Abstract
<title>Abstract</title> <p> <bold>Introduction</bold> This study examines how the opening of Public–Private Partnership (PPP) hospitals, and their travel-time accessibility to local populations, influence healthcare utilization in Türkiye. Since the mid-2010s, Türkiye has implemented one of the world’s largest PPP health infrastructure programs through the development of large-scale “city hospitals” aimed at modernizing healthcare infrastructure and expanding service capacity. While these investments are expected to improve access to healthcare services, empirical evidence on their effects on healthcare utilization and the role of spatial accessibility remains limited. <bold>Methods</bold> The study uses a balanced provincial panel dataset covering all 81 provinces in Türkiye between 2012 and 2023. A quasi-experimental difference-in-differences (DiD) approach with an event-study specification is employed to estimate the causal impact of PPP hospital openings on key healthcare utilization indicators. To incorporate the spatial dimension of healthcare access, the analysis further includes measures of population coverage within specified travel-time and distance thresholds from newly opened hospitals, allowing treatment effects to vary according to accessibility levels and added bed capacity. <bold>Results</bold> The findings indicate that healthcare utilization increases following the opening of PPP hospitals, with the strongest and most consistent effects observed in outpatient services. In contrast, inpatient admissions per capita remain relatively stable despite substantial increases in bed capacity, suggesting that utilization responses are driven primarily through outpatient care pathways rather than increased hospitalization volumes. The intensity analysis further shows that utilization gains are larger in provinces where a greater share of the population lives in close proximity to the new hospitals and increase modestly with higher levels of added bed capacity. <bold>Conclusion</bold> The results suggest that PPP hospital investments in Türkiye have improved healthcare utilization mainly by enhancing outpatient access, particularly in areas with higher spatial accessibility to the new facilities. The findings highlight the importance of considering geographic accessibility and population coverage when evaluating the effectiveness of large-scale health infrastructure investments and planning future hospital locations. <bold>JEL</bold> I18, H51, C23, R41 </p>