Jamshidi Leila, Ramezani Mozhdeh, Razavi Seyed Sajad, Ghalichi Leila
Mental and Social Health office, Ministry of Health, Tehran, Iran.
Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Dec 23;31:109. doi: 10.14196/mjiri.31.109. eCollection 2017.
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. 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. 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. 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.
提供公平获取高质量医疗服务的机会是卫生系统最重要的目标之一。本研究于2012年至2013年开展，旨在确定伊朗医院服务质量的公平程度。在这项横断面研究中，采用多阶段随机整群抽样从伊朗100家医院选取了1003名患者。计算集中指数以从患者角度确定医疗质量的公平性。此外，基于医院的认证得分计算基尼指数，从专家角度调查医院服务质量的公平性。通过逻辑回归分析相关因素。显著性水平设定为α = 0.05。使用Excel v.2010、SPSS v.21和Stata v.8分析数据。从患者和专家的角度来看，医院服务质量均存在显著的不公平性。事实上，医疗质量的集中指数（95%置信区间）具有显著性，为0.128（0.080，0.176），这表明从患者角度来看，经济状况较好的人能获得质量更好的服务。此外，医院认证得分的基尼指数（95%置信区间）为0.166（0.156，0.176），这意味着从专家角度来看，医院服务质量存在不公平性。基于患者经济状况观察到的医院护理质量显著不平等凸显了旨在减少这种情况的支持性政策的必要性。
