One Plane Ticket, Multiple Responsibilities: How Should Health Tourism Contracts Be Drafted?

Why is a standard service contract insufficient in health tourism?

Medical tourism is a multifaceted legal relationship where an individual travels to another country for treatment, receives healthcare services, and often benefits from transportation, accommodation, translation, transfers, escort, and post-treatment follow-up services.

In this process, the patient is not only interacting with the physician. Depending on the specifics of the case;

• Health facility,
• The physician who performed the intervention,
• International health tourism intermediary organization,
• Travel agency,
• Hotel or accommodation establishment,
• The transfer company,
• Interpreter,
• Insurance company

They can be separate parties to the contract or service chain.

Therefore, regulating health tourism relationships with a single-page "patient admission form" or a generic "package deal" creates serious legal risks. The scope of healthcare services, the role of the intermediary organization, pricing, complications, post-treatment follow-up, personal health data, and dispute resolution must be clearly separated.

Legal basis: What legislation governs health tourism contracts?

The fundamental regulatory basis for health tourism contracts the Regulation on International Health Tourism and Tourist Health,This Regulation replaces the previous regulation from 2017 and introduces new authorization, monitoring, quality, and service standards for healthcare facilities and intermediary organizations conducting international health tourism activities. The legal basis of the Regulation is the relevant provisions and supplementary articles of Article 9 of the Basic Law on Health Services No. 3359.

When preparing a health tourism contract, one cannot be bound solely by this Regulation. Depending on the nature of the contract, additional measures may also be taken

• Turkish Code of Obligations No. 6098,
• Law No. 6502 on Consumer Protection,
• Law No. 1219 on the Manner of Practice of Medicine and Related Professions,
• Law No. 3359 on Basic Health Services,
• Patient Rights Regulation,
• Law No. 6698 on the Protection of Personal Data,
• Regulation on Personal Health Data,
• Law No. 5718 on International Private Law and Procedural Law,
• Depending on the nature of the activity, the Travel Agencies and Travel Agencies Association Law No. 1618 applies
• Regulations regarding promotion and information in health services

applicable.

The relationship established between a private healthcare institution and an individual patient for a fee is mostly considered a consumer transaction. Therefore, the contract terms must be clear, understandable, and balanced; they must not contain terms that violate the principle of fairness and are detrimental to the patient; and they must be regulated in accordance with the provisions regarding defective services. Law No. 6502 considers services provided for a fee or benefit as falling within the scope of consumer transactions.

Instead of a single contract, a "contract architecture" should be established

Instead of cramming all obligations in health tourism relationships into a single document, separate, complementary contracts and information documents should be prepared.

1. Healthcare contract between the patient and the healthcare facility

This contract should regulate diagnosis, treatment, surgery, care, physician services, medical follow-up, and the responsibilities of the healthcare facility.

The specific institution providing the healthcare service must be clearly stated. The hospital or clinic's trade name, license information, health tourism authorization certificate, address, and contact information should be included in the contract.

2. Mediation and organizational agreement between the patient and the mediating institution

The intermediary institution;

• Healthcare facility survey,
• Appointment scheduling,
• The treatment offer is communicated to the patient
• Translation,
• Transfer,
• Accomodation,
• Escort and communication coordination

It should be clearly defined what services it undertakes, such as those listed.

The intermediary agency should not present itself as a healthcare facility or the party providing the treatment. In advertising regulations that came into effect after 2025, it was also accepted that the intermediary agency must state that it does not provide the healthcare service itself, but that the service it is facilitating is provided by the relevant healthcare facility.

3. Cooperation protocol between the healthcare facility and the intermediary organization

In addition to the contracts made with the patient, there should be a separate commercial protocol between the healthcare facility and the intermediary organization.

In this protocol;

• Patient referral procedure,
• Authorization documents of the parties,
• Commission or service fee,
• Billing,
• Transfer of patient data,
• Promotional activities,
• Complaint management,
• Emergency communication,
• Post-treatment follow-up,
• The relationship between fault and recourse

It should be regulated.

The contract signed between the intermediary agency and the patient should not contradict the protocol it has with the healthcare facility. Otherwise, it becomes unclear to the patient who is responsible for which service.

4. Informed consent documents

A treatment agreement and informed consent are not the same document.

A contract regulates the commercial and legal obligations of the parties. Informed consent, on the other hand, ensures that the patient gives permission for a specific medical procedure after understanding its risks and alternatives.

Therefore, a general contractual clause such as "The patient accepts all complications" does not replace proper medical information.

5. KVKK (Personal Data Protection Law) information text and necessary data transfer documents

Health information is considered special category personal data. A patient's test results, photographs, passport information, surgical plans, and medical history may be transferred between hospitals, intermediary agencies, translators, insurance companies, or third parties abroad.

