Regulation on Promotion and Information Activities on Healthcare Services Has Been Published!

Turkey is recognised as a prominent destination in the world in terms of health tourism. By providing high-quality healthcare services on an international platform, our country both strengthens our healthcare sector and contributes to our economy. In today's world where promotions for health services have gained an important place, The Regulation on Promotion and Information Activities on Healthcare Services ("Regulation"), which entered into force on 29 July 2023.

Regulation, which entered into force after being published in the Official Gazette dated 29 July 2023 and numbered 32263, introduced significant restrictions on the promotion and information activities carried out by healthcare professionals, healthcare institutions, organisations, establishments and international health tourism intermediary organisations, and on the promotion and information activities carried out by persons, institutions and organisations that do not have authorisation, permission or licence in the field of healthcare service provision.

This article examines the stringent new rules that the Regulation imposes. Understanding how healthcare promotion will evolve in the new era is critical for all parties in the sector.

1- Fundamental Principles

Regulation prohibits implicit or explicit advertisements in healthcare service provision. Also, it provides certain principles as the following:

• Promotion and information shall comply with public morality, medical deontology and professional ethics.
• Information regarding the provision of healthcare services shall only be provided by healthcare professionals who are legally authorized to do so.
• Promotion and information that misleads and misdirects the public, endangers personal and public health, creates a demand and unfair competition environment in a way to give the impression that health care facilities accept and treat patients other than the specialties in which they treat patients shall not be allowed.
• Promotion and information shall not include explanations about medical and treatment methods that have not been scientifically and clinically proven to be accurate, have not become established medical methods, have not been defined and regulated as medical procedures by the Ministry of Health ("Ministry"), even if they are performed by a healthcare professional, and statements that diseases are treated or helped to be treated with these methods may not be used.
• Promotion and information shall be limited to the branches of specialization, address and contact information of health care facilities that accept and treat patients, as well as health-protective and health-promoting information related to the field of health provided; and for doctors and dentists, the main and sub-specialty specialties, academic title, examination days and hours, time and place of patient admission, as well as health-protective and health-promoting information related to the field of health provided.
• In publicity and information, the title of specialty other than the main and subspecialty specialties that are legally available shall not be written or used.
• Activities that may create the impression that patients are making a thank you announcement for health services shall not be carried out.
• Promotion and information shall not be in content that will direct the patient directly or indirectly to the healthcare professional or healthcare organization.
• No referral shall be made to a specific healthcare professional or healthcare institution through intermediary organizations, publications and communication channels for reasons such as medical assistance services, general health check-ups, health screening, consultancy and information.
• Scientific terms, research results or quotations from scientific publications and statistical data shall not be presented in such a way as to produce different results from what they actually are.
• Promotion and information that abuses people's trust or exploits their lack of knowledge in order to create the perception that the goods or services subject to healthcare services are different or superior to others shall not be provided.
• The date of the last update of the information on websites and contact information for the website editor shall be clearly indicated.
• Health facilities and doctors shall be allowed to register with internet search engines. However, the keywords to be used and all information on the result page of the search engines cannot be contrary to the principles in the Regulation.
• Personal telephones shall not be called without the knowledge and consent of individuals, and advertisements and promotions shall not be made by sending letters, short messages, electronic mail and messages through social networking tools.
• Health services cannot be offered for marketing purposes such as incentives, sweepstakes and gifts, and advertising, promotion and information cannot be provided for this purpose.
• Except for the distribution of scientific, statistical and newsworthy information, all kinds of advertisements, promotions and similar activities related to organ and tissue harvesting and donation are prohibited.

Regulation clearly states that compliance with these principles is mandatory for promotions and information provided on social networking sites and websites. Indeed, those who engage in promotional and informative activities in violation of these principles and those who share them are held equally responsible. 

Also, it has been made mandatory to obtain permission from the Ministry prior to the promotion and information activities to be carried out within the scope of social responsibility projects and campaigns to be carried out for healthcare services. Promotion and information activities to be carried out as a result of the permission are limited to the scope and duration of the social responsibility project and only to the persons or organizations that will benefit from the project.

2- Using Visual Content in Promotion and Information

Within the scope of Regulation, health professionals are defined as doctors, dentists, pharmacists, nurses, midwives, and optician and the other professions.

