KAMU HASTANELERİNDE MEDİKAL TURİZMİNİN GELİŞİMİNİ ETKİLEYEN FAKTÖRLER

Medikal turizm dünya çapında gelişmekte olan bir sektördür. Günümüzde, 50’den fazla ülkede medikal turizmin ulusal bir endüstri haline geldiği tespit edilmiştir. Hindistan, Tayland, Singapur, Malezya gibi Asya ülkeleri popüler medikal turizm yerleri olmasına rağmen, Türkiye medikal turizmde istenilen seviyeye ulaşamamış ve medikal turizm pazarından yeterince pay alamamıştır. Bu çalışmanın amacı, Türkiye'de kamu sektöründe medikal turizmin gelişimini etkileyen faktörlerin tespit edilmesidir. Araştırma Türkiye’de kamu hastanelerinde yürütülmüştür. Araştırmada nitel ve tanımlayıcı araştırma yöntemi benimsenmiştir. Nitel veriler hastane yöneticileri ile derinlemesine görüşerek elde edilmiştir. Araştırmanın evrenini Türkiye’de medikal turizm ile ilgili İstanbul, Antalya, İzmir, Ankara, Muğla, Aydın, Adana ve Kocaeli illerinde görev yapan kamu sağlık kuruluşları yöneticileri oluşturmaktadır. Araştırma sonuçlarına göre Türkiye’de kamu sektöründe medikal turizmin gelişimine etki eden temel faktörler, imaj problemi, tanıtım eksikliği, sağlık politika ve düzenlemeleri, kapasite problemleri, uzman/işgücü eksikliği, dil ve iletişim problemleri, turistik tesis azlığı ve hastane alt yapı problemleri olarak tespit edilmiştir. Anahtar Kelime: Medikal Turizm, Hastane, Sağlık. JEL Sınıflandırma Kodları: I11, I19

Türkiye’de Renal Replasman Tedavi Yöntemlerinin Geri Ödeme Kurumu Perspektifinden Maliyet Analizi

Bu araştırmanın amacı, kronik böbrek yetmezliği tedavisinde uygulanan Renal Replasman Tedavi (RRT) yöntemleri olan hemodiyaliz (HD), periton diyalizi (PD) ve böbrek transplantasyonu (Tx) tedavi seçeneklerinin Sosyal Güvenlik Kurumu (SGK) perspektifinden maliyetlerini tespit etmektir. Bu araştırmanın evrenini Akdeniz Üniversitesi hastanesinde RRT yöntemleri ile tedavi alan hastalar oluşturmaktadır. Araştırmada örneklem çekilmemiş, RRT yöntemi ile tedavi alan hastalarının tamamı alınmıştır. Araştırmada retrospektif maliyet yöntemi uygulanmıştır. Tedavi işlemlerin fiyatlandırılmasında güncel Sağlık Uygulama Tebliği (SUT) puanı/fiyatı esas alınmıştır. İlaçların kamu fiyatının tespit edilmesinde RxMediaPharma® İnteraktif İlaç Bilgi Kaynağı programından ve Türk Eczacılar Birliğinin web uygulaması Tebrp ilaç veri tabanı programından yararlanılmıştır. Bu çalışmada, HD’in hasta başına yıllık maliyeti 96.800,06.-TL ve PD’in 149.296,32.-TL olarak, Tx’nun birinci yıl maliyeti 126.617,39.-TL ve ikinci yıl maliyeti 26.996,42.-TL olarak hesap edilmiştir. Son dönem böbrek yetmezliği sebebiyle RRT alan toplam hasta sayısının kamu bütçesine yükü 7.003.754.527,09.- TL’dir. Bu tutar sağlık hizmetlerine ayrılan kaynağın %1,89’una ve SGK’na ayrılan bütçenin %3,75’ine ve SGK hastane harcamalarının ise %6.85’ine karşılık gelmektedir. Bu nedenle öncelikle bu hastalığın hastalık yükünü azaltacak sağlık politikaları geliştirilebilmeli ve tedavi sürecinde kullanılan sağlık kaynakları maliyet- etkili bir şekilde yönetilmelidir

