measuring socio-economic inequality in utilization of type 2 diabetes services

Abstract

Introduction: Health inequities are important issue; this study was conducted in order to measuring socio-economic inequality in utilization of type 2 diabetes services. Methods: This study is an explanatory sequential mixed method that was conducted in two Quantitative and Qualitative phases. In the Quantitative part, type 2 diabetes patients referred to health centers, hospitals and diabetes clinics in Isfahan and Khuzestan provinces were selected through available samples. Using the Concentration Index(CI) approach, the existence of inequality in utilization of type 2 diabetes services was examined. In the next step, in order to analyze the inequality, the inequality contribution of each of the determining factors was determined by concentration index analysis method. Next step, we conducted in-depth interviews with key experts in the field of health to extracted effective solutions. Results: most of the samples were 1306 (65.3%) men. The most age group involved was799 people (40%) over 60 years. concentration index value in outpatient services was 0.31 (p<0.05), inpatient services -0.10 (p>0.05), and pharmaceutical services 0.11 (p<0.05). This means that there was a disparity in the use of outpatient and drug services for type 2 diabetic patients, while the disparity in inpatient services is not significant. Variables contributing to inequality for outpatient services were health status (33.54%), basic insurance (27.43%) and socio-economic status (24.08%), also in pharmaceutical services, health status variable (22.20%), basic insurance (13.63%) and socio-economic status (34.35%) contributed to socio-economic inequality in utilizing from services related to type 2 diabetes patients. Also, the experts' point of view for solutions to reduce socio-economic inequalities in Iran were classified in 3 main themes (socio-economic status, health status, basic insurance) and 29 sub-themes. Conclusion: According to the results, it is suggested that targeted health interventions for the poor patient, and the efforts towards outpatient and medicinal items insurance coverage for type 2 diabetic patients. Improving the status of variables affecting of socio-economic inequality in type 2 diabetic patients and improving the status of the country's health system, strengthening the package of basic health insurance utilization.