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Experiencing an urgent health problem is one of the situations in which a person feels most vulnerable and helpless. While patients and their relatives focus solely on obtaining medical care during this process, they may, in panic and anxiety, overlook the nature of the hospital, the charges and their financial obligations. So, can private hospitals charge fees for emergency department services? Read our article, in which we address this issue within the framework of the relevant legislation and the decisions of the Court of Cassation (Yargıtay)!
Emergency health services are an area in which a rapid and effective response is of vital importance in situations that threaten an individual's life. For this reason, there are specific statutory provisions, constitutional provisions and international conventions in Türkiye governing the charging of fees for services provided in the emergency departments of private hospitals. In this article, whether private hospitals may charge fees in their emergency departments will be assessed in the light of the relevant legislation, the decisions of the Court of Cassation (Yargıtay), the relevant articles of the Constitution and the international conventions to which Türkiye is a party; the legal remedies for the refund of amounts unlawfully collected will also be discussed.
The Constitution of the Republic of Türkiye defines access to health services as a fundamental right. Article 56 of the Constitution, with the words "Everyone has the right to live in a healthy and balanced environment.", states that the State is obliged to ensure that everyone can lead their life in physical and mental health. In this context, access to emergency health services is recognised as a fundamental human right. Furthermore, Article 17 of the Constitution guarantees the right to life of individuals with the provision "Everyone has the right to life and the right to protect and develop his/her corporeal and spiritual existence." Emergency health services are an indispensable element for the protection of the right to life, and any obstruction of access to these services constitutes a violation of Article 17 of the Constitution.
On the other hand, Türkiye is a party to various international conventions that guarantee access to health services. One of them is the United Nations International Covenant on Economic, Social and Cultural Rights. Article 12 of this Covenant recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Restricting access to emergency health services, or charging fees for these services, may amount to a violation of this Covenant. In addition, Article 2 of the European Convention on Human Rights protects the right to life. Obstructing access to emergency health services, or charging fees for these services, may be regarded as a violation of the right to life.
In our country, the emergency department services of private hospitals are shaped by various statutory provisions. Pursuant to Article 21 of the Regulation on Private Hospitals (Özel Hastaneler Yönetmeliği), private hospitals are obliged to provide emergency health services, to admit emergency cases irrespective of whether the patient has health insurance or the ability to pay, and to provide the necessary medical intervention without delay. Moreover, pursuant to Article 32 of the Law No. 2219 on Private Hospitals (Hususi Hastaneler Kanunu), private hospitals are under an obligation to admit patients in emergencies and to administer the necessary treatment. This Law provides that services in the provision of emergency health services are to be rendered irrespective of the patients' financial circumstances.
In many of its decisions on the matter, the Court of Cassation (Yargıtay) has persistently and expressly stated that a decision must be made according to the result of an expert report to be obtained on the basis of the provisions of the Social Security legislation. According to the Court of Cassation (Yargıtay), whether the patient was admitted through the emergency department, whether the reason for the emergency admission required urgent intervention, when the patient reached a stable condition and, accordingly, whether a fee may be charged must all be determined by an expert report. Indeed, a private hospital may not charge a fee to a patient in cases requiring urgent intervention, such as a traffic accident, cerebral haemorrhage, a panic attack and the like, until the patient has been stabilised. As for interventions carried out after the patient has become stable, whether a fee may be charged must be decided according to the type of intervention, with reference to the legislation and the Health Implementation Communiqué (Sağlık Uygulama Tebliği). (Court of Cassation 13th Civil Chamber, 2017/1812 E., 2020/418 K.; Court of Cassation 13th Civil Chamber, 2017/802 E., 2018/7247 K.; Court of Cassation 13th Civil Chamber, 2016/11909 E., 2018/12442 K.; Court of Cassation 13th Civil Chamber, 2015/42095 E., 2017/4693 K.)
In conclusion, in the emergency departments of private hospitals in Türkiye, it is a legal obligation to provide emergency health services irrespective of whether patients have health insurance or the ability to pay, and not to charge fees for these services. The relevant legislation, the constitutional provisions, the international conventions and the decisions of the Court of Cassation (Yargıtay) all clearly demonstrate that charging fees to patients in emergencies is contrary to law. Accordingly, charging patients fees for services provided in the emergency departments of private hospitals is contrary to the statutory provisions, the constitutional provisions, the international conventions and case law. Where a fee has been collected from a patient who was admitted to a private hospital through the emergency department and received services because of an emergency health condition, it is possible to obtain a refund of the amounts unlawfully collected by applying to the Consumer Arbitration Committee (Tüketici Hakem Heyeti) or the Consumer Court (Tüketici Mahkemesi).
