Measuring and Explaining Socioeconomic Inequalities In Public Healthcare Utilization In Western Iran: Evidence from a Cross-sectional Survey

Background: Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran. Study design: A cross-sectional study. Methods: Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on sociodemographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017. The concentration index (C) was used to measure and decompose socioeconomic inequalities in the utilization inpatient and outpatient care in public sector. The indirect standardization method was used to estimate the horizontal inequity (HI) indices in inpatient and outpatient care use. Results: The utilization outpatient (C=-0.121, 95% CI:-0.171, -0.071) and inpatient care in public sector (C=-0.165, 95% CI:-0.229, -0.101) were concentrated among the poor in Kermanshah, Iran. Socioeconomic status, health-related quality of life, marital status and having a chronic health condition were the main determinants of socioeconomic-related inequalities in the utilization of inpatient and outpatient care in public sector among adults. The distributions of outpatient (HI=-0.045, CI: -0.093 to 0.003) and inpatient care (HI= -0.044 95% CI: -0.102, 0.014) in Kermanshah were pro-poor. These results were not statistically significant (P < 0.05). Conclusions: The utilization of public healthcare services in Iran are pro-poor. The pro-poor distribution of inpatient and outpatient care in public facilities calls for initiatives to increase the allocation of resources to public facilities in Iran that may greatly benefit the health outcomes of the poor.