Tracking socio-economic inequalities in healthcare utilization in Iran: a repeated cross-sectional analysis

• Published in: BMC public health 2020-06, Vol.20 (1), p.1-929, Article 929
• Main Authors: Vahedi, Sajad, Yazdi-Feyzabadi, Vahid, Amini-Rarani, Mostafa, Mohammadbeigi, Abolfazl, Khosravi, Ardeshir, Rezapour, Aziz
• Format: Article
• Language: English
• Subjects: Analysis; Concentration index; Cross-sectional studies; Decomposition; Decomposition analysis; Economic analysis; Economic aspects; Economic development; Expenditures; GDP; Gross Domestic Product; Health care; Health care disparities; Health care industry; Health care policy; Health care reform; Health inequality; Health insurance; Health services; Health services utilization; Healthcare services; Income distribution; Inequality; Iran; Medical care utilization; Outpatient services; Principal components analysis; Public health; Public sector; Reforms; Rural areas; Socioeconomic factors; Socioeconomics; Studies; Surveys; Utilization
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-09001-z

Background Although some healthcare reforms such as Health Transformation Plan (HTP) were implemented in Iran to provide required healthcare services, few studies have been conducted to track the impacts of these reforms on socio-economic inequality in healthcare utilization. This study aims to track socio-economic inequalities in healthcare utilization and their changes between 2008 and 2016 in Iran. Methods Required data were obtained from two of Iran's utilization of healthcare services survey conducted in 2008 and 2016. Erreygers concentration index (EI) was used to measure inequality in the utilization of outpatient and inpatient healthcare services (UOH and UIH). The decomposition of EI (DEI) was used to explain healthcare utilization inequality. Oaxaca decomposition (OD) was also employed to track the changes in EI in this period. Result Inequality in UOH increased from 0.105 to 0.133 in the studied years, indicating the pro-rich distribution of UOH. Inequality in UIH decreased from 0.0558 to - 0.006. DEI showed that economic status was the main factor that contributed to inequality in the UOH and UIH. OD showed that residence in rural areas and supplementary insurance were the main contributing factors in the increased inequality of UOH. Moreover, OD also showed that economic status was the main contributing factor in the reduced inequality of UIH. Conclusion While Iran still suffers from significant socio-economic inequalities in UOH, it seems that healthcare reforms, especially HTP, have reduced UIH inequality. Expanding healthcare reforms into the outpatient sector and also implementing effective health financing policies could be recommended as a remedy against UOH inequality. Keywords: Iran, Health inequality, Healthcare services, Concentration index, Decomposition analysis