Therefore, the data processing and transfer process should not be glossed over with a vague paragraph within a commercial contract; a GDPR disclosure text, an explicit consent text where necessary, and data processor agreements should also be prepared.

First check: Do the parties have the necessary authorization documents?

Healthcare facilities and intermediary organizations operating in the field of international health tourism must be authorized under the relevant legislation. The authorization status of healthcare facilities and intermediary organizations should be checked against the Ministry of Health's current lists before a contract is signed.

A contract made with a clinic or organization company that does not have the necessary license;

• Administrative sanctions,
• Suspension of activity,
• Deceiving the consumer,
• Impossibility of performing the contract,
• Compensation and reimbursement liability

This can lead to consequences such as these.

The Ministry of Health mandates that hospitals, medical centers, laboratories, and dialysis centers currently holding health tourism licenses be accredited by TÜSKA (Turkish Health Institute) by December 31, 2026; and that other healthcare facilities complete the specified certification process. Therefore, in long-term cooperation agreements, suspension or cancellation of the license, or failure to complete accreditation, should be specifically stipulated as grounds for termination.

The parties to the contract must be listed completely and accurately

It is not sufficient to simply list the trademarks of the parties in a health tourism contract. The contract must also include:

• The full trade name of the healthcare facility is:
• Tax and MERSIS information,
• License and authorization document information,
• The full name and authorization document of the intermediary institution
• The patient's full name as it appears on the passport,
• Citizenship,
• Passport number,
• Foreign address,
• Email and phone information,
• Name and title of authorized signatories

It should be included.

If a service is advertised under one brand name but the invoice is issued by another company, this relationship must be clearly explained. It should not be left unclear which company the patient paid, which company provided the healthcare service, and which intermediary agency was involved.

The scope of treatment should not be turned into a guarantee of a definitive outcome

The medical procedures planned in the contract should be described as clearly as possible. However, a definitive surgical plan should not be formulated based on photographs or reports sent remotely if the patient has not yet undergone a physical examination.

In this case, the contract states:

• The preliminary assessment was conducted remotely
• The final treatment decision will be made after a face-to-face examination
• The physician may change the procedure or deem the treatment inappropriate due to new medical findings
• How to get a refund in such a situation

It must be clearly regulated.

Guaranteed statements such as "the patient will be completely cured," "there will be no scarring," "100% success will be achieved," or "results will be obtained in a single session" should be avoided. However, concrete promises made to the patient by the clinic or intermediary organization in advertisements and correspondence can later be used in evaluating the scope of the contract and claims of defective service.

The package price should list each item individually

A significant portion of disputes in health tourism stem from a lack of clarity regarding the scope of the package price communicated to the patient.

The contract must clearly indicate which of the following items the price includes:

• Doctor's fee,
• Hospital or operating room fees,
• Anesthesia,
• Implants and medical devices,
• Laboratory and imaging,
• Medicines,
• Intensive care,
• Hospitalization,
• Companion expenses,
• Translation,
• Airport transfer,
• Urban transportation,
• Hotel and accommodation,
• Follow-up examinations,
• Revision processes,
• Treatment of complications,
• Flight ticket.

The phrase "all-inclusive package" alone is not sufficient. Services not included should also be listed.

If additional procedures are required during treatment, the patient must be informed in advance, their written consent should be obtained if possible, and a separate arrangement should be made for emergency interventions.

Currency, exchange rate, and payment method should not be left unclear

Medical tourism fees are generally determined in euros, dollars, or pounds sterling. The contract should include:

• Payment currency,
• Deposit amount,
• The due date for the remaining payment,
• If payment is to be made in Turkish Lira, the exchange rate to be applied is:
• Bank and transfer fees,
• Credit card commission,
• Taxes,
• The company account to which the payment will be made,
• The party that will issue the invoice

It must be clearly shown.

The legal consequences may differ depending on whether the payment is made to the physician's personal account, the intermediary agency's account, or the healthcare facility's account. The patient should be able to understand which service they are paying for and to which party.

Cancellation and refund policies should be determined before the patient arrives

Medical tourism patient;

• Inability to obtain a visa,
• Flight cancellation,
• Changes in health status,
• The doctor may not deem the intervention appropriate
• Risks are identified during pre-operative examinations
• The hospital postponed the operation

They may not be able to use the service due to this reason.

The contract should clearly state the conditions under which the deposit will be refunded, what fees may be deducted, and the timeframe for the refund.

Absolute clauses such as "No payment will be refunded if the patient does not attend for any reason" can raise concerns about unfair terms and excessive penalties under consumer law, especially in cases where healthcare services are not provided at all.

In cases where the healthcare facility is unable to provide the service, the physician changes, the license is suspended, or the operation is canceled due to reasons originating from the facility, full refunds and compensation for the patient's direct losses should be regulated separately.

