The Hierarchy of Hospitals

I chose my doctor based off of recommendations from an in-law – and a bit of online research done by a sister-in-law confirming that her past patients were all extremely satisfied with her work.  I also chose to go to a (giant) public (university) hospital because that meant that everything I could possibly need would be there – and 90% of it would be covered by my fresh-pressed Turkish government health insurance.

For my first two prenatal visits I went to GBD Clinic – a private clinic run by the former professor of Hacetepe University who had previously overseen my other sister-in-law’s two births (some 10 and 20 years ago).  The clinic was nice – spacious and white, in a converted apartment building up the leafy green boulevard from some of our favorite bookstores, cafes, and restaurants.  Free tea and coffee; a waiting area fitted with white leather chairs, glass tables and plenty of magazines.  The doctor spoke quite excellent English, and gave quiet 30 minute consultations.  But we also paid 400+ TL (about $140 US) for every visit, and then had to go running around the city getting blood samples from different hospitals and clinics as none of that could be processed at the clinic.  He only worked with private hospitals – which meant that we would have to find a hospital for birth too.  And he was occasionally abroad for conferences or seminars – so it was possible he wouldn’t be there at the moment when I was giving birth.

Finding a fully-fitted hospital seemed like a better idea.  And once I got my Turkish health insurance (following my residence permit, obtained under my husband’s name) it seemed sensible to check out government hospitals as well.  Which is how I ended up at Gazi.

GAZINow Gazi isn’t much to look at.  The campus where the hospital(s) are located is just a corner filled with trees, taxis, and giant tower buildings.  The inside of the polyclinic is nearly always crowded, the slightly dim hallway lighting makes it look like a prime setting for a B-grade zombie flic, the line for the elevators is usually so long that we generally take the stairs (to the 9th floor), and the only comfortable place to sit is really only the cafes downstairs. But they have absolutely everything and – perhaps it’s just a vein running through our joint families – I think we trust professors and medical students more than non-academic medical personnel.  I mean, someone who has written six books on the subject should know what they’re doing, right?  I don’t really care if I have to pay for my tea or coffee and wait in a pleather purple chair.

And so far my experience has been pretty good.  I go in.  The nurse who knows up (which is how we got our first appointment) always gives us a warm smile.  I show my ID, get checked in, and then pay the 122 TL ($40) for an appointment with a professor (docent appointments are about $20), wait a bit, get weighed and measured, and then see the doctor. If I need to, I go downstairs for blood work or urine samples, results from both of which are sent directly to their secretary by 4pm the same day.  Their recommendations and analysis have always been spot-on, and I appreciate that the farthest I have to go is up or down stairs – and not across the city.  Coming from a country where insurance is not that simple, it’s also great that basically everything is covered and we aren’t constantly shelling out money here and there.  The basics are covered and all you have to pay for is special treatment – appointments with a professor, a private room for birth.

gazi hospital

A normal room at Gazi

This past Wednesday during my appointment the doctor noticed that my amniotic fluid levels had dropped more than they should, and I was told to stay in the hospital hooked up to an IV overnight.  Which is when I noticed something.  I was put in a room with two other women with late pregnancy complications in the birthing wing.  The two other women were both about my age – but both were (quite friendly) headscarf-covered housewives, both with children at home, ages 4 and 7.  Similarly, the other women staying in the hospital wing were generally younger, non-professionals belonging to a socio-economic class one or two steps down from our families.

Because [almost] everyone at our economic level (and E’s salary is definitely puts us in the “comfortable” zone in Turkey) goes to a private hospital.  Even families with half of our combined income go to private hospitals, at least for birth.  Why?


A private room at TOBB – one of Ankara’s nicer hospitals

Private hospitals aren’t necessarily nicer.  Some of them are – some of them have extraordinarily well-qualified doctors and nice, comfortable facilities.  But most of them exist because, since the advent of Turkey’s current ruling party, doctors in public hospitals have faced more and more pressure to take on an increasing number of patients (an eye doctor I talked to can see up to 50 patients for glasses fittings in a single day) and when they get burned out/want to make more money, they open private clinics (like my first doctor who had found it more profitable not to be a professor) or find employment in private hospitals.  Private hospitals are thus more expensive primarily because they aren’t covered by government insurance, and because their employees aren’t on the government payroll.  The service you are paying for may be no different – and may not actually be up to the same [medical] standards. The same goes for the rooms – many are not nicer than those at public hospitals.

So going to a private hospital really seems to be a sort of status symbol – a signifier that you can pay.  But just as I prefer the trolleybus over taxis in Bishkek (some taxis are nice, but it’s rather a gamble and at least the trolley is predictably safe,  clean, and runs at a set speed along a set line), I don’t see the need to pay more for a private hospital.  Medical education in Turkey is generally considered to be very high quality.  My doctor is excellent, the medical students looking after patients are motivated, and I’ve gotten everything I’ve needed.  Even the hospital food isn’t bad.  I’ll pay $100 extra to stay in a private room for birth – but I don’t see the need to pay a lot more to stay in a private hospital, just for the outfit. Interesting thing from the photos above – the room decoration may be different, but the hospital beds are exactly the same.  I’d rather use our insurance and save the money to pay for other things that actually make a difference – like going on a seaside vacation in July or sending our kid to art classes a few years down the line.




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