Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran

doi:10.1186/s12913-019-4443-0

Multicenter Study

. 2019 Aug 30;19(1):614.

doi: 10.1186/s12913-019-4443-0.

Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran

Yousef Chavehpour¹, Arash Rashidian¹, Abraha Woldemichael^{2

3}, Amirhossein Takian^{1

4

5}

Affiliations

¹ Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. abrahaw2010@gmail.com.
³ School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. abrahaw2010@gmail.com.
⁴ Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.

PMID: 31470849
PMCID: PMC6717334
DOI: 10.1186/s12913-019-4443-0

Multicenter Study

Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran

Yousef Chavehpour et al. BMC Health Serv Res. 2019.

. 2019 Aug 30;19(1):614.

doi: 10.1186/s12913-019-4443-0.

Authors

Yousef Chavehpour¹, Arash Rashidian¹, Abraha Woldemichael^{2

3}, Amirhossein Takian^{1

4

5}

Affiliations

¹ Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. abrahaw2010@gmail.com.
³ School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. abrahaw2010@gmail.com.
⁴ Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.

PMID: 31470849
PMCID: PMC6717334
DOI: 10.1186/s12913-019-4443-0

Abstract

Background: This study aims to assess geographical distribution of hospitals and extent of inequalities in hospital beds against socioeconomic status (SES) of residents of five metropolitan cities in Iran.

Methods: A cross-sectional analysis was conducted to measure geographical inequality in hospital and hospital bed distributions of 68 districts in five metropolitan cities during 2016 using geographic information system (GIS), and Gini and Concentration indices. Correlation analysis was performed to show the relationship between the SES and inequality in hospital beds densities.

Results: The study uncovered marked inequalities in hospitals and hospital beds distributions. The Gini indices for hospital beds were greater than 0.55. The aggregated concentration indices for public and private hospital beds were 0.33 and 0.49, respectively. The GIS revealed that 216 (70.6%) hospitals were located in two highest socioeconomic status classes in the cities. Only 29 (9.5%) hospitals were located in the lowest class. The public, private, and the cumulative hospitals beds distributions in Tehran and Esfahan showed significant (p < 0.05) positive correlation with SES of the residents.

Conclusions: The high inequalities in hospital and hospital beds distributions in our study imply an overlooked but growing concern for geographical access to healthcare in rapidly urbanizing metropolitan cities in Iran. Thus, regardless of ownership, decision-makers should emphasize the disadvantaged areas in metropolitan cities when need arises for the establishment of new healthcare facilities in order to ensure fairness in healthcare. The metropolitan cities and rapid urbanization settings in other countries could learn lessons to reduce or prevent similar issues which might have hampered access to healthcare.

Keywords: Geographical distribution; Hospital beds; Hospitals; Inequality; Main cities; Regionalization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Geographical location of hospitals against residential floor area per capita in districts of five metropolitan cites in Iran (sources: authors work)

**Fig. 2**
Concentration curves for (a) private, and (b) public hospital beds in five metropolitan cities in Iran

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References

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1. Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D. Geographic access to cancer care in the US. Cancer. 2008;112(4):909–918. - PubMed
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[1] Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60(6):1251–1266. - PubMed

[2] Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60(6):1251–1266. - PubMed

[3] Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D. Geographic access to cancer care in the US. Cancer. 2008;112(4):909–918. - PubMed

[4] Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D. Geographic access to cancer care in the US. Cancer. 2008;112(4):909–918. - PubMed

[5] Nobles M, Serban N, Swann J. Spatial accessibility of pediatric primary healthcare: measurement and inference. Ann Appl Stat. 2014;8(4):1922–1946.

[6] Nobles M, Serban N, Swann J. Spatial accessibility of pediatric primary healthcare: measurement and inference. Ann Appl Stat. 2014;8(4):1922–1946.

[7] Ye H, Kim H. Measuring spatial health disparity using a network-based accessibility index method in a GIS environment: a case study of Hillsborough County, Florida. Int J Geospatial Environ Res. 2014;1(1):2.

[8] Ye H, Kim H. Measuring spatial health disparity using a network-based accessibility index method in a GIS environment: a case study of Hillsborough County, Florida. Int J Geospatial Environ Res. 2014;1(1):2.

[9] Peipins LA, Graham S, Young R, Lewis B, Foster S, Flanagan B, et al. Time and distance barriers to mammography facilities in the Atlanta metropolitan area. J Community Health. 2011;36(4):675–683. - PMC - PubMed

[10] Peipins LA, Graham S, Young R, Lewis B, Foster S, Flanagan B, et al. Time and distance barriers to mammography facilities in the Atlanta metropolitan area. J Community Health. 2011;36(4):675–683. - PMC - PubMed

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Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran

Affiliations

Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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