Changes over time and determinants of medical imaging devices utilization in Türkiye: A panel data analysis, 2013-2022

Objective: This study aims to examine the regional and temporal variations in the demand for medical imaging services in Türkiye during the 2013-2022 period and to empirically determine the macro-health, socio-demographic, infrastructural, and digital dynamics driving these changes using panel data analysis and analysis of variance methods.Methods: Utilizing data from the Turkish Statistical Institute and the Ministry of Health, a balanced panel dataset was constructed covering the Nomenclature of Territorial Units for Statistics (NUTS) Level-1 regions of Türkiye for the 2013-2022 period. Statistical analyses were conducted using STATA 14.2 software. One-Way Analysis of Variance (ANOVA) and Bonferroni post-hoc tests were applied to investigate the geographical asymmetries in imaging intensities. The most efficient estimator between fixed and random effects models was determined using the Hausman test. Results: Econometric analyses revealed that geriatric population dynamics dominantly drive Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) demand. Ultrasonografi (USG) functions as a routine physical examination extension, whereas Doppler requisitions confirm supplier-induced demand. Coronavirus disease 2019 (COVID-19) induced sharp negative structural breaks in MRI, Echocardiography (ECHO), and mammography screenings due to suspended elective/prophylactic services, while chest CT utilization experienced an anomalous pandemic peak. NUTS-1 ANOVA proved that CT imaging is geographically homogeneous. Conversely, MRI, Doppler USG, ECHO, and mammography asymmetrically cluster in developed western metropolises, whereas USG concentrates in eastern and central regions due to prenatal/pediatric requirements.Conclusion: High-tech imaging demand in Türkiye has decoupled from physical supply, driven instead by defensive medicine reflexes; conversely, vital preventive services face structural and socio-cultural barriers. Rather than investing in redundant equipment, policymakers should establish legal safeguards against malpractice anxieties, promote digital health literacy, and deploy targeted mobile public health strategies to eliminate diagnostic access gaps in underserved regions.