Inequities in health and health care between provinces of Iran : promoting equitable health care resource allocation

Investigation of the influence of public expenditure on health lends support to the opinion that equitable distribution of financial resources would help to reduce inequities in health. This thesis set out to establish inequities in access to health care and health outcomes across the provinces of Iran and explore equitable resource allocation models to contribute to the reduction of health inequities. Inequities were measured based on the relationship between a range of health indicators and socioeconomic status in the provinces. Information on mortality, morbidity, and socioeconomic factors were taken respectively from the Death Registration System, Health Profile in Iran (2003), and Iran's 2006 census. There were significant relationships between mortality and socioeconomic indicators across the provinces, with the larger rates of mortality in the worst-off provinces. Coronary risk factors (diabetes, high serum cholesterol) were significantly associated with socioeconomic factors; with higher prevalence of the risk factors in the well-off provinces. There were also significant relationships between access to health services (hospital delivery and vaccination) and socioeconomic status; with lower access in the worst-off provinces. The resource allocation models based on population size and age/sex structure changed the health expenditure in favour of the well-off provinces to contribute to the reduction of inequities in morbidities. However, models based on mortality and deprivation changed the expenditure towards the worst-off provinces, in order to bridge the inequities in mortality and access to health services. Equity targets set, based on a combination of age/sex, mortality, and deprivation, indicated that nineteen provinces had received a share of expenditure higher than the equity target, with the largest in Mazanderan and seven provinces received a share lower than the target, with the largest in Tehran. A five-year plan was developed to move the expenditure from the hyper-financed provinces to the under- financed ones.