Türkiye’s growing demand for traditional and complementary medicine has created a difficult regulatory problem. The public continues to seek services such as cupping, leech therapy, phytotherapy, acupuncture, and spiritual healing, but the formal health system has not developed sufficient accessible and affordable capacity to meet this demand. A recent policy analysis by Bostan, Yesildag, and Sevim (2026) examines how Türkiye responded to this mismatch through three consecutive regulations introduced between March 2025 and July 2026.
The study’s central message is straightforward: prohibiting a service does not eliminate demand. When legal providers are unable or unwilling to supply the service, demand moves towards informal, domestic, and unlicensed channels. Türkiye’s policy response therefore represents an alternative to the conventional choice between strict prohibition and complete deregulation. Instead, the government has begun creating licensed and traceable institutional settings in which previously contested activities can be monitored.
A Regulatory Paradox
Türkiye’s health-professions legislation has historically concentrated clinical authority in licensed physicians. The 2014 Traditional and Complementary Medicine Regulation formally incorporated several traditional practices into the healthcare system, but authorized their provision mainly through certified physicians and approved healthcare facilities. This change gave traditional and complementary medicine legal recognition without necessarily creating adequate service capacity.
The article identifies a critical contradiction within this model. Physicians hold the legal authority to provide these services, but the public-sector performance-payment system may discourage them from doing so. According to the interviewed providers, a traditional and complementary medicine consultation lasting approximately 30 minutes may generate the same performance score as a prescription renewal completed in two minutes. Some certified physicians consequently avoid working in traditional and complementary medicine units, while others allow their certificates to remain unused. In one reported example, although five physicians were registered with a hospital unit, one physician treated approximately 90% of its patients. Waiting times reportedly reached six months (Bostan et al., 2026).
This situation can be described as an “authority-without-supply” problem. The state grants exclusive authority to a professional group but maintains financial and organizational conditions that discourage that group from exercising it. Demand does not disappear. It is redirected towards unlicensed providers who may operate beyond effective inspection.
The Patient-Safety Consequences of Unlicensed Provision
The study draws on semi-structured interviews with 58 service providers from Türkiye’s seven geographical regions. Participants included physicians, herbalists, traditional and spiritual healers, academics, and other practitioners. Their accounts reveal several plausible patient-safety risks associated with unlicensed practice.
Reported incidents included permanent scarring caused by improperly performed cupping, the reuse of unsterile blades, a leech allegedly used on multiple clients, burns resulting from improvised treatments, and deaths associated with exposure to sulphur gas at a thermal site. Participants also described an inspection system that operated largely in response to individual complaints rather than through systematic surveillance. Unlicensed services continued to be advertised on social media even after healthcare professionals reported the relevant accounts (Bostan et al., 2026).
These findings should nevertheless be interpreted carefully. The incidents were reported by providers and were not independently confirmed through hospital records, inspection reports, complaint databases, or forensic evidence. The study therefore demonstrates credible risk pathways rather than estimating the prevalence of adverse events. This distinction is important because evidence of possible harm is not equivalent to evidence about how frequently that harm occurs.
Türkiye’s Three-Part Policy Response
Between March 2025 and July 2026, Türkiye introduced three regulations that collectively represent a gradual restructuring of services located at the margins of conventional healthcare.
The first regulation, issued in March 2025, created licensed Health Professional Service Units. It allowed ten categories of allied health professionals to practise independently within defined licensing, equipment, physical-space, and inspection requirements.
The second regulation, issued on 2 July 2026, established a controlled market for medicinal herbal teas. Products within this category must undergo scientific review, receive authorization from the Turkish Medicines and Medical Devices Agency, be registered in the Product Tracking System, and be sold through pharmacies. This creates package-level traceability while maintaining a distinction between medicinal products and food-purpose herbal teas or supplements.
The third regulation, issued on 4 July 2026, created Wellness Centres and Wellness Units. These facilities may provide traditional and complementary practices as non-curative wellness services. They must operate under specified physical conditions and employ a full-time responsible physician. Staff without a formal employment relationship with the centre are prohibited from providing services.
The common policy logic is institutional containment. Instead of attempting to eliminate contested practices or fully integrating them into conventional medical care, the regulations create identifiable locations, licensed providers, responsible professionals, and traceable products. This approach may make previously invisible activities more visible to regulators.
