Turkey’s so-called city hospitals — sprawling medical complexes that President Recep Tayyip Erdogan has touted as a “dream” project — have come to produce such colossal bills for taxpayers that not even prodigality could explain away the irrational “build-operate-lease” model on which they rest. While the urgency of the COVID-19 pandemic has overshadowed the unprecedented costs, monthly budget spending figures by the Health Ministry suggest that the city hospitals might swallow up tens of billions of dollars in public money by the time their 25-year contracts with the government end.

Amid Turkey’s growing economic woes, the companies operating the hospitals were paid 4.8 billion Turkish liras ($645.5 million) by the government for rent and services in the first seven months of the year, with the two categories representing roughly equal sums. Based on the cost of publicly owned hospitals, that money could have financed the construction of 10 hospitals with a capacity of 1,000 beds each. Moreover, the contracts have been denominated in euros, meaning that the cost of the payments the companies receive keep increasing amid the continued depreciation of the lira.

Facilitating access to health care was a major priority of the ruling Justice and Development Party (AKP) when it came to power 18 years ago. In its early years in power, the AKP enjoyed the budgetary means to step up spending on health care as the Turkish economy grew, boosted by a steady inflow of foreign capital. Though the burden of expansion was foisted on medical workers, mainly doctors, the electorate was happy with its easier access to health care, which became one of the main lynchpins of the AKP’s consecutive election wins. Yet the improvement was more quantitative than qualitative.

Encouraged by the popular content, the AKP turned to a public-private partnership model, which Britain had used, to launch the new city hospitals. Instead of using its own budget to build hospitals, the government encouraged companies to erect giant health care complexes, offering them generous incentives, including the allocation of land. Accordingly, the government would pay rent to the companies to use the buildings, in addition to euro-denominated service fees in areas such as physiotherapy, radiology and pathology. Other facilities in and around the complexes, including cafes, canteens, nurseries and hotels, as well as services such as car parking, cleaning and information management are similarly operated by the contractors.