Iran University of Medical Sciences, Tehran, Iran.
University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Inquiry. 2024 Jan-Dec;61:469580241229622. doi: 10.1177/00469580241229622.
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
医疗保健中的不平等利用可能会影响健康权。获得医疗保健服务以及实现积极的健康结果和健康公平是促进人权的基本原则。本研究旨在评估和分析不同社会人口亚组之间门诊卫生服务利用（OHSU）的社会经济相关不平等，为促进健康公平的政策提供信息。数据通过对伊朗德黑兰的 1200 户家庭进行横断面调查收集。通过集中、瓦格斯塔夫和埃里格斯指数来衡量社会人口亚组之间 OHSU 的不平等。分解用于确定导致 OHSU 不平等的因素。边际效应和弹性用于计算社会人口变量在不平等中的相对绝对份额。OHSU 的利用率为 63.61%（CI：60-66.80），主要集中在社会经济地位较好的家庭中。根据结果，居住在富裕社区（相对份额（RS）：85.48）和家庭中有残疾成员（RS：6.58）是 OHSU 向特权群体集中的最重要因素。相比之下，健康知识水平极低（RS：-83.79）和拥有基本医疗保险（RS：-3.92）使 OHSU 向社会经济地位较低的家庭集中。该研究是基于调查数据进行的，这可能会导致一些限制。由于本研究是一项横断面研究，我们无法确定解释变量与门诊卫生服务利用及其相关预测因素之间的因果关系。有残疾成员的家庭，以及有慢性病成员的家庭，在获得医疗保健服务方面可能会面临严重的不平等。为这些家庭提供便利获得医疗服务的政策可以在改善健康公平方面发挥重要作用。
