Of men and machines: The challenge of increasing diagnostic precision in the Turkish health system

Date

2025-9-26

Author

Kaynak, Mehtap Tuğba

Metadata

Show full item record

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Item Usage Stats

2260
views

0
downloads

Cite This

This thesis analyses underdiagnosis as a systemic cost and burden to the Turkish healthcare system, analysing it through three dimensions of diagnostic capacity strain: human, institutional, and technological. Building on Arrow's (1963) economics of uncertainty, underdiagnosis is examined as a systemic outcome of asymmetric information, incentive misalignments, and constrained capacity, reflecting the volumetric capacity increases and health system reforms experienced by the Health Transformation Program increased access, but also intensified pressures on physicians and institutions. Thus, while imaging volumes increased, the marginal informational yield of additional scans was limited by overworked doctors, uneven institutional structures, and variable machine quality. This paradox helps explain why overutilization and underdiagnosis coexist as consequences of systemic imbalance. Then, the empirical analysis combines nationwide patient- and hospital-level datasets from 2015–2016 and 2019–2023. Logistic regression and instrumental variable (IV) models estimate how physician workload, hospital tier, repeat MRI behaviour, and machine quality affect the probability of underdiagnosis, measured via ICD-10 R-coded diagnoses. Results indicate that higher daily patient loads, peripheral hospital environments, and low MRI quality significantly increase diagnostic uncertainty. IV estimates further confirm that both physician workload and repeat MRI rates causally elevate underdiagnosis probabilities. The findings demonstrate that diagnostic precision is constrained simultaneously by human effort, institutional structure, and technological reliability. Türkiye's experience illustrates a broader lesson: expanding access without embedding quality safeguards risks entrenching inefficiency and underdiagnosis. Policy implications include recalibrating performance incentives, ensuring adequate staffing, monitoring repeat imaging as a quality metric, and ensuring that access gains translate into real improvements in patient outcomes.

Subject Keywords

Health Economics, Diagnostic Capacity, Underdiagnosis, Magnetic Resonance Imaging (MRI)

URI

https://hdl.handle.net/11511/116001

Collections

Graduate School of Social Sciences, Thesis