Showing 15 results for Equity
Aziz Rezapour, Farbod Ebadifard Azar, Saber Azami Aghdash, Asghar Tanoomand, Seyed Morteza Hosseini Shokouh, Negar Yousefzadeh, Pezhman Atefi Manesh, Ali Sarabi Asiabar,
Volume 29, Issue 1 (1-2015)
Abstract
Background: Households’ financial protection against health payments and expenditures and equity in utilization
of health care services are of the most important tasks of governments. This study aims to measuring equity
in household’s health care payments according to fairness in financial contribution (FFC) and Kakwani indices
in Tehran-Iran, 2013.
Methods: This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200
households. Households were selected using stratified-cluster sampling including typical families who reside in
the city of Tehran. The data were analyzed through Excel and Stata v.11 software. Recall period for the inpatient
care was 1 year and for outpatient 1 month.
Results: The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the
indicator was ascending by the rise in the ranking of households’ financial level. The Kakwani index was estimated
to be a negative number (-0.00125) which indicated the descending trend of health financing system. By
redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated
to be a positive number (0.090555) which indicated the ascending trend of health financing system.
Conclusion: According to this study, the equity indices in health care financing denote injustice and a descending
trend in the health care financing system. This finding clearly shows that deliberate policy making in health
financing by national health authorities and protecting low-income households against health expenditures are
required to improve the equity in health.
Hamid Ravaghi, Massomeh Goshtaei, Alireza Olyaee Manesh, Nazanin Abolhassani, Jalal Arabloo,
Volume 29, Issue 1 (1-2015)
Abstract
Background:
In this regard, in Iran a plan was developed and accordingly 52 indicators to measure equity in
health were developed and announced by the Ministry of Health in collaboration with other sectors.
This study aims to obtain a deeper understanding of the development of health equity indicators and
identify their implementation challenges and proposed solutions from the perspective of policy makers
and executives responsible for the indicators development and implementation.
To reduce the health inequity, it is necessary to measure and monitor these inequalities.Methods
Stakeholders involved in the development and implementation of these health equity indicators (at
national and provincial levels), and the review and analysis of relevant documents including meeting
minutes, working plans and working progress reports. Data were analyzed using a framework analysis
approach.
: In this qualitative study, data were gathered using semi-structured interviews with 15Results
the use of health equity indicators and process of indicators development, challenges of
development and implementation of the indicators and laying the groundwork for the establishment
of indicators. The findings showed that policy makers' viewpoint on concepts and indicators is different
from those of executives and their perceptions have little in common. The establishment of
indicators requires accurate stakeholders' understanding and accurate insight into the issue of equity
in health, political will, financing, training and empowerment of organization's employees, legal requirements,
and finally a clear action plan.
: Four main themes were identified, including the concept of equity in health and its importance,Conclusion
and executives. As the attention has been focused recently on the issue, in addition to knowledge
improvement, proper solutions with an intersect oral collaboration approach in order to tackle challenges
should be considered.
: The development of the indicators requires a shared understanding among policy makers
Maryam Beheshtian, Ardeshir Khosravi, Alireza Olyaeemanesh, Hossein Malekafzali, Shirin Bonakdar Esfahani, Leila Hosseiny Ghavamabad, Saeideh Aghamohammadi, Mahnaz Nouri, Elaheh Kazemi, Mohammadreza Zakeri, Fatemeh Sagha,
Volume 29, Issue 1 (1-2015)
Abstract
Background: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators.
Methods: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool.
Results: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data.
Conclusion: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country.
Masoumeh Hosseini, Alireza Olyaeemanesh, Batoul Ahmadi, Saharnaz Nedjat, Faranak Farzadi, Mohammad Arab, Arash Rashidian,
Volume 30, Issue 1 (1-2016)
Abstract
Background: Gender inequality harms the health of millions of women and girls in all over the world. This study aimed to identify the state of gender equity in the health sector of the Islamic Republic of Iran.
Methods: This study was based on the secondary analysis of the available data in four provinces. The research team held three sessions to select the appropriate indicators for measuring gender equity in Iran. Moreover, using the data of different sources, the indexes were evaluated by applying the brain storming method.