KAMU HASTANELERİNDE PERFORMANS DEĞERLENDİRMESİ: VERİ ZARFLAMA ANALİTİK HİYERARŞİ PROSESİ (VZAHP) VE PABON LASSO MODELİ (PLM) UYGULAMASI

Amaç: Bu araştırmanın amacı, Akdeniz Bölgesi’nde faaliyet gösteren kamu hastanelerinin göreceli teknik etkinlik düzeylerini belirlemektir. Yöntem: Araştırmada, hastanelerin performanslarının belirlenmesinde Veri Zarflama Analizi (VZA), Analitik Hiyerarşi Prosesi (AHP) ve Pabon Lasso Modeli (PLM) kullanılmıştır. İlk olarak ağırlık kısıtlaması olmadan VZA, daha sonra AHP ile elde edilen ağırlıklı VZA modeli uygulanmıştır. En son aşamada yatak kullanım performasını belirlemede PLM kullanılmıştır. Bulgular: VZA modeline göre hastanelerin %34’ü teknik düzeyde verimlidir. Girdi ve çıktıların ağırlıkları dikkate alınarak yapılan VZA’ya göre hastanelerin %12,8’inin teknik düzeyde verimli olduğu tespit edilmiştir. PLM’ye göre hastanelerin %31,9’unun en verimli bölgede (3. Bölge) yer aldığı saptanmıştır. Özgünlük: Bu araştırmada hastane verimliliklerini belirlemede hibrit yöntem olan Veri Zarflama Analitik Hiyarşi Prosesi (VZAHP) ve PLM yöntemleri birlikte ele alınmıştır. Hibrit yöntemlerin birlikte kullanılarak hastanelerin performansına yönelik kanıta dayalı bilgiler sunulması, yapılan çalışmanın özgünlüğü ortaya koymakta ve literatürdeki eksikliği dolduracağı öngörülmektedir

EFFICIENT DRUG STOCK CONTROL IN HOSPITAL OPERATIONS AN APPLICATION IN PAMUKKALE UNIVERSITY HOSPITAL

International Congress of Management Economy And Policy, 26-27 Kasım 2016, İstanbulHastane işletme maliyetlerinin yaklaşık % 20-25’ini ilaç giderleri oluşturmaktadır. Bu durum hastaneleri en az stok seviyesiyle ilaç bulundurmalarını zorunlu kılmaktadır. Ancak ilaçlar, sağlık hizmeti sunumunda en önemli girdilerinden biri olup yokluğunda telafisi mümkün olmayan sonuçlar ortaya çıkabilmektedir. Bu çalışmanın amacı, Pamukkale Üniversite Hastanesinin 2015 yıllına ait 753 ilaç harcamalarının ABC, VED ve ABC-VED Matris stok kontrol yöntemlerine göre analiz edilmesidir. Araştırma sonucunda 753 adet ilaç için toplam 33.147.173,17-TL harcama yapılmıştır. ABC analizine göre, ilaçların % 4,78’i, yıllık ilaç harcama tutarının % 70 (36 ilaç)’ini A kategorisi ilaçları oluşturmaktadır. Diğer % 11 ilaç yıllık ilaç harcama tutarının % 20 (85 ilaç)’ini oluşturmakta (B kategori), geri kalan % 84 ilaç (632 ilaç) ise yıllık ilaç harcamasının sadece %10’unu oluşturmaktadır (C Kategori). VED analizine göre, ilaçların yaklaşık %41’i hayati ilaçlar, % 54’i gerekli ilaçlar geri kalan % 5’i ise isteğe bağlı ilaçlar olarak sınıflandırılırmıştır. ABC-VED matris analizi 753 kalem ilacın 316 kalemi (%86) kategori I, 411 (% 14) kalemi kategori II ve 26 (% 0,08) kalemi ise kategori III olduğunu belirlenmiştir. Hastaneler ABC, VED ve ABC-VED matrisi analizleriyle stoklara gereksiz yapılan stok kontrolleri azaltabilecek, hastane ilaç stok kayıp, kaçak ve ilaç eksiklikleri ortadan kaldırılabilecektir.Approximately %20-25 of hospital operating costs constitute drug expenditures. This situation requires hospitals to keep drug at least at the stock level. However, medicines are one of the most important inputs in health care delivery and in the absence of it which irreversible consequences can arise. The aim of this study is to analyze Pamukkale University Hospital' s 2015 drug expenditures by ABC, VED and ABC-VED matrix stock control methods. As a result of the research, a total of 33,137,173.17 TL was spent for 753 drugs. According to ABC analysis, constitute category A drugs of %4,78 of the drugs and %70 (36 drug) of the annual drug expenditure. The other %11 drug, constitute %20 (85 drug) of annual drug expenditure (category B). In any case remaining %84 drug (632 drug) only constitute %10 of the annual drug expenditure (category C). According to the VED analysis, classified of drugs, approximately %41 for vital drug, %54 for neccesary drug, %5 for optional drug. ABC-VED matrix analysis showed that 316 items (%75) of the 753 items category I, 411 (%14) items category II and 26 items (%0.08) category III. The hospitals will be able to reduce of maked for unneccesary stock controls with ABC, VED and ABC-VED matrices and will be removed hospital drug stock losses, illegal drugs and drug shortages

Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990–2019: results from the Global Burden of Disease Study 2019

Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Findings Globally, in 2019, among HIV-negative individuals, there were 1.18 million (95% uncertainty interval 1.08-1.29) deaths due to tuberculosis and 8.50 million (7.45-9.73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1.15 million (1.01-1.32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1.01 million (0.82-1.23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1.5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4.27 (3.69-5.02), 6.17 (5.48-7.02), and 1.17 (1.07-1.28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2.23 (2.03-2.44) times greater among males than females, whereas the fraction due to unsafe sex was 1.06 (1.05-1.08) times greater among females than males. Interpretation As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestone

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

OUTSOURSİNG IN MEDICAL SERVICES:ECONOMIC ANALYSIS OF MAGNETIC RESONANCE IMAGING (MRI) TECHNOLOGY

International Congress of Management Economy And Policy, 26-27 Kasım 2016, İstanbulBu araştırmanın amacı bir üniversite hastanesinde MRG sağlık teknolojisi yatırım kararının satın alım veya dış kaynak kullanımı alternatifinin ekonomik değerlendirilmesi ve bu teknolojilerin yatırım projesi önceliğinin belirlenmesidir. Araştırma bir üniversite hastanesinde yürütülmüştür. Araştırmada proje değerlendirme yöntemi olarak Net Bugünkü Değer Yöntemi kullanılmıştır. Hastanelerde radyoloji hizmetlerinde en çok dış kaynak kullanımı MRG hizmetlerinde yararlanılmaktadır. Hastanelerde MRG dış kaynak kullanımının temel nedeni maliyet düşürme ve bekleme sürelerini kısaltmaktır. Araştırma bulgularına göre, MRG dış kaynak kullanımının satın alma yöntemine göre daha öncelikli olduğu tespit edilmiştir. Hastane yöneticilerinin yatırım kararları verirken farklı alternatifleri değerlendirmelidir. Bu durum hastane kaynaklarının daha maliyet etkin yönetilmesine katkı sağlayabilecektir.The purpose of this research is to provide an economic evaluation of the purchase or outsourcing alternative of the MRI health technology investment decision in a university hospital and to determine the investment project priority of these technologies. The research was conducted in a university hospital. Net Present Value Method was used as project evaluation method in the research. The most outsourced use of radiology services in hospitals is used in MRI services. The main reason for the use of MRI outsourcing in hospitals is to shorten costreducing and waiting times. According to research findings, it was determined that MRI outsourcing has a higher priority than purchasing method. Hospital administrators should consider different alternatives when making investment decisions. This may contribute to more cost effective management of hospital resources