Determinants of Inequity in Health Care Services Utilization in Markazi Province of Iran

Hassanzadeh, Jafar; Mohammadbeigi, Abolfazl; Eshrati, Babak; Rezaianzadeh, Abbas; Rajaeefard, Abdolreza

doi:10.5812/ircmj.3525

Cited by 44 publications

(58 citation statements)

References 24 publications

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“…Therefore, such households enjoy a better health status and do not necessarily need to utilize health services. These findings are in line with the results of a study by Hassanzadeh, whereas they are in contrast to some previous studies (15). It seems that knowledge improvement in the society can promote the health status and reduce the risk of diseases.…”

Section: Discussionsupporting

confidence: 90%

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Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance

et al. 2017

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Background: Research on the utilization of health services provides an opportunity to identify and determine the quantity and quality of factors, which can facilitate or debilitate access to services. Policymakers believe that factors affecting the use of health services should be quantified in order to allocate further resources to indicators, which can help reduce inequalities. This study aimed to investigate factors affecting the utilization of outpatient services and to determine the effect of health insurance on financial support for individuals. Methods: The present study included all Iranian households, which had been recruited by the Statistical Center of Iran in 2012 -2013. The data were analyzed in 2 logit models and divided into urban and rural areas. Results: According to the results, basic and full insurance coverage was the main factor, influencing the utilization of outpatient health services. Furthermore, age composition of households affected their utilization of these services. More precisely, households with more members aged < 5 or > 65 years tended to use outpatient services more frequently. In addition, households with female heads and those from higher decile groups were more likely to use outpatient services. On the contrary, educational level and household size had negative effects on demand for outpatient health services. Conclusions: Based on the results, there was a significant association between social and economic status and utilization of outpatient services. For decreasing the observed inequalities, policymakers should pay particular attention to households with low income and members aged < 5 or > 65 years and provide access to health services for these groups (eg, access to family physicians).

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Section: Discussionsupporting

confidence: 90%

“…Nevertheless, inequality among different social classes has not been reduced, which indicates considerable differences among these groups in terms of utilization of health services (15).…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance

et al. 2017

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“…Studies conducted by Etemad et al and also by Hasanzadeh et al found no significant difference between rural and urban areas in Iran in benefiting from healthcare services and meeting health needs. However, a study conducted by Hosseinpour et al indicated a significant difference in unmet needs between satellite villages and other rural areas and also urban areas …”

Section: Discussionmentioning

confidence: 96%

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Moradi

Naghdi

Brown

et al. 2018

Health Planning & Management

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The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.

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“…A few studies have examined health care utilization inequity in Iran (22)(23)(24)(25)(26), most of which have measured health inequalities in different health care services (27)(28)(29)(30)(31). Most of these studies have evaluated subnational data, therefore, their data cannot be used at the national level (25,26,32).…”

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confidence: 99%

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

et al. 2019

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Background: Equitable health care utilization is a pillar of the Universal Health Coverage (UHC) and is also a concern to policymakers. Measuring and quantifying the inequalities are essential in assessing the progress toward achieving the UHC goals. Several studies have focused on overall measures of unfair inequality in health care utilization. The overall approaches to outpatient and inpatient services are not representative of the differences in health care usage in public and private sectors in a mixed healthcare system, like Iran. A few studies have assessed inequality measures for general practitioners (GPs), specialists (SPs), and hospital admission services in different sectors, separately. Objectives: This study aimed at measuring health care utilization inequalities in outpatient and inpatient health services in public and private sectors in Iran. Methods: In this study, national representative data derived from the utilization of health services survey (UHSS) in 2014 was used. The concentration curve (CC) and concentration index (CI) were applied to assess inequalities in health care utilization services, including the number of GP visits, SP visits, and admission in hospitals. We used ADePT software to produce a nonlinear estimation of CI for these count variables. The indirect standardization method was used to standardize the services for differences in needs by age and gender. The inequality in health care utilization was examined in both public and private sectors, separately. Results: Based on the results, public and private outpatient settings, except for the private GP visits, followed a pro-poor pattern. Inpatient admission in the public sector had a pro-poor model, but it showed a pro-rich pattern in the private sector. GP visits in the private sector changed in favor of the poorer people and SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. CI for family physician (FP) and GP visits in public and private sectors, and also SP visits in public and private sectors was -0.089, -0.086, -0.010, 0.025, and -0.018, respectively. CI for the inpatient admission in public and private sectors was -0.126 and 0.157, respectively. GP, SP and hospital services utilization showed a pro-poor pattern. Conclusions:The results of this study showed that most of the health care utilization followed a pro-poor model in the mixed health care system in Iran. SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. Although public outpatient services need more attention to maintain their pro-poor distribution, SP visits in the public sector should be more considered to follow a pro-poor pattern. Health policymakers are recommended to take measures to eliminate barriers to access this service. This may lead to reduce a gap between the poor and rich people in the utilization of the health care and moving toward the UHC.

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Determinants of Inequity in Health Care Services Utilization in Markazi Province of Iran

Cited by 44 publications

References 24 publications

Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance

Factors Affecting the Utilization of Outpatient Health Services and Importance of Health Insurance

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

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