Determinants of Inequity in Health Care Services Utilization in Markazi Province of Iran
Determinants of Inequity in Health Care Services Utilization in Markazi Province of Iran
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DOI：
10.5812/ircmj.3525
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发表时间：
2013-05-01
影响因子：
0.4
通讯作者：
Rajaeefard, Abdolreza
中科院分区：
文献类型：
--
作者：
Hassanzadeh, Jafar;Mohammadbeigi, Abolfazl;Rajaeefard, Abdolreza
背景资料：来自伊朗的国家和国际统计数据表明，大多数健康指标都取得了进步和成就，但在特殊群体和省级层面的某些指标存在差异。Objectives：我们的目的是评估当地寻求医疗保健设施（HCU）不公平的主要预测因素。本研究使用了2008年在伊朗Markazi省进行的HCU调查收集的数据。根据伊朗家庭框架，采用了系统抽样方法，选择了758户家庭和2 711名个人。采用主成分分析（PCA）构建的家庭财富指数和广义估计方程（GEE）模型中的鲁棒登录链接函数对不公平性进行预测。结果：66.4%的贫困人口选择门诊就医，其中97.7%的贫困人口获得了适当的服务。调整家庭聚集效应和协变量混杂效应后，GEE模型显示女性（OR = 2.44，CI：1.24-4.81）和有住院需求者（OR = 2.14，CI：1.23-3.72）的HCU存在不公平性。处于家庭财富指数最低的五分位数与较低的门诊医疗服务使用率相关（OR = 0.45，CI; 0.23-0.88）。结论：尽管国家健康指标有所改善，但不同人群使用医疗服务的方式不同，但HCU中的这些不公平与社会和个人因素有关。此外，很明显，卫生部门的设施和获得卫生服务的机会并不是唯一的预测因素。
Background: National and international statistics from Iran have indicated that progresses and achievements have been made for most health indicators, but there are differences in some indicators in special groups and at the provincial level.Objectives: Our aim was to assess the main predictors of inequity in seeking Health Care Utilities (HCU) locally.Patients and Methods: Data gathered from the HCU survey, which was conducted in the Markazi province of Iran during 2008, was used in the present study. A systematic sampling method, based on the Iranian household framework, was applied in order to choose 758 households as well as 2711 individuals. The household wealth index constructed by Principle Component Analysis (PCA) and robust login link function in Generalized Estimation Equation (GEE) model were used in order to determine the predictors of inequity.Results: 66.4% of those in need sought outpatient health care from which 97.7% received appropriate services. After adjustment for the clustering effect of household as well as confounding effect of the covariates, GEE model showed that there were inequities in HCU for females (OR = 2.44, CI; 1.24-4.81) and subjects with inpatient need (OR = 2.14, CI: 1.23-3.72). Being in the lowest quintile of household wealth index was associated with the lower use of outpatient health services (OR = 0.45, CI; 0.23-0.88).Conclusions: In spite of improvements in the national health indicator, different groups of people use health care services differently, but these inequities in HCU are related to social and individual factors. Also, it is clear that health sector facilities and the accessibility to health services are not the only predictors.