Decomposition of inequity determinants of healthcare utilization, Iran

Mohammadbeigi, Abolfazl; Hassanzadeh, Jafar; Eshrati, Babak; Rezaianzadeh, Abbas

doi:10.1016/j.puhe.2013.01.001

Cited by 29 publications

(30 citation statements)

References 17 publications

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“…The awareness of the people living in urban regions is higher than others, so they are more willing to pay for health insurance [14]. The negative coefficient of the number of illiterate persons in the family confirmed the rule of awareness on health insurance contributions.…”

Section: Discussionmentioning

confidence: 69%

“…Iran has two big health insurances: social security insurance and Iran health insurance organization. These two big insurances are subsets of the government and private health insurances do not have large contributions [14]. The share of out of pocket health expenditures was very high in the country (52.5% in 2012, and the health financing system was not successful enough to protect people from financial risks.…”

Section: Introductionmentioning

confidence: 99%

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Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Rad

Khodaparast

2016

Eurasian J Med

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Objective: Having progressive health finance mechanism is very important to decrease inequity in health systems. Revenue collection is one of the aspects of health care financing. In this study, taxation system and health insurance contribution of Iranians were assessed. Materials and Methods:Data of 2012 household expenditures survey were used in this study, and payments of the families for health insurances and tax payments were extracted from the study. Kakwani index was calculated for assessing the progressivity of these payments. At the end, a model was designed to find the effective factors. Results:We found that taxation mechanism was progressive, but insurance contribution mechanism was very regressive. The portion of people living in urban regions was higher in the payments of insurance and tax. Less educated families had lower contribution in health insurance and families with more aging persons paid more for health insurance. Conclusion:Policy makers must pay more attention to the health insurance contribution and change the laws in favour of the poor.Keywords: Health insurance, taxation, progressivity, Iran, equity, concentration curve, Kakwani Index Öz Amaç: Progresif sağlık finansmanı mekanizmasının bulunması sağlık sistemlerinde eşitsizliği azaltmak için çok önemlidir. Gelir toplama, sağlık finansmanının bir parçasıdır. Bu çalışmada, İranlı-ların vergi sistemi ve sağlık sigortasına katkısı değerlendirilmiştir. Gereç ve Yöntem:Bu çalışmada 2012 hanehalkı harcamaları verileri kullanılmıştır ve sağlık sigortaları ile vergi için ailelerin öde-meleri ortaya konmuştur. Bu ödemelerin sürekliliğini değerlen-dirmek için Kakwani endeksi hesaplanmıştır. Sonunda etkili olan faktörleri bulmak için bir model tasarlanmıştır. Bulgular:Vergilendirme mekanizmasının progresif, ancak sigorta katkı mekanizmasının son derece regresif olduğu saptanmıştır. Vergi ve sigorta ödemelerinde kentsel bölgelerde yaşayan insanların payı daha yüksektir. Eğitim seviyesi düşük ailelerin sağlık sigortasına katkısı düşük bulunmuş ve daha yaşlı kişilerin bulunduğu aileler ise daha fazla ödeme yapmıştır.Sonuç: Politika yapıcıların, sağlık sigortası katkısına daha fazla dikkat göstermesi ve yasaları yoksulların lehine değiştirmesi gerekmektedir.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Rad

Khodaparast

2016

Eurasian J Med

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“…Therefore, other proxies are used as alternatives. [25,26] In this study, by using principal component analysis (PCA), first, the variables having the greatest effect on the variance of the total variables were identified and then a new variable (SES) was constructed based on these variables. [27][28][29] In the present study, by using the principal component analysis method, the asset index was created.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Inequalities in Tobacco Smoking in Women Aged 15-54 in Iran: A multilevel model

oradi

Goodarzi

Khosravi

2020

Preprint

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Background Significant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran.MethodThis study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants.ResultsThe prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women.ConclusionInequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.

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“…A few studies have examined health care utilization inequity in Iran (22)(23)(24)(25)(26), most of which have measured health inequalities in different health care services (27)(28)(29)(30)(31). Most of these studies have evaluated subnational data, therefore, their data cannot be used at the national level (25,26,32). Other studies in Iran have not measured the differentiation between public and private sectors (27,33).…”

mentioning

confidence: 99%

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

et al. 2019

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Background: Equitable health care utilization is a pillar of the Universal Health Coverage (UHC) and is also a concern to policymakers. Measuring and quantifying the inequalities are essential in assessing the progress toward achieving the UHC goals. Several studies have focused on overall measures of unfair inequality in health care utilization. The overall approaches to outpatient and inpatient services are not representative of the differences in health care usage in public and private sectors in a mixed healthcare system, like Iran. A few studies have assessed inequality measures for general practitioners (GPs), specialists (SPs), and hospital admission services in different sectors, separately. Objectives: This study aimed at measuring health care utilization inequalities in outpatient and inpatient health services in public and private sectors in Iran. Methods: In this study, national representative data derived from the utilization of health services survey (UHSS) in 2014 was used. The concentration curve (CC) and concentration index (CI) were applied to assess inequalities in health care utilization services, including the number of GP visits, SP visits, and admission in hospitals. We used ADePT software to produce a nonlinear estimation of CI for these count variables. The indirect standardization method was used to standardize the services for differences in needs by age and gender. The inequality in health care utilization was examined in both public and private sectors, separately. Results: Based on the results, public and private outpatient settings, except for the private GP visits, followed a pro-poor pattern. Inpatient admission in the public sector had a pro-poor model, but it showed a pro-rich pattern in the private sector. GP visits in the private sector changed in favor of the poorer people and SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. CI for family physician (FP) and GP visits in public and private sectors, and also SP visits in public and private sectors was -0.089, -0.086, -0.010, 0.025, and -0.018, respectively. CI for the inpatient admission in public and private sectors was -0.126 and 0.157, respectively. GP, SP and hospital services utilization showed a pro-poor pattern. Conclusions:The results of this study showed that most of the health care utilization followed a pro-poor model in the mixed health care system in Iran. SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. Although public outpatient services need more attention to maintain their pro-poor distribution, SP visits in the public sector should be more considered to follow a pro-poor pattern. Health policymakers are recommended to take measures to eliminate barriers to access this service. This may lead to reduce a gap between the poor and rich people in the utilization of the health care and moving toward the UHC.

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Decomposition of inequity determinants of healthcare utilization, Iran

Cited by 29 publications

References 17 publications

Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Socioeconomic Inequalities in Tobacco Smoking in Women Aged 15-54 in Iran: A multilevel model

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

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