The Court of Accounts' 2025 regularity audit report on the Health Ministry includes 22 pages of findings on city hospitals operated under the public-private partnership (PPP) model.
The Court of Accounts concluded that the ministry’s 2025 financial reports and statements generally contained “accurate and reliable information in all material respects.” However, its findings on city hospitals were presented separately from its audit opinion on the financial statements, under the “Other Findings” section on pages 32-53.
Final completion process unresolved at 17 hospitals
City hospital contracts require the Health Ministry to issue a final completion certificate 24 months after the issuance of the practical completion certificate. The Court of Accounts found that, as of the end of 2025, the ministry had not completed this process at 17 city hospitals even though the 24-month period had expired.
Kütahya City Hospital entered its operating phase in Mar 2024 and had therefore not yet reached the two-year threshold by the end of 2025.
The failure to close the final accounts also left financial obligations between the ministry and the companies unresolved. The Court of Accounts cited unfinished or omitted construction work, missing medical equipment and furnishings, discrepancies involving commercial and administrative areas, VAT exemptions and timing differences caused by projects being completed early or late.
The Health Ministry said it introduced new arrangements for final account procedures in 2025 and that commissions began work on the Elazığ, Eskişehir and İzmir projects in Jan 2026. The Court of Accounts said the ministry had still not completed the process for any hospital as of 2026.
Construction began before official site handover at all 18 hospitals
The Court of Accounts found that companies began construction before the official site handover at all 18 city hospitals it examined.
At Ankara Bilkent City Hospital, the company started construction about six months before the formal site handover. The ministry deducted those six months from the hospital’s operating period.
It did not make the same adjustment at the other city hospitals.
The Court of Accounts called on the ministry to use the actual construction start date at the other hospitals as well and recalculate their operating periods accordingly.
Unfinished work not reflected in payments
The Court of Accounts identified work that had been included in projects but was later abandoned by the ministry or left undone, incomplete or unfinished by companies. Some equipment was also not delivered.
Despite these shortcomings, the ministry did not deduct the value of the missing work and equipment from the total fixed investment amount or the related service fees.
The Court of Accounts said the ministry should recalculate investment amounts and service payments to reflect unfinished work and missing equipment.
VAT exemptions granted to companies during the investment phase were also not reflected in the projects’ financial terms.
Under the relevant legislation, the financing cost calculated for projects benefiting from a VAT exemption, or the equivalent period, must be deducted from the rent amount, lease term or operating period, depending on the nature of the project.
The Court of Accounts found that the ministry had not made these adjustments in projects benefiting from the exemption.
It also found that, at some hospitals, companies were responsible for heating and cooling costs in areas used for laundry, catering, laboratory, imaging and sterilization services, but the ministry had not deducted those expenses from service payments.
The ministry said it had initiated deductions at 17 hospitals. The Court of Accounts said the documents submitted to it allowed it to verify deductions only at the Adana, Bursa, Elazığ, Kocaeli, Kütahya, Manisa, Tekirdağ and Mersin city hospitals. It said the procedures had not been completed at the other 10 hospitals.
Some companies used areas outside approved projects
The Court of Accounts found that some companies carried out commercial activities in areas larger than those specified in approved projects.
At some hospitals, commercial operators also used storage areas that were supposed to be reserved for the administration.
The ministry did not reflect this additional use in occupancy charges.
Noting that companies may have generated additional revenue from the extra commercial space, the Court of Accounts called on the ministry to calculate the financial impact of the excess use.
At the Kütahya and Tekirdağ city hospitals, the ministry had also not completed the acceptance process for commercial areas or set the applicable commercial activity fees.
The Court of Accounts called on the ministry to identify the additional commercial areas and calculate the amounts companies should pay for using them.
Missing and noncompliant medical equipment
The Court of Accounts also found shortcomings in medical equipment and furnishings that companies were contractually required to provide.
Acceptance records at Kütahya City Hospital listed some medical devices as “noncompliant.” Some devices lacked records in the Product Tracking System or certificates of service competence from the Turkish Standards Institution, while integration of some devices into the Hospital Information Management System had not been completed.
The company also delivered some furnishings incomplete.
Missing medical equipment was also identified at Kayseri City Hospital.
Faulty medical devices remained out of service for extended periods
The Court of Accounts also found that the ministry and companies had been unable to agree on who should cover the cost of repairing faulty medical devices.
In some cases, the parties could not determine whether malfunctions were caused by the company, the administration or third parties. High insurance deductibles also delayed repairs.
As a result, some medical devices remained out of service for extended periods.
The Court of Accounts said this had caused “disruptions in the provision of health services.”
It also noted that the contracts require companies to provide uninterrupted service despite disputes between the parties.
The Court of Accounts called on the ministry and the companies to jointly determine the causes of equipment failures, establish responsibility and return the devices to service.
Most sterilization delays were not reported
The Court of Accounts found that sterilization of operating room equipment at some city hospitals exceeded contractual time limits.
Most of the delays were not reported to the help desk, and no service failure points were calculated.
The Health Ministry said it had issued warnings to contractors, imposed penalties and service fee deductions, and taken corrective action for previous periods.
The Court of Accounts said the ministry had not provided documents proving these measures and that sterilization delays and failures to report them were continuing.
Market testing was delayed
City hospital contracts require the prices of certain services to be subjected to market testing at specified intervals. The process is intended to determine the most economically advantageous price for services and equipment.
The Court of Accounts found that market testing had not begun at all at the Kayseri, Manisa, İstanbul Başakşehir and Tekirdağ city hospitals.
At the Mersin, Yozgat, Elazığ Fethi Sekin, Ankara and Bursa city hospitals, the ministry completed market testing for some services but had not finalized the process for building and land services, shared services management and the Hospital Information Management System.
The ministry also acknowledged delays in the market testing process.
The Court of Accounts called on the ministry to address the delays and complete the tests according to the contractual schedule.
MP Kara: ‘Findings are made, but no action is taken’
Nermin Yıldırım Kara, an MP for the opposition Republican People’s Party (CHP) from Hatay, said the Court of Accounts findings showed that companies had failed to meet their contractual obligations.
Criticizing the failure to reduce rental or operating periods for companies benefiting from VAT exemptions, Kara said, “The companies are doing whatever they want, and the ministry is simply watching.”
She also argued that failing to deduct construction periods that began before the official site handover from operating periods would result in the public sector making payments to companies for longer periods.
“For years, the Court of Accounts’ findings on city hospitals could fill an encyclopedia,” Kara said. “Findings are made, but no action is taken.”
(VC/VK)
