Horizontal Inequity in Access to Outpatient Services among Shiraz City Residents, Iran

Zahra Kavosi, Abolfazl Mohammadbeigi, Vajihe Ramezani-Doroh, Nahid Hatam, Abdosaleh Jafari, Azarmidokht Firoozjahantighi


Background: lack of access to health services has been mentioned as one of the main causes of health inequity in health system. The aim of this study was to measure horizontal inequity in access to outpatient services in Shiraz.

Method: This household survey was conducted among 1608 participants above 18 years in Shiraz in 2012. Four-stage sampling was used. According to high amount of zero-valued of outpatient services utilization, Zero inflated regression model was established. We computed concentration index (CI) for determining actual (CIM) and indirect standardized utilization (CIIS) of outpatient services in order to compute horizontal inequity index (HII). The results were analyzed using Stata software, version 8.

Results: The CIM was not statistically significant (-0.016, 95% CI: -0.097, 0.066). But the CIIS was statistically significant and favored the rich (0.06, 95% CI: 0.010 to 0.001). The horizontal inequity index was -0.076.

Conclusions: There was no inequality in actual amount of outpatient utilization, maybe High subsidization to health care by government in public sector, high insurance coverage, low prices of health services in the public sector, quality of services and opportunity cost of high income groups were the reasons for our results.


Healthcare Inequalities; Access to Health Care; Outpatient health Services; Utilization; Iran

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