To demonstrate the difference between females and males, the ratio of females to males was measured in each indicator. The confidence intervals were used to show significant differences in the gap between men and women. Educational indicators were analyzed using the appraisal framework of UNESCO and International Institute for Education Planning.
Results: Findings revealed gender equality in the indicators of education and under–five underweight in all the provinces. However, the indicator of information on the mild psychological diseases showed inequality in favor of males. Infants’ mortality, under-five mortality, crude death, drug abuse and smoking showed inequality in favor of females in all the four provinces. The incidence of tuberculosis, severe psychological diseases, and basic and supplementary insurance coverage was equal in all provinces except Tehran.
Conclusion: This study revealed gender inequality in many indicators among the provinces. Therefore, improving this condition requires policymaking, planning, and conducting appropriate strategies with proper gender approaches.
Nahid Hatam, Mohammadreza Zakeri, Ahmad Sadeghi, Sajad Darzi Ramandi, Ramin Hayati, Elham Siavashi,
Volume 30, Issue 1 (1-2016)
Abstract
Background: One of the important aspects of equity in health is equality in the distribution of resources in this sector. The present study aimed to assess the distribution of hospital beds in Shiraz in 2014.
Methods: In this retrospective cross-sectional study, the population density index and fair distribution of beds were analyzed by Lorenz curve and Gini coefficient, respectively. Descriptive data were analyzed using Excel software. We used Distributive Analysis Stata Package (DASP) in STATA software, version 12, for computing Gini coefficient and drawing Lorenz curve.
Results: The Gini coefficient was 0.68 in the population. Besides, Gini coefficient of hospital beds’ distribution based on population density was 0.70, which represented inequality in the distribution of hospital beds among the nine regions of Shiraz.
Conclusion: Although the total number of hospital beds was reasonable in Shiraz, distribution of these resources was not fair, and inequality was observed in their distribution among the nine regions of Shiraz.
Seyed Abbas Mirabedini, Seyed Mohammad Esmaeil Fazl Hashemi, Ali Sarabi Asiabar, Aziz Rezapour, Saber Azami-Aghdash, Hassan Hosseini Amnab,
Volume 31, Issue 1 (1-2017)
Abstract
Background: Out-of-pocket and informal payments are considered as 2 most important topics for equity in health care financing. Therfore, this study was conducted to systematically review and meta-analyze the status of these payments in Iran's health care system.
Methods: Required data were collected through searching the following key terms: "Unofficial", "Informal Payment", "Iran", "Health Financing", "Health expenditure", and "Out-of-pocket" on Scopus, PubMed, IranMedex, SID, and Google Scholar databases. After extracting and screening previous studies, data were collected from the articles using PRISMA pattern. To perform the meta-analysis, Comprehensive Meta-Analysis (CMA: 2) software was used.
Results: A total of 15 studies were entered in this review. Overall, the rate of out-of-pocket payments was estimated to be 50% (95% CI: 45-57%). A significant correlation was found between gender and the rate of out-of-pocket payments (p≤0.05). Moreover, the overall rate of informal payments was found to be 35%. Most of the informal payments were in form of cash, and the main reasons for informal payments were appreciating the staff and medical team as well as requests made by the hospital staff. Length of stay, marital status, employment status, income, and insurance coverage were key factors in the field of informal payments.
Conclusion: According to the results of the present study, out-of-pocket and informal payments are more prevalent in Iran. Considering the negative effects of these payments on the health care system, it is of prime importance to implement extensive interventions to reduce or even prevent these payments.
Leila Jamshidi, Mojdeh Ramezani, Seyed Sajad Razavi, Leila Ghalichi,
Volume 31, Issue 1 (1-2017)
Abstract
Background: Providing fair access to high-quality healthcare services is one of the most important goals of health systems. This study was conducted between 2012 and 2013 to determine the level of equity in the quality of hospital services in Iran.