The information should be provided in language the patient can understand

It is not sufficient to have only a consent form signed in Turkish by a foreign patient. The patient must also:

• The illness or current condition,
• The planned intervention,
• The risks of the intervention,
• Possible complications,
• Alternative therapies,
• The consequences of refusing treatment,
• Recovery time,
• Possibility of revision

They should learn it in a language they can understand.

If an interpreter was used, the interpreter's identity, language spoken, and participation in the interview must be recorded. The consent form and the translated text must have the same content.

If translation services are provided by an intermediary agency, the responsibility for inaccurate or incomplete translations should be stipulated in the contract. However, the healthcare institution cannot completely delegate its obligation to provide medical information to the intermediary agency.

Complications, malpractice, and revision should be distinguished from each other

The concept of complication must be clearly defined in the agreement. A risk accepted by medical science that can arise despite appropriate intervention is not the same as a physician's negligent practice.

The contract states that;

• What are the known complications?
• Which healthcare facility will intervene if a complication arises,
• Who will pay for the treatment costs?
• What should the patient do if they encounter problems after returning to their country?
• Whether the revision process is free of charge,
• Medical waiting period for revision,
• Who is responsible for transportation and accommodation expenses?

It should be organized in detail.

The clause "no liability will be accepted if complications occur" is not a valid or safe solution. Liability may arise if complications are not diagnosed in a timely manner, are mismanaged, or are not disclosed to the patient beforehand.

The new health tourism regulations also include obligations regarding complication insurance for surgical procedures. Therefore, the scope, limits, exclusions, and how the patient can access insurance for complications should be clearly explained in the contract or supplementary information document.

Post-treatment follow-up cannot be excluded from the contract

Medical tourists often return to their home country shortly after the procedure. Therefore, the post-discharge process must be clearly defined in the contract.

The contract states that;

• Inspection dates,
• The minimum duration the patient must stay in Türkiye,
• Remote interview method,
• Emergency hotline,
• Method of sending photos or reports,
• Coordination with the patient's doctor in their home country,
• Prescription and medication tracking,
• whether there is anything preventing them from traveling,
• What symptoms require emergency medical attention?

It should be noted.

The consequences of a patient returning early, failing to attend a follow-up appointment, or not following physician instructions can also be regulated. However, a healthcare facility cannot, through a general clause, place all follow-up responsibility on the patient.

In which country and by whom will the health data be stored?

In health tourism, health data often circulates across borders. A patient's documents may be shared with a doctor, insurer, intermediary organization, call center, or cloud service provider abroad.

The Turkish Personal Data Protection Law (KVKK) currently includes adequacy decisions, appropriate safeguards, standard contracts, and other transfer methods specified in the law regarding data transfer abroad. Standard contract texts and implementation documents were published by the Board in 2024. Therefore, simply adding the phrase "The patient agrees to the transfer of their data abroad" to a commercial contract is insufficient.

In the contract and GDPR documents;

• Who is the data controller?
• Whether the intermediary organization is a data controller or a data processor,
• Which data was collected,
• For what purposes the data is used,
• To which individuals or countries it was transferred,
• Whether or not foreign servers are used,
• Storage time,
• Data security measures,
• Patient's rights to appeal

It should be explained.

Since health data is considered special categories of personal data, the processing activity must be based on one of the legal requirements in the current Article 6 of the KVKK (Law on Protection of Personal Data) and adequate security measures must be taken.

Separate permission is required for photos and videos

Consent to treatment does not imply consent to the use of pre- and post-operative images of the patient for advertising purposes.

For photo and video use;

• Intended use,
• The platform where it will be published,
• The country where it will be used,
• Whether the image will be anonymized or not,
• Whether or not it will be used in sponsored advertising,
• Method of revoking permission

It should be organized in a separate document.

The use of patient stories or images in promotional activities targeting foreign countries within the scope of health tourism is subject to documentation of the patient's explicit consent and respect for patient privacy. Furthermore, there are rules requiring promotional activities to be conducted on separate platforms targeting foreign countries and the publication of a health tourism authorization certificate.

Providing medical treatment should not be conditional on a patient consenting to the use of their image for advertising purposes.

The intermediary agency cannot guarantee medical outcomes

The role of the intermediary organization and the role of the healthcare facility must be clearly separated.

The intermediary organization;

• We shouldn't make a diagnosis
• They should not choose medical intervention,
• One should not guarantee success on behalf of the doctor
• It should not present itself as a clinic or hospital
• They should not answer the patient's medical questions in place of the authorized physician.

However, the intermediary agency cannot absolve itself of all responsibility simply by claiming to be the "communicator." It remains liable for its own services if it provides incorrect information about the healthcare facility, works with an unauthorized organization, sells services it did not promise, fails to refund payments, or does not adequately provide transfer and accommodation services.

What is said in the advertisement should not contradict the contract

There should be consistency between the healthcare facility's website, social media advertising, patient representative messages, price quote, and the final contract.

