Diabetes burden and health expenditure in Türkiye and OECD countries: A value-based health care perspective

Abstract

Background & Objective: Diabetes mellitus is a major global cause of morbidity and mortality. In Türkiye, the diabetes burden has increased markedly, raising concerns about health system performance and expenditures. Our objective was to compare diabetes burden, health expenditures, and avoidable hospital admissions in Türkiye and Organisation for Economic Co-operation and Development (OECD) countries (2010-2021), and to examine their associations within a value-based health care (VBHC) framework.

Methodology: This retrospective cross-national comparative study examined Türkiye and OECD countries between 2010 to 2021. Data were obtained from IHME-GBD-2021, OECD Health Statistics, and WHO National Health Accounts. Trend analyses and regression models were used to assess associations between diabetes-related disability-adjusted life years (DALYs), health expenditures, and financing indicators.

Results: Türkiye’s diabetes-related DALY levels were consistently higher than the OECD average, with the gap widening from 18% in 2010 to 34% in 2021 (p=0.008). Preventable hospital admissions were also more frequent in Türkiye (242.7 vs. 147.9 per 100,000; p=0.006). Across OECD countries, higher per capita health expenditures showed negative associations with DALY rates, whereas in Türkiye rising expenditures were observed alongside higher DALYs. Out-of-pocket spending (OOPS) correlated positively with the diabetes burden in Türkiye, while a higher public share of expenditure (GGHE-D) was associated with reduced OOPS.

Conclusion: Despite rising health expenditures, proportional improvements in diabetes outcomes have not been achieved in Türkiye. Strengthening primary care, preventive strategies, outcome measurement, and financial protection may support the transition toward value-based health care and help reduce the diabetes burden.