Regulation explicitly prohibits the use of before and/or after images that are comparative and demand-generating in terms of the effects of the treatment in the promotion and information provided by healthcare professionals and healthcare facilities regarding the healthcare services they provide. The using of visual content is only possible provided that certain principles and guidelines are complied with;

• The visual content to be shared shall not include images and expressions that are contrary to the rules of public morality, that pose a threat to public health and well-being, that violate personal rights and freedoms, that exploit the private or social life of the patient, that cause public anxiety or that are misleading.
• In order to use visual content belonging to the patient, the explicit consent of the patient himself/herself, or his/her parent or guardian if he/she is a minor or incapacitated, shall be obtained and the Patient Rights Regulation shall be complied with. The Consent Form for Recording and Processing Visual Content attached to the Regulation shall be used when obtaining explicit consent.
• The patient has the right to see the visual content to be shared in advance. The permission to share visual content shall be withdrawn at any time upon the request of the patient himself/herself or, if the patient is a minor or incapacitated, upon the request of his/her parent or guardian, without being bound by any procedure or condition. The healthcare facility or the relevant healthcare professional is obliged to immediately process and finalize the patient's withdrawal request.
• Patients who do not give permission for image sharing shall be informed and assured that there will be no change in the diagnosis and treatment practices and the fees to be charged.
• No payment or discount shall be made to the patient in return for the permission to use the visual content, and no gift shall be given.
• The media of videos and photographs to be used in promotion and information shall not be contrary to the reality of the techniques used and shall be displayed without misleading makeup. Technological changes or corrections shall not be applied to the visual contents afterwards. It is mandatory to indicate the date of processing and the date the image was displayed on the visual content.
• Patient comments made on visual content, even if made in other media, or expressions that would mean a thank you announcement shall not be shared. It is mandatory to completely close the posts of visual content to comments.
• Patient images shall not be shared during surgery or medical intervention and in the operating room.
• Visual content of intimate parts of the body shall not be shared in violation of the general rules of morality.
• Posts with visual content shall be made by the healthcare facility or the relevant healthcare professional themselves. The fact that these posts are made by others does not eliminate the responsibility of the relevant healthcare facility or healthcare professional.
• Shared visual content shall not be published in media such as print, visual media, social media platforms, websites, etc. as sponsored or by paying a fee.
• Images related to the region, location, medical devices, equipment, tools, equipment or personnel or any similar element shall not be shared in order to give the impression that the healthcare professional or healthcare organization is superior or better than other healthcare professionals or healthcare organizations.

3- Inspection and Sanctions

Promotional and informative activities will be regularly screened by the authorized units of the Ministry through press and media organs and websites. In addition, necessary notifications will be made to the Ministry of Commerce or Provincial Directorates of Commerce to be evaluated by the Board of Advertisement about the promotion and information activities that are found to be in violation. Please see the following sanctions in this matter:

• If it is determined that promotion and information is provided by doctors or dentists in violation of the provisions of Regulation, an administrative fine will be imposed on doctors in accordance with Article 27 and will be imposed on dentists in accordance with the provisions of Article 44 of the Law No 1219 on the Practice of Medicine and Medical Practices.
• The health facility that is detected to have carried out promotional and informative activities contrary to the provisions of Regulation will be warned twice and if it is detected to have carried out promotional and informative activities contrary to the provisions of the Regulation for the third time within one year, the activity of the unit in the relevant branch of medicine or specialty will be suspended for three days.
• The international health tourism health facility or international health tourism intermediary organization that is found to have provided promotion and information in violation of the provisions of Regulation will be warned once. If it is detected for the second time within one year, the health tourism activities of the organization and facility will be suspended for one month, and if it is detected for the third time, the health tourism activities of the organization and facility will be suspended for three months.  
• If it is detected that medical treatment centers where organ transplants are performed are promoting and informing in violation of the provisions of Regulation, the cadaver organ distribution of medical treatment centres where organ transplants are performed will be stopped for three months in the first detection, and in the second detection, the operating permit will be revoked for three months depending on the type of transplantation. Criminal complaints will also be filed against persons who advertise or publish advertisements for the procurement of organs or tissues.
• If it is determined that there are criminal elements that endanger human health or negatively affect the diagnosis and treatment process or prevent this process in health-related promotions and information made through social media and websites a criminal complaint can be filed to block access to the relevant content in according to Law No. 5651.

Furthermore, in the event that healthcare professionals and other real persons who are found to promote and inform in violation of the provisions of Regulation are public officials, further action shall be taken against them in accordance with the provisions of the relevant legislation to which they are subject.

Please be informed that we are closely monitoring the effects of such restrictive regulations on the promotion of health activities in our country, where health tourism is one of the most important sources of income.

You can access the Regulation in Turkish by this link.

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