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Socio-economic Inequality of Outpatient and Inpatient Healthcare Services: A Crosssectional Study in Iran

Document Type : Original Article

Authors

1 Student Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

2 Social Determinants of Health Research Center, Research Institute for Prevention of Non Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran

3 School of Paramedicine, Qazvin University of Medical Sciences, Qazvin, Iran

10.30476/jhsss.2022.95822.1616

Abstract

Background: Ensuring equal utilization of health services has always been a priority in health systems globally. Iran implemented reforms such as the Health Transformation Plan (HTP), in which one objective was to reduce inequity in access to inpatient and outpatient services. These studies aimed to measure inequality in health services utilization in Qazvin, Iran, and clarify inpatient and outpatient utilization patterns among socioeconomic subgroups of the population.
Methods: This cross-sectional study recruited 442 households living in Qazvin, Iran, in 2019. We collected data using a tool that included demographic characteristics, socioeconomic status, and health services utilization. We applied the concentration index to measure inequality and performed data analysis using STATA 15.
Results: Based on our estimates, the utilization rates of outpatient and inpatient services in the study sample were 0.89±1.39 and 0.45±0.94, respectively. There was no statistically significant difference in the use of outpatient healthcare services in terms of gender and insurance coverage of the households, while literacy, age, and health condition had statistically significant effects on inpatient healthcare utilization (P<0.05). Furthermore, the marginal effects of age and literacy on the utilization of outpatient services were statistically significant (P<0.05), so that literacy and aging increased the outpatient HSU. Except for age, the marginal effects of other characteristics on the utilization of inpatient services were statistically significant (P<0.05).
Conclusion: Our findings indicated that inequality in healthcare utilization reduced over time, showing that in addition to reducing inequality in HSU, population groups with lower socio-economic status have benefited more from both inpatient and outpatient services.

Highlights

Parisa Naseri (Google Scholar)
Sima Rafiei (Google Scholar)

