Geographic distribution of need and access to health care in rural population: an ecological study in Iran

Abstract

IntroductionEquity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009.MethodsCensus data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs) were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP), crude birth rate (CBR) and crude mortality rate (CMR) in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR.ResultsThere were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared.ConclusionResults showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

Relative inequalities in geographic distribution of health care resources in Kermanshah province, Islamic Republic of Iran

“…We used the Gini coefficient and the index of dissimilarity which are both commonly used in analysing inequality in the distribution of health care resources (10,22,23).…”

“…While there is a positive relationship between the geographical availability of health care resources and the health status of populations, increasing health care resources alone does not necessarily lead to improved health outcomes. People regardless of their race, sex and geographical region should be guaranteed fair access to health care services (9,10).…”

Network and Spatial Analysis to Assess and Guide Decisions about Equitable Accessibility to Health Services: The Public Palliative Care System in Extremadura (Spain)

“…The former was obtained by dividing the coverage range into ten equal parts and representing each decile of coverage along the horizontal axis with the percentage of the total available to the population on the ordinate axis. The Gini index was estimated according to the methods proposed by for grouped data, with zero corresponding to perfect equality (everyone has access to the same resources) and 1 corresponding to perfect inequality (only one person has all the resources and the others have nothing) [20,21].…”

Inequality in Distribution of Health Care Resources in Iran: Human Resources, Health Centers and Hospital Beds

“…In another study, in evaluating the geographical distribution of ICU beds for non-cardiac diseases in Iran, showed that the distribution of intensive care unit beds in the provinces of the counCopyright © 2018, Shiraz E-Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited U n C o r r e c t e d P r o o f try was fair, however, the number of beds was lower than in other countries (14). In addition, In another study, in regards to examining the geographical distribution of access to health care in rural areas, have shown that there is a significant difference in the distribution of health house based on rural mortality rates (15).…”