Decomposing health-service volume growth in Türkiye: volume-based physician productivity and physician-density growth in a 12-country OECD comparison.

BACKGROUND: Türkiye's 2003 Health Transformation Programme, combining insurance expansion, primary-care reform and activity-based supplementary payment, was followed by one of the fastest expansions of health-service use among OECD countries with comparable data. Whether it was met by adding physicians or by higher recorded volume per physician has not been quantified.

OBJECTIVE: To decompose Türkiye's health-service volume growth (1990-2019) into physician-density and volume-per-physician margins, and compare the pathway with OECD countries meeting the coverage criteria.

METHODS: Descriptive analysis of OECD Health Statistics and IHME Global Burden of Disease Study 2023 series, 1990-2019. A log-additive identity decomposes per-person volume growth into recorded service volume per physician and physician density. Cross-country comparisons use period means (1990-2002 versus 2003-2019) in a 12-country core selected by an ex ante coverage rule, with sensitivity analyses.

RESULTS: Consultations per physician rose from 1444 (1990) to 5026 (2019). Volume per physician accounted for 82% of consultation growth in 2003-2008 (69% over 2003-2019), growing 11.2 log points a year against 3.6 pre-reform as density growth slowed. The increase was the largest of 12 countries with comparable coverage; comparator medians were negative. Medical-graduate output stayed below its pre-reform mean until 2015.

CONCLUSIONS: The timing is consistent with demand-side reform preceding growth in the training pipeline, most volume growth occurring through higher recorded volume per physician. Reforms expected to raise service use should include prospective workforce planning and monitoring of volume relative to capacity.