Decomposition of inequity determinants of healthcare utilization, Iran

Objective To investigate and decompose the determinants of healthcare utilization in a central province in Iran. Study setting Data from 2711 individuals were gathered through interview in a cross-sectional study in Markazi province, Iran, as part of the Healthcare Utilization Survey in 2008. Methods The household economic index (HEI) was created using principal component analysis, and data were analyzed according to the type of healthcare utilization. In addition, the generalized estimation equation model was used to identify the determinants, and the concentration index was calculated and decomposed based on the healthcare utilization determinants. Results HEI was a fixed determinant for all three types of healthcare utilization (general physician, specialist and health worker); however, other determinants changed with the type of health care. The greatest contributors to inequity in the use of general physician, specialist and health worker care were HEI quintile (41.4%), housewife/retired (32.8%) and living in an urban area (47%), respectively. The concentration index was highest for specialist care and lowest for health worker care. Conclusion The pattern of utilization differed between the types of health care. Nevertheless, inequity in healthcare utilization is related to government health policies, including the role of the system in reducing inequity by application of policies such as the family physician and rural insurance programme; and factors which are beyond the health system authorities, and are related to population living standards and need intersectoral cooperation.