جستجوی مقالات مرتبط با کلیدواژه « شاخص تمرکز » در نشریات گروه « پزشکی »

Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces.

Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14.

The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services.

Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.

 Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas.

This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software.

 A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P<0.05). Also, 1.32% of the fifth income quintile (highest income) used rehabilitation services, while this rate was 0.35% for households in the first quintile (P<0.001). Zanjan, Qazvin, Khuzestan, Isfahan, Lorestan, Bushehr, and Semnan provinces had the lowest service utilization rates in urban/rural areas and the whole country. Qom province had a better status regarding service utilization in urban areas, while East Azerbaijan, Mazandaran, Golestan, Yazd, Fars, and Hormozgan provinces had higher service utilization rates in rural areas. Overall, East Azerbaijan, Mazandaran, and Qom provinces had a higher rate of utilization. The CI value for the whole country was reported at 0.24 (95% CI: 0.17-0.30), indicating a higher inequality in utilization in favor of the rich. The CI values for rural and urban areas were 0.27 and 0.19, respectively (P<0.001).

There is inequality in the utilization of rehabilitation services in favor of the rich households in Iran, and low-income households have lower access to these services. The inclusion of rehabilitation services in the primary health insurance package with appropriate pricing and population coverage, and fair distribution of rehabilitation services following the needs of public and private sectors, can increase the access and utilization of rehabilitation services.

This research was conducted to investigate the socioeconomic and geographical inequality in mortality from road traffic accidents in Iran in 2016.
  In this descriptive cross-sectional study, the data of 16,584 people that died from road traffic accidents in 2016 were received from the Legal Medicine Organization. Theil entropy index was used to determine inequality in geographic areas. Moreover, relative and absolute concentration indices were used to measure inequality in mortality from RTAs across educational levels.
  The mortality rate from road traffic accident was 21.5 per 100,000 people. Theil index was 0.66 for traffic-related deaths among the provinces, indicating an unequal distribution of traffic injuries caused by traffic accidents among the provinces. When inequality was measured at smaller geographical levels, i.e., among cities in each province, the results indicated a fair distribution across smaller geographic levels. The focus index also indicated a fair distribution of traffic accidents among the deceased sub-classes (concentration index & 95% CI: -0.13 (-0.41; 0.16).
  Our findings showed that the distribution of mortality from road traffic accidents was unequal at provincial positions. According to our findings, mortality from traffic accidents was distributed equally among the socioeconomic and urban levels. Therefore, health managers can use the findings of this study to develop interventions to reduce inequalities. In addition to targeting factors contributing to known social inequalities in the health and social status, other factors should be considered and applied to evaluate their interventions in the future.

Life satisfaction is one of the important dimensions of health, which is influenced by health determinants. The aim of this study was to investigate the status of socioeconomic inequalities in satisfaction with life in women aged 15-54 in Iran.

In this cross-sectional study, randomized multistage cluster sampling with equal clusters was done to select the participants. A total of 35,305 women aged 15-55 were enrolled in the study. Data analysis was done in two stages. In the first stage, social and economic inequalities were investigated using the concentration index and concentration curve method. In the second stage, a multilevel method was used to identify the determinants.

The mean life satisfaction was 12.81±4.23. The concentration index for dissatisfaction with life was -0.06 [95% CI: -0.1, -0.02], indicating dissatisfaction with life in low socioeconomic groups. The results of multilevel analysis showed that age, marital status, occupation, place of living, education, and the economic class correlated with dissatisfaction with life in women (P<0.05).

There is inequality in dissatisfaction with life. Dissatisfaction is concentrated in the poorer groups of the society and varies in different provinces. Socioeconomic variables affect inequality in satisfaction with life in women, which need to be addressed to reduce inequalities

The status of financial participation of individuals in health financing is one of the challenging issues in assessing the performance of health systems in the world. The concern about the financing of the health system and its consequences on Iranian households from about a decade ago is a turning point in attracting the attention of researchers and policymakers to this area. This study has been calculated financial contribution of people in Iran health system in 2015.
Using cost-income information of 38252 Iranian households collected by the Statistical Center of Iran in 2015, the distribution of health expenditures of households based on the income approach is calculated and factors influencing the concentration index are measured.
The results showed that the concentration index of health care expenditures in Iran was 0.3318. This is indicative of the progressive status of household participation in financing the health system. Also, dental expenditures with the index of 0.496 have the highest inequality in the distribution of health care expenditures. Payment for hospital services and dental care services had the highest share in increasing the coefficient index.
Having insurance coverage as one of the most important policy tools to achieve the desired model of household financial participation has a significant effect on the distribution of financial participation of households and the most important factor in reducing the coefficient of concentration index

Financing in the health system will be equitable when the costs of health care for households in based on their ability to pay rather than on the disease risk are were distributed. The aim of this study was to assess equity in the public health care financing based on two main sources of funding include direct payments by households for public health care and public health budget is distributed.
This study was descriptive analytic study, and the registration statistics of the Ministry of Health and Medical Education Statistics Center of Iran in 2013 was used. The main variables studied including direct payments by households for public health care, public health budgets and household income distribution were studied separatelyin the provinces of the country. For data analysis, Excel as calculation software was used. Indicators used in this study to assess equity in health cost financing include the Gini coefficient, concentration index and the Kakwani progressive index.
In 2013, the Gini index of income distribution among households and the concentration index of direct payments by households for public health care in the provinces were 0.387 and 0.056, respectively. On this basis, Kakwani progressive index and the concentration index of public health budget in the provinces were obtained -0.331 and -0.05, respectively. Accordingly, Kakwani progressive index, equivalent to -0.337 percent was calculated.
The assessment made based on the Gini coefficient, concentration index, and the Kakwani progressive index show that the distribution of the public budget in the provinces of country and direct payments by households for public health care, based on the household income variable, is inequitable.

Inequity in health is a universal term which used for showing current differences، variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers. The calculation، advantage and disadvantage of most common health-inequity indexes including slope index of inequity، relative index of inequality، Theil’s Index، mean log deviation، index of disparity، Gini coefficient، weighted utilization social welfare function، absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data. Average of health care utilization in in-need subjects was 66. 4%. This indicator was in the first to fifth quintiles equal to 57. 6%، 63. 4%، 71. 6%، 69. 5% and 75. 3%، respectively. Relative concentration index and Gini coefficient was calculated as 0. 053 and 0. 0062، respectively. Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes، concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

Health status of societies is amongst the basic indices of economic and social development and hence investment in this section has direct impacts on social welfare and economic growth. Low quality of health care and inequality in health care expenditure contributions can lead to different forms of social and economic consequences. This is the main concern of the public policy makers، in particular those who are engaged with health care services. The main purpose of this study was to measure inequality in health care expenditures in rural and urban areas of Iran. In order to compare the results of the country''s 5-year economic and social plans، we measured the inequality in the first years of the plans. In this study، Gini coefficient، concentration index، Kakwani and Atkinson indices were used to measure inequality in health care expenditures in urban and rural areas of Iran for the selected years. We used the household expenditure survey data collected by the Iran Statistical Center. The results of the study showed that concentration of health expenditures for urban، rural and the whole households of the country had small fluctuations and few changes were made during the study period. Calculation of the total national health expenditures showed that Kakwani index was positive during the mentioned period. Based on the calculations of the Atkinson index، inequality did not improve during period of the study. Health care inequality scores were relatively high and there were volatility in inequality figures. This fluctuation indicates that health policy could not have effective influence on health care expenditures inequality. Increasing inequality is due to the relatively high inflation plagued the society and regional discrepancy in access to the services.