In the advertisement;

• Surgery performed by a specific physician
• Specific brand of implant,
• Five-star hotel,
• Free revision,
• Lifetime surveillance,
• Certain success,
• No trace left

If promises have been made, the complete elimination of these promises in the contract may give rise to a dispute.

The healthcare promotion regulation dated November 12, 2025, allows organizations with health tourism authorization certificates to promote their services abroad through separate channels and under specific conditions, but it does not permit misleading advertising. The intermediary organization must not give the impression of being a healthcare facility and must operate in compliance with the HealthTürkiye system.

How should the applicable law and competent court be determined?

Since health tourism contracts involve a foreign element, the applicable law and dispute resolution methods must be clearly defined.

The contract may stipulate that Turkish law shall apply and that Turkish courts shall have jurisdiction. However, when choosing law and jurisdiction;

• The patient's status as a consumer,
• Mandatory provisions protecting consumers,
• Providing healthcare services in Türkiye,
• The country where the intermediary institution is located,
• Where the payment was made,
• The need for the decision to be enforced in another country

should be taken into consideration.

Unilateral provisions stating that "the patient can only file a lawsuit in Türkiye and only in the court located at the headquarters of the healthcare institution" may be controversial from a consumer law perspective.

If an arbitration clause is to be used, the patient's situation, the amount in dispute, the arbitration costs, and whether the clause was genuinely negotiated should be evaluated. Arbitration or foreign court clauses hidden in standard contracts that effectively render the patient's right to sue unusable are risky.

The language of the agreement and which text takes precedence must be determined

The contract should be prepared in a language the patient understands, at least. If two texts are to be prepared, one in Turkish and one in a foreign language;

• Both texts contain the same content
• Which text should be considered authoritative in case of a conflict?
• The patient read and understood the text,
• Whether an interpreter was used

It should be noted.

The provision stating that only the Turkish text is valid does not resolve every dispute for patients who do not speak Turkish and have accepted the contract in a foreign language. The patient may also incur additional liability due to relying on the translation provided.

Risky clauses that should not be in the contract

The use of the following provisions may give rise to serious validity and liability issues:

• "The patient has accepted all complications and cannot claim any rights."
• "Neither the doctor nor the hospital is liable under any circumstances."
• "Payments made are non-refundable under any circumstances."
• "The healthcare provider can unilaterally change the price."
• "Patient photographs may be used indefinitely and without limitation."
• "The physician can perform any procedure he deems necessary without obtaining consent."
• "The intermediary agency is not responsible for any services."
• "The patient hereby waives all rights to sue and file a complaint."
• "Only the healthcare institution can decide whether revision is needed, and the decision cannot be appealed."
• "All responsibility ends once the patient returns to their country."

Such provisions may be deemed invalid on the grounds of violating mandatory legal principles, personal rights, consumer law, and the principle of good faith.

Medical tourism contract implementation checklist

The following checks should be carried out before the contract is signed:

1. The authorization documents of the healthcare facility and the intermediary organization must be verified.
2. The organization providing the healthcare service and the organization receiving the payment must be clearly identified.
3. Treatment contracts and intermediary service contracts should be distinguished.
4. It should be explained that the final treatment plan may change after the examination.
5. All services, both included and excluded from the package price, should be listed.
6. Deposit, cancellation, and refund terms should be balanced.
7. The concepts of complication, revision, and malpractice should not be confused with one another.
8. Informed consent must be obtained separately from the commercial contract.
9. The patient should be informed in their own language.
10. KVKK (Personal Data Protection Law) documents, health data, and documents for data transfer abroad must be prepared.
11. Permission for photography and advertising should be kept separate.
12. Post-treatment follow-up and emergency communication should be arranged.
13. Insurance coverage and application procedures should be explained.
14. The advertisement, price offer, and contract terms must be consistent with each other.
15. The applicable law, the competent court, and the method of dispute resolution must be clearly defined.

Conclusion: A well-prepared contract protects not only the hospital but also the patient and the intermediary agency

The aim of a health tourism contract is not to eliminate the healthcare provider's liability as much as possible. Such an approach would both undermine the patient's trust and increase the risk of the contract provisions being deemed invalid.

A well-prepared contract;

• What the patient bought,
• Who will provide the healthcare service?
• What tasks does the intermediary organization undertake?
• What does the fee include?
• How to manage the complication and revision process,
• With whom your personal health data will be shared,
• Which course of action to take in case of a dispute

It should be presented beforehand and in a clear manner.

Healthcare services, intermediary services, informed consent, and personal data processes should be regulated by separate documents; however, all documents should form a consistent contractual system. The biggest legal mistake in health tourism is assuming that a single package is being sold to the patient, leaving responsibility for healthcare, transportation, accommodation, data transfer, and complications within the same vague text.