1 Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA 2 Department of Economics, Middle East Technical University, Ankara, Turkey 3 Department of Economics, Hacettepe University Health Economics and Health Policy Research and Application Center, Ankara, Turkey 4 Hacettepe University Health Economics and Health Policy Research and Application Center, Ankara, Turkey 5 Department of Radiology, Hacettepe University, Ankara, Turkey 6 Department of Pediatric Surgery, Hacettepe University Health Economics and Health Policy Research and Application Center, Hacettepe University, Ankara, Turkey Correspondence Ilhan Can Ozen, Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Email: iozen@hsph.harvard.edu Abstract This study aims to investigate the determinants of the quali- ty MRI in the Turkish healthcare system. The analysis is done by analysing the referred cases to a major university radiolo- gy department in Turkey, and matching the hospital and MRI use characteristics of the source institutions, where the orig- inal MRI was taken. Quality of MRI was measured by special- ist radiologists. The resulting quality was analysed by gender and imaging area characteristics, source institutional quality, MRI use statistics in source institution and MRI machine use inclination of the source institution. Chi-square and logis- tic regression were conducted, with regional fixed effects. In the largest dataset, the highest quality institutions have significantly higher average expected MRI quality compared to one level beneath them (0.74 vs. 0.63) (P = 0.02), there is also a significant MRI quality difference between the sec- ond highest level of institution, and the third and the fourth (0.63–0.54). Smaller (<0.1) but significant quality difference (P = 0.05) exists for institutions with the lowest two quality levels. In the smaller dataset, with data only from the low- est two institutional quality groups, with a finer institutional quality grading, differences in institutional quality is again found to be a significant driver of MRI quality (P = 0.035). KEYWORDS health economics, health system development, MRI quality, Turkey RESEARCH ARTICLE Not just about machines: Analysis of MRI quality determinants in the Turkish health system context İlhan Can Özen 1,2 | Dilek Başar 3,4 | Selcen Öztürk 3,4 | Ekim Gümeler 5 | Deniz Akata 5 | Arbay Özden Çiftçi 6 DOI: 10.1002/hpm.3373 Received: 8 June 2020 Revised: 27 July 2021 Accepted: 15 October 2021 1 Int J Health Plann Mgmt. 2021;1–11. © 2021 John Wiley & Sons Ltd. wileyonlinelibrary.com/journal/hpm