Methods: In this cross-sectional study, 1,003 patients were chosen from 100 hospitals in Iran with multi-stage random cluster sampling. Concentration index was calculated to determine equity of healthcare quality from patients’ viewpoint. Furthermore, the equity of hospital services’ quality was investigated from experts’ perspective by calculating Gini index based on the hospitals’ accreditation scores. Analyzing the related factors was done by logistic regression. The significance level was set at α=0.05. Data were analyzed using Excel v.2010, SPSS v.21, and Stata v.8.
Results: There was a significant inequity in the quality of hospital services in both patients’ and experts’ point of view. In fact, concentration index (95% confidence interval) for the quality of healthcare was significant, 0.128 (0.080, 0.176), indicating better quality of services for those with higher economic status from patients’ point of view. Furthermore, Gini index (95% confidence interval) for hospitals’ accreditation scores was 0.166 (0.156, 0.176), meaning that there was inequity in hospital services quality from experts’ point of view.
Conclusion: The significant inequality observed in the quality of hospital care based on the economic status of the patients highlights the necessity of the supportive policies aiming at reduction of this condition.
Maedeh Raznahan, Mohammad Hassan Emamian, Fateme Alipour, Hassan Hashemi, Hojjat Zeraati, Akbar Fotouhi,
Volume 33, Issue 1 (2-2019)
Abstract
Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middle-aged population in 2009 and 2014.
Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05.
Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821-0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods.
Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.
Katayoun Falahat, Monir Baradaran Eftekhari, Asghar Ebadifar, Masoumeh Eltemasi, Zahra Sobhani, Elham Ghalenoee, Elham Habibi,
Volume 34, Issue 1 (2-2020)
Abstract
Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran’s health research system (HRS).
Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators.
Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers’ indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers’ high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences.
Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.
Hesam Ghiasvand, Efat Mohamadi, Alireza Olyaeemanesh, Mohammad Mehdi Kiani, Bahram Armoon, Amirhossein Takian,
Volume 35, Issue 1 (1-2021)
Abstract
Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.
Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.
Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).
Conclusion: As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and context-based, economic, social, and political aspects of health as well.
We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.
Efat Mohamadi, Alireza Olyaeemanesh, Amirhossein Takian, Fatemeh Yaftian, Mohammad Mehdi Kiani, Bagher Larijani,
Volume 36, Issue 1 (1-2022)
Abstract
Background: The impact of the COVID-19 pandemic on human life has led to profound consequences in almost all societies worldwide, and this includes its significant impact on all aspects of health. Health equity has been among the main challenges in any healthcare system. However, with the COVID-19 crisis worsening health inequalities, the need to prioritize health equity in upstream national and international plans must receive scholarly attention. Therefore, this paper reports the findings of a review of the current synthesized evidence about the impact of the COVID-19 pandemic on health equity.
Methods: This is a comprehensive review in which we retrieved relevant studies during the period starting from 12/01/2019 to 01/15/2021 are retrieved from various databases. The PRISMA flow diagram and a narrative approach are used for synthesizing the evidence.
Results: We initially retrieved 1173 studies, and after a primary quality appraisal process, 40 studies entered the final phase of analysis. The included studies were categorized into five main outcome variables: Accessibility (95%), Utilization (65.8%), Financial protection: 15 (36.5%), Poverty (31.7%), and Racism (21.9%)
Conclusion: COVID-19 pandemic has been the most devastating global challenge in recent history. While the COVID-19 crisis is still unfolding, its multidimensional adverse effects are yet to be revealed. Nevertheless, some people, e.g., the elderly, minorities, as well as marginalized and poor persons, have suffered the COVID-19 consequences more than others. In line with the whole government/whole society approach, we advocate that governments need to strengthen their special efforts to reduce the extra burden of the pandemic on the most vulnerable populations.
Maryam Hedayati, Iravan Masoudi Asl, Mohammad Reza Maleki, Ali Akbar Fazaeli, Salime Goharinezhad,
Volume 37, Issue 1 (2-2023)
Abstract
Background: The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years.
Methods: This scoping review is guided by Arksey and O’Malley’s scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings.
Results: From 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household’s gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage.
Conclusion: The result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.
Abasat Mirzaei, Morteza Joshani-Kheibari, Reza Esmaeili,
Volume 37, Issue 1 (2-2023)
Abstract
Background: Health and economy has substantially been influenced by the coronavirus disease 2019 (COVID-19) pandemic. Because of these impacts, household financial contribution to health system is likely to be changed. This study aimed to compare the distribution of household financial contributions before and during the COVID-19 epidemic.
Methods: This is a cross-sectional study. The data were obtained from Iran's Households Income and Expenditure Survey as a national representative survey and included 38,328 households in 2019 (before COVID-19) and 37,577 households in 2020 (during COVID-19 pandemic). The household expenditures deflated according to the Consumer Price Index. The indices of households’ out-of-pocket Payments (OPP), catastrophic health expenditures (CHE), and impoverishment were calculated based on a standard methodology. Data analysis was done using an Excel-based software.
Results: The households' total expenditures declined for both urban and rural areas during the COVID-19 outbreak. Meanwhile, health expenditure experienced a negative growth rate for urban and rural households at –25.75% and –15.47%, respectively. The average per capita of OOP annually was 1,220,416 ($41.086 PPP) Rials for urban households and 1,017,760 Rials ($34.263 PPP) for rural households in 2020 (the era of COVID-19), which had dropped –30% and –16%, respectively, relative to 2019 (before COVID-19). The proportional share of health service types from the total health expenditure did not change importantly after the onset of COVID-19. The incidence of CHE and impoverishment due to health payments reduced after the onset of COVID-19.
Conclusion: The households' health expenditures changed considerably during the COVID-19 pandemic and these changes were the same for the urban and rural areas. Despite COVID-19 multi-faceted shocks, the findings of this study showed a slight decline in the incidence of CHE and impoverishment caused by health expenditures. It might be due to forgone health services during the COVID-19 pandemic. Data from these household surveys have some limits to depicting the real effects of this crisis.
Mohammadreza Sheikhy-Chaman, Aziz Rezapour, Aidin Aryankhesal, Ali Aboutorabi,
Volume 38, Issue 1 (1-2024)
Abstract
Background: Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period.
Methods: The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software.
Results: The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level.
Conclusion: A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.
Bakhtiar Piroozi, Banaz Adnan Saeed, Azad Shokri, Hossein Safari, Farhad Moradpour, Mehdi Zokaei, Kaveh Qaderi Bagajan, Amjad Mohamadi-Bolbanabad, Yadolah Zarezadeh,
Volume 39, Issue 1 (1-2025)
Abstract
Background: Mental disorders are prevalent among individuals with disabilities, often exacerbated by socioeconomic factors. This study aims to examine the prevalence of mental disorders among people with disabilities in Iran, addressing a significant yet under-researched issue within this population.
Methods: Conducted in 2023, this cross-sectional study focused on adults with physical and sensory disabilities (sight, hearing, speech) in Sanandaj city. A total of 613 individuals participated, selected through simple random sampling. Data were gathered utilizing the General Health Questionnaire-28 (GHQ-28). Multivariate logistic regression identified significant predictors of mental disorder suspicion, while the concentration index (C) and concentration curve (CC) measured prevalence inequality. Data analysis was conducted using STATA software version 16.0.
Results: The prevalence of mental disorder suspicion was 56.7% (344 individuals), with severity categorized as 29.7% mild, 16.6% moderate, and 10.4% severe. Significant predictors for increased odds of mental disorder symptoms included being female (AOR: 1.55; 95% CI: 1.05-2.29), under 30 years old (AOR: 3.46; 95% CI: 1.55-5.76), unemployed (AOR: 4.10; 95% CI: 2.74-6.14), lacking supplementary insurance (AOR: 2.78; 95% CI: 1.49-5.20), and belonging to the poorest economic class (AOR: 4.23; 95% CI: 2.34-7.62). The suspicion of mental disorders was unevenly distributed and concentrated among individuals with lower economic status (C = -0.395).
Conclusion: This study highlights significant mental health disparities among individuals with disabilities, particularly in economically disadvantaged groups. Health policies should focus on prevention and access to mental health services, such as community-based programs, healthcare provider training, and financial assistance, alongside efforts to improve employment opportunities for this population.