Keywords

References
  1. Saito E, Gilmour S, Yoneoka D, Gautam GS, Rahman MM, Shrestha PK, et al. Inequalityand inequity in healthcare utilization in urban Nepal: a cross-sectional observational study.Health Policy Plan. 2016;31(7):817-24. doi: 1093/heapol/czv137.
  2. Morton S, Pencheon D, Squires N. Sustainable Development Goals (SDGs), and their implementation: A national global framework for health, development and equity needs a systems approach at every level. Br Med Bull. 2017;124(1):81-90. doi: 10.1093/bmb/ldx031. PMID: 29069332.
  3. Kakemam E, Dargahi H. The Health Sector Evolution Plan and the Technical Efficiency of Public Hospitals in Iran. Iran J Public Health. 2019;48(9):1681-9. PMID: 31700824. PMCID: PMC6825684.
  4. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-104. doi: 10.1016/S0140-6736(05)71146-6. PMID: 15781105.
  5. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-45. doi: 10.2190/986L-LHQ6-2VTE-YRRN. PMID: 1644507.
  6. Vahedi S, Rezapour A, Mohammadbeigi A, Khosravi A. Economic Inequality in Outpatient Healthcare Utilization: The Case of Iran. J Res Health Sci. 2018;18(3):e00424. PMID: 30270216.
  7. Mouteyica AEN, Ngepah N. Health expenditure convergence and the roles of trade and governance in Africa. Arch Public Health. 2023;81(1):77. doi: 10.1186/s13690-023-01078-3. PMID: 37118822.
  8. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So near, so far: four decades of health policy reforms in Iran, achievements and challenges. Archives of Iranian medicine. 2019;22(10):592–605.
  9. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE; European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81. doi: 10.1056/NEJMsa0707519. PMID: 18525043.
  10. Marmot MG, Bell R. Action on health disparities in the United States: commission on social determinants of health. JAMA. 2009;301(11):1169-71. doi: 10.1001/jama.2009.363. PMID: 19293419.
  11. Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalitiesJournal of Epidemiology & Community Health. 2002;56:647-652.
  12. Braveman P, Krieger N, Lynch J. Health inequalities and social inequalities in health. Bull World Health Organ. 2000;78(2):232-4; PMID: 10743295. PMCID: PMC2560692.
  13. Bahadori M, Sanaeinasab H, Ghanei M, Mehrabi Tavana A, Ravangard R, Karamali M. The Social Determinants of Health (SDH) in Iran: A Systematic Review Article. Iran J Public Health. 2015;44(6):728-41. PMID: 26258086.
  14. Beheshtian M, Olyaee Manesh A, Bonakdar S, Malek Afzali H, Larijani B, Hosseini L, Zakeri M, Dastgerdi MV. Intersectoral collaboration to develop health equity indicators in iran. Iran J Public Health. 2013;42(Supple 1):31-5.
  15. Hassanzadeh J, Mohammadbeigi A, Eshrati B, Rezaianzadeh A, Rajaeefard A. Determinants of inequity in health care services utilization in markazi province of iran. Iran Red Crescent Med J. 2013;15(5):363-70. doi: 10.5812/ircmj.3525. PMID: 24349720.
  16. Veisani Y, Delpisheh A. Decomposing of Socioeconomic Inequality in Mental Health: A Cross-Sectional Study into Female-Headed Households. J Res Health Sci. 2015;15(4):218-22. PMID: 26728906.
  17. LeRoy S. Welfare and Poverty: Family Matters, 1st ed., Fraser Forum Ltd. 2002;221-30.
  18. Ranjbar Ezzatabadi M, Khosravi A, Bahrami MA, Rafiei S. Socio-economic inequalities in health services utilization: a cross-sectional study. Int J Health Care Qual Assur. 2018;31(1):69-75. doi: 10.1108/IJHCQA-04-2017-0059. PMID: 29504844.
  19. Zuckerman KE, Lindly OJ, Sinche BK, Nicolaidis C. Parent health beliefs, social determinants of health, and child health services utilization among U.S. school-age children with autism. J Dev Behav Pediatr. 2015;36(3):146-57. doi: 10.1097/DBP.0000000000000136. PMID: 25741947.
  20. Thomson K, Hillier Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018;18:1-21.
  21. Mackenbach JP, Meerding WJ, Kunst AE. Economic costs of health inequalities in the European Union. J Epidemiol Community Health. 2011;65(5):412-9. doi: 10.1136/jech.2010.112680. PMID: 21172799.
  22. Kazemi Karyani A, Woldemichael A, Soofi M, Karami Matin B, Soltani S, Yahyavi Dizaj J. Explaining Socioeconomic Inequality Differences in Catastrophic Health Expenditure Between Urban and Rural Areas of Iran After Health Transformation Plan Implementation. Clinicoecon Outcomes Res. 2020;12:669-81. doi: 10.2147/CEOR.S261520. PMID: 33204128.
  23. Chant S. Women-Headed Households: Poorest of the Poor?: Perspectives from Mexico, Costa Rica and the Philippines 1. IDS bulletin. 1997;28(3):26-48. doi: 10.1111/j.1759-5436.1997.mp28003003.x.
  24. Ekholuenetale M, Nzoputam CI, Barrow A, Onikan A. Women's enlightenment and early antenatal care initiation are determining factors for the use of eight or more antenatal visits in Benin: further analysis of the Demographic and Health Survey. J Egypt Public Health Assoc. 2020;95(1):13. doi: 10.1186/s42506-020-00041-2. PMID: 32813174. PMCID: PMC7364685.
  25. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Lorch SA, Lee HC, Phibbs CS, Rogowski J, Gould JB, Firebaugh G. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. JAMA Pediatr. 2019;173(5):455-61. doi: 10.1001/jamapediatrics.2019.0241. PMID: 30907924.
  26. Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A. Socioeconomic inequity in health care utilization, Iran. J Epidemiol Glob Health. 2013;3(3):139-46. doi: 10.1016/j.jegh.2013.03.006. PMID: 23932056.
  27. Borrell C, Rue M, Pasarín MI, Rohlfs I, Ferrando J, Fernandez E. Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994). Prev Med. 2000;31(6):691-701. doi: 10.1006/pmed.2000.0751. PMID: 11133336.
  28. Carr-Hill R, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. Br Med J. 1996;312:1008–12. doi: 10.1136/bmj.312.7037.1008.
  29. Moorin, R.E., Holman, C.D.J. The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status. BMC Health Serv Res. 2006. doi: 10.1186/1472-6963-6-74.
  30. Van der Heyden JH, Demarest S, Tafforeau J, Van Oyen H. Socio-economic differences in the utilisation of health services in Belgium. Health Policy. 2003;65(2):153-65. doi: 10.1016/s0168-8510(02)00213-0. PMID: 12849914.
  31. Budi Hidayat, Hasbullah Thabrany, Hengjin Dong, Rainer Sauerborn, The effects of mandatory health insurance on equity in access to outpatient care in Indonesia, Health Policy and Planning. 2004;19(5):322–35. org/10.1093/heapol/czh037.
  32. Leung GM, Tin KY, O'Donnell O. Redistribution or horizontal equity in Hong Kong's mixed public-private health system: a policy conundrum. Health Econ. 2009;18(1):37-54. doi: 10.1002/hec.1342. PMID: 18264997.
  33. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag. 2015;4(10):637-40. doi: 10.15171/ijhpm.2015.160. PMID: 26673172.
  34. Sözmen K, Ünal B. Explaining inequalities in Health Care Utilization among Turkish adults: Findings from Health Survey 2008. Health Policy. 2016;120(1):100-10. doi: 10.1016/j.healthpol.2015.10.003. PMID: 26563631.
Journal of Health Sciences & Surveillance System
Volume 12, Issue 1
January 2024
Pages 75-82
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