As in most OECD countries, university hospitals are generally the destination of last resort for the patients with the complex needs. University hospitals generally house the most highly trained specialists, in part through their ability to offer a combination of challenging clinical practice and the opportunity to undertake research. Without adjustments to reflect the more complex patients that they see, Turkey’s university hospitals are likely to face the more extreme cases where the operational cost of a service is greater than that reimbursed by die SSI’s flat package rates.