Volume 23, Issue 88 (5-2023)
refahj 2023, 23(88): 85-105 |
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Khodabakhshi A, Asemaneh Z. (2023). Investigating the Distribution of Health Resources in Iran by Using Gini Coefficient (2011-2020). refahj. 23(88), 85-105. doi:10.32598/refahj.23.88.4235.1
URL: http://refahj.uswr.ac.ir/article-1-4143-en.html
URL: http://refahj.uswr.ac.ir/article-1-4143-en.html
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Introduction: One of the goals of health systems and policies in this section is equality in access to health resources and facilities. Although health resources and facilities in countries have diversity and different levels, but the distribution of health resources are the most important goal of the health system in any country. Nowadays, justice in health and solving injustice in the health sector is one of the most important concerns of health systems in the world, especially in developing countries. The distribution of human resources and health facilities is considered as one of the factors affecting the health of people in any country, and any inequality in the distribution of health resources and facilities leads to inequality in people's