8.

(4) If any deficiencies or non-conformities are detected as a result of the on-site inspection, the applicant shall be notified in writing of the deficiencies or non-conformities detected. Upon the applicant’s written notification to the Directorate that the deficiencies or non-conformities have been remedied, a new on-site inspection shall be conducted.

(5) If no deficiencies or non-conformities are detected as a result of the inspections, the license application file containing the joint technical report, expert branch report and application documents shall be sent to the Ministry within fifteen working days.

(6) The license document in Annex-6 shall be issued for private hospitals deemed appropriate as a result of the evaluation conducted by the Ministry. In the event of a non-conformity to the preliminary permit document or the conditions sought for the license, the license shall not be issued and the deficiencies or non-conformities detected shall be notified to the applicant in writing through the Directorate.

(7) If no deficiencies or non-conformities are detected, the licensing procedures of private hospitals shall be finalized within fifteen working days at the latest from the date of sending to the Ministry. This period shall start again as of the date of completion of the deficiency in the files returned due to deficiency and notification to the Ministry.

(8) Detection of deficiency or non-compliance as a result of the examination and evaluations shall not extend the licensing period.

However, the Regulation provides that private hospitals that have received preliminary permission from the Ministry before 1/1/2019 and have not completed their licensing procedures at the end of the five-year licensing period shall be granted an additional period until 31/12/2028 in order to complete their licensing procedures.

Temporary Article 8- (1) Private hospitals that have received preliminary permission from the Ministry within the scope of temporary article 1 of the repealed Private Hospitals Regulation published in the Official Gazette dated 27/3/2002 and numbered 24708 before 1/1/2019 and have not completed their licensing procedures at the end of the five-year licensing period shall be granted an additional period until 31/12/2028 in order to complete their licensing procedures.

Article 11- (1) A private hospital with an activity permit document shall start accepting and treating patients. The license granted to a private hospital that does not start accepting and treating patients by obtaining an activity permit document within six months from the date of its license by the Ministry shall be cancelled by the Ministry.

(2) Applications for an activity permit document shall be made by licensed private hospitals through the EKİP system together with the documents in Annex-10.

(3) If there is no deficiency or inappropriateness in the application document, the Directorate shall issue the activity permit document in Annex-7, the work document in Annex-12 for all healthcare professionals, and the responsible director and assistant responsible director documents in Annex-11 for the responsible director within fifteen working days at the latest.

(5) Private hospitals may start their activities with at least one-fourth of the total number of specialist physicians determined by the Ministry, provided that there are no fewer than four clinician specialist physicians.

The repealed Regulation included regulations regarding relocation and mergers within the same province and relocation and mergers outside the province. The Regulation dated January 30, 2025 includes regulations regarding the relocation and mergers of private hospitals only within the same province in its 12th article, and differs from the repealed Regulation in this respect.

Article 12- (1) Private hospitals may only relocate or merge within the province they are located in, with the permission of the Ministry, in line with planning principles.

(2) In the event of a merger of private hospitals, the number of beds registered in their licenses, the number of physicians and specialist physicians are added up and merged. Merged private hospitals cannot be separated.

(3) Private hospitals applying for merger and/or relocation must obtain a preliminary permit document within two years at the latest from the date their request is approved, and a license document within three years from the date the preliminary permit document is obtained, and must finalize the relocation/merger procedures. If a change is requested in the address based on the preliminary permit within two years from the date of receipt of the preliminary permit document obtained within the scope of this article, the Ministry may grant permission for the preliminary permit address change without granting any additional time, provided that it complies with the planning provisions. (4) Private hospitals that have requested a merger or relocation cannot make a new merger or relocation request before these procedures are completed.

Article 13- (1) In case of transfer of private hospitals to persons within the scope of this Regulation, it is mandatory to apply to the Directorate within one month at the latest from the date of transfer with the relevant documents in Article 14 of Annex-8. The hospital’s activities continue under the responsibility of the transferor until a license and activity permit is issued in the name of the transferee. If it is not desired to operate under the responsibility of the transferor, the hospital’s activities are suspended until a license and activity permit is issued in the name of the transferee. If the transfer is deemed appropriate, the license document in Annex-6 and the activity permit document in Annex-7 are issued in the name of the new owner within fifteen business days.

(2) Due to deficiencies and/or non-conformities detected during the inspection of the private hospital, the transferee is deemed to have assumed the responsibilities of the transferor. The period granted to the transferor due to deficiencies and/or non-conformities is re-granted upon the transferee’s request. In case the private hospital’s activities are suspended, the transferee must wait for the completion of the activity suspension period.

(3) The licenses of private hospitals whose licenses are suspended may be transferred only once during the suspension period. (4) A hospital taken over in accordance with this article cannot be transferred again within two years.

The most important change brought by the Regulation dated January 30, 2025 is the removal of the transfer of staff in private hospitals. The repealed Regulation dated 2002 allowed a private hospital to transfer staff to a private hospital or medical center in another province if the Ministry deemed it appropriate. However, the new Regulation does not include any regulation regarding the transfer of staff in private hospitals. Therefore, unlike the repealed Regulation, staff transfer will no longer be possible in private hospitals.

In addition, the new Regulation clearly states that health personnel will work in private hospital staff with a contract (as insured within the scope of Article 4, first paragraph, subparagraph (a) of the Social Insurance and General Health Insurance Law No. 5510). This regulation aims to prevent the establishment of companies and employment of physicians.

Article 15- (1) Private hospitals must meet the minimum personnel standards in Annex-1.

(2) Healthcare personnel work in private hospital cadres with a contract and as insured within the scope of Article 4, first paragraph, subparagraph (a) of the Social Insurance and General Health Insurance Law No. 5510 dated 31/5/2006, by issuing a personnel work certificate through EKİP. When necessary, the personnel work certificate is presented and checked through EKİP.

(3) The activities of hospitals where the number of active clinician specialist physicians falls below four are suspended for a maximum of two years. If the deficiency is remedied, the private hospital continues its activities. The license of a private hospital that cannot eliminate the specialist physician deficiency at the end of two years is revoked.

Although the practice of cadre transfer has been terminated with the new Regulation, the Temporary Article 10 of the Regulation allows private hospitals that are licensed and active as of the date the Regulation enters into force to transfer cadres to other private hospitals until 31.12.2025.

Temporary Article 10- (1) Private hospitals that are licensed and active as of the date of entry into force of this article may transfer the vacant physician and specialist physician positions on the effective date of this article to another private health institution until 31/12/2025, provided that it complies with the plans of the Ministry.

[1] Ministry: Ministry of Health.

[2] Directorate: Provincial or district health directorate.