Towards equity in healthcare workforce distribution: regional progress and remaining gaps in türkiye, 2007–2023
1
Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
2
Department of Public Health, Hacettepe University, Ankara, Turkey
Popul. Med. 2026;8(Supplement Supplement 1):A1603
ABSTRACT
BACKGROUND:
Türkiye has historically had weaker healthcare workforce distribution compared to European neighbours [1]. Following comprehensive health system reforms in 2003, the country substantially expanded health services [2]. However, the effects of these reforms on regional distribution of healthcare resources over time remains incompletely quantified.
METHODS:
Publicly available Turkish Statistical Institute data were used to construct a regional panel for 2007–2023 using annual counts of physicians by cadre, nurses, and hospitals. Densities per 100,000 population were calculated for each of Turkey's 12 statistical regions. Population-weighted Gini coefficients quantified inequality for each indicator, with linear regression estimating temporal trends.
RESULTS:
National workforce densities increased substantially between 2007 and 2023: specialist physicians rose from 77.1 to 118.6 per 100000 (+53.7%), general practitioners from 49.0 to 64.3, residents from 27.5 to 56.3, and nurses from 134.1 to 290.8. Population-weighted Gini coefficients declined significantly for general practitioners (0.13 to 0.05, -63%), nurses (0.11 to 0.06, -43%), and specialists (0.21 to 0.15, -30%) (all p≤0.008). However, regional disparities persisted: in 2023, specialist density ranged from 73.0 (Southeast Anatolia) to 170.5 (West Anatolia) per 100000. Inequality in university hospitals increased (Gini 0.37 to 46).
CONCLUSIONS:
Türkiye’s health system has undergone continuous transformation since 2003, most notably with the introduction of the Family Medicine System in 2010 as part of nationwide health reforms [2,3]. However, even though these reforms contributed to the expansion of the health workforce and improvements in geographical equity; regional disparities are persistent. Increasing concentration of tertiary care facilities, disparities in specialist services and continued gaps compared to OECD standards indicate that the reforms have not fully addressed the dual challenge of workforce scarcity and inequality [1]. Targeted policies to strengthen specialist services and tertiary infrastructure in underserved regions therefore remain critical priorities.
Türkiye has historically had weaker healthcare workforce distribution compared to European neighbours [1]. Following comprehensive health system reforms in 2003, the country substantially expanded health services [2]. However, the effects of these reforms on regional distribution of healthcare resources over time remains incompletely quantified.
METHODS:
Publicly available Turkish Statistical Institute data were used to construct a regional panel for 2007–2023 using annual counts of physicians by cadre, nurses, and hospitals. Densities per 100,000 population were calculated for each of Turkey's 12 statistical regions. Population-weighted Gini coefficients quantified inequality for each indicator, with linear regression estimating temporal trends.
RESULTS:
National workforce densities increased substantially between 2007 and 2023: specialist physicians rose from 77.1 to 118.6 per 100000 (+53.7%), general practitioners from 49.0 to 64.3, residents from 27.5 to 56.3, and nurses from 134.1 to 290.8. Population-weighted Gini coefficients declined significantly for general practitioners (0.13 to 0.05, -63%), nurses (0.11 to 0.06, -43%), and specialists (0.21 to 0.15, -30%) (all p≤0.008). However, regional disparities persisted: in 2023, specialist density ranged from 73.0 (Southeast Anatolia) to 170.5 (West Anatolia) per 100000. Inequality in university hospitals increased (Gini 0.37 to 46).
CONCLUSIONS:
Türkiye’s health system has undergone continuous transformation since 2003, most notably with the introduction of the Family Medicine System in 2010 as part of nationwide health reforms [2,3]. However, even though these reforms contributed to the expansion of the health workforce and improvements in geographical equity; regional disparities are persistent. Increasing concentration of tertiary care facilities, disparities in specialist services and continued gaps compared to OECD standards indicate that the reforms have not fully addressed the dual challenge of workforce scarcity and inequality [1]. Targeted policies to strengthen specialist services and tertiary infrastructure in underserved regions therefore remain critical priorities.
| eISSN: | 2654-1459 |
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