Why Regulation Alone May Be Insufficient
The reforms represent an important institutional development, but their success will depend on implementation. Legal permission does not automatically generate accessible, safe, or geographically equitable services.
The most important unresolved issue is financing. Traditional and complementary services remain largely dependent on out-of-pocket payments, while physician payment incentives are poorly aligned with the time required to provide them. If these financial conditions remain unchanged, physicians may be reluctant to work as responsible professionals in newly established centres. The system could then reproduce the same shortage that originally encouraged unlicensed provision.
Geographical accessibility is another concern. Standalone Wellness Centres require at least 500 square metres of space, while units operating within another facility require at least 300 square metres. These requirements may be affordable in metropolitan markets but difficult to satisfy in small towns and economically disadvantaged regions. Licensed services could therefore become concentrated in urban areas, while informal provision remains dominant in underserved communities.
The regulations may also struggle to reach domestic practices. Herbal preparations, family advice, prayer-based practices, and recommendations circulated through social media take place outside inspectable premises. Facility licensing can improve the safety of visible providers, but it cannot by itself regulate the broader social environment in which people make treatment decisions.
A Future Research Agenda
The limitations identified in the study provide a clear agenda for future research. The first priority should be a prospective evaluation of the new regulations. Researchers should compare conditions before and after implementation by monitoring the number, professional composition, geographical distribution, and survival of licensed service units and Wellness Centres. Rural and urban patterns should be analysed separately to determine whether the reforms reduce or widen inequalities in access.
The second priority should be the inclusion of patients and service users. The current evidence is based exclusively on providers’ perspectives. Nationally representative surveys and qualitative patient studies are needed to examine why people select licensed or unlicensed providers, how they assess credibility, which sources they trust, how much they pay, and whether they disclose traditional medicine use to their physicians. Age, education, income, health literacy, region, chronic disease status, and digital-media use should be incorporated into these analyses.
Third, Türkiye needs an active adverse-event surveillance system for traditional and complementary practices. Hospital records, poison-control data, infection reports, malpractice complaints, inspection findings, and pharmacovigilance databases could be linked to identify injuries and complications. A standardized reporting taxonomy should distinguish the type of intervention, provider qualifications, care setting, product source, preventability, and clinical severity. Without such data, regulation will be guided by striking anecdotes rather than reliable estimates of risk.
Fourth, future studies should evaluate the clinical effectiveness and cost-effectiveness of individual interventions rather than treating traditional and complementary medicine as a single category. Evidence-supported practices should be distinguished from ineffective or harmful ones. This evidence could inform limited public reimbursement for clearly defined indications while preventing insurance coverage from being interpreted as unrestricted scientific endorsement.
Fifth, financing reforms should be tested empirically. Pilot programmes could compare time-adjusted physician payments, bundled payments, limited insurance reimbursement, and protocol-based task-sharing. Outcomes should include waiting times, licensed-provider participation, patient expenditure, substitution away from unlicensed services, and adverse-event rates.
Finally, implementation research should examine whether regulatory safeguards survive in practice. Türkiye’s earlier experience shows that requirements can weaken after formal adoption. Future evaluations should therefore assess inspection frequency, compliance with responsible-physician requirements, certification renewal, continuing professional education, staff affiliation, product traceability, and enforcement against misleading digital advertising.
The Broader Policy Lesson
Türkiye’s experience shows that the boundary between formal healthcare and informal practice cannot be managed solely through prohibition. Regulation must address the economic incentives of professionals, the distribution of authorized services, public trust, digital advertising, product traceability, and patients’ ability to pay.
The new regulations create a potentially useful institutional pathway between unregulated practice and conventional clinical care. However, their true value will depend on whether they produce safer services, reduce informal provision, improve equitable access, and generate measurable patient benefits. For now, they should be understood as a promising regulatory experiment whose outcomes remain to be demonstrated, not as evidence that the underlying problem has already been solved (Bostan et al., 2026).
Reference
Bostan, S., Yesildag, A. Y., & Sevim, F. (2026). Regulating practice at the margins: Türkiye’s sequential policy response to unlicensed traditional, complementary, and independent health service provision, 2025–26. European Journal of Public Health, 36(5), Article ckag150. https://doi.org/10.1093/eurpub/ckag150