• Sessions
• Presentations
• Posters
• Rooms

Presentation

Session: Posters
Room: TBA
Time: Fri 13:00-14:30

Presenter: Mohammad Hajizadeh (School of Economics and Australian Centre for Economic Research on Health (ACERH). University of Queensland)

Abstract

This paper uses nationwide survey data derived from the 2003 Utilization of Health Services Survey (UHSS) in Iran n=16,935) to measure deviations from the horizontal equity (equal health care for equal need) principle in ambulatory care and inpatient utilization in Iran. We estimate indices of horizontal inequity for health care utilization using six measures of health care consumption: hospital admissions, general practitioner visits, specialist visits, dentist visits, any visit to a medical practitioner ("physician visits"), and ambulatory care visits. A measure of income is typically used to construct such concentration indices.
The UHSS does not, however, contain income data. To overcome this data limitation, observable household characteristics are used to construct a wealth index (WI). Specifically, we use principal component analysis (PCA) to construct a measure of household wealth that is based on household assets, including: the number of rooms of the dwelling per (household) capita, indicators for whether or not the dwelling has a bathroom, separate kitchen, and the types of cooking, heating and cooling devices, the household possesses, as well as car and motorcycle ownership.
Indirect standardization is used to generate horizontal inequity(HI) indices in two ways:(i)with only health care indicators(self-reported need for health care services, age and gender) and(ii)with health care need indicators, plus other socioeconomic variables (e.g. income, education, region of residence). Irrespective of which standardization approach is adopted, the computed HIs are positive for all health services except hospital admissions (for which the index is negative when we include both health and socioeconomic and demographic variables in the standardization function). These results suggest that the utilization of health care in Iran is generally --with the exception of hospital admissions -- pro-rich. Moreover, we find that not only are doctor visits has a pro-rich distribution but also that the distribution of specialist services is more pro-rich than the distribution of primary health care (GP) services.
The result of our decomposition analysis demonstrates that the WI and "region" are the most important pro-rich factors that contribute to the inequality of use in Iran. Meanwhile, the variable "education" also reveals to have significant effect on the inequality more specifically in the use of dentist visit. This work is the first study to employ such a WI measure to generate estimates of health sector inequalities. Thus, in addition to producing novel results for Iran, this approach may be useful in other settings where data on income per se is not readily available.

Key Terms

Horizontal inequity, Health care utilization, Principal Components Analysis, Iran

Authors:

Mohammad Hajizadeh (School of Economics and Australian Centre for Economic Research on Health (ACERH). University of Queensland) , Luke Connelly (School of Economics and Australian Centre for Economic Research on Health (ACERH). Unversity of Queensland) , James Butler ( Australian Centre for Economic Research on Health (ACERH). Australian National University) and Ardeshir Khosravi (Ministry of Health and Medical Education, Iran)

Search with Google