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. 2020 Jun 12;20(1):914.
doi: 10.1186/s12889-020-09071-z.

Assessing horizontal equity in health care utilization in Iran: a decomposition analysis

Farideh Mostafavi  1 , Bakhtiar Piroozi  1 , Paola Mosquera  2 , Reza Majdzadeh  3 , Ghobad Moradi  4   5
Affiliations

Assessing horizontal equity in health care utilization in Iran: a decomposition analysis

Farideh Mostafavi et al. BMC Public Health. .

Abstract

Background: Despite the goal of horizontal equity in Iran, little is known about it. This study aimed i) to assess socioeconomic inequality and horizontal inequity in the healthcare utilization; and ii) to explore the contribution of need and non-need variables to the observed inequalities.

Methods: This study used national cross sectional dataset from Utilization of Health Services survey in 2015. Concentration Index (C), Concentration Curve (CC) and Horizontal Inequity index (HI) were calculated to measure inequality in inpatient and outpatient health care utilization. Decomposition analysis was used to determine the contribution of need and non-need factors to the observed inequalities.

Result: Results showed the pro-poor inpatient services in both rural (C = - 0.079) and non-rural areas (C = - 0.096) and the pro-rich outpatient services in both rural (C = 0.038) and non-rural (C = 0.007). After controlling for need factors, HI was positive and significant for outpatient services in rural (HI = 0.039) and non-rural (HI = 0.008), indicating that for given need, the better off especially in rural make greater use of outpatient services. The HI was pro-poor for inpatient services in both rural (HI = - 0.068) and non-rural (HI = -0.090), was significant only in non-rural area. Non-need factors were the most important contributors to explain inequalities in the decomposition analysis.

Conclusion: Disentangle the different contribution of determinants, as well as greater HI in rural areas for outpatient and in non-rural areas for inpatient services, provide helpful information for decision makers to re-design policy and re-distribute resource allocation in order to reduce the socioeconomic gradient in health care utilization.

Keywords: HEALTH SERVICES; Health inequalities; SOCIAL INEQUALITIES; SOCIO-ECONOMIC.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Concentration curve for outpatient and inpatient health care utilization in rural and non-rural
See this image and copyright information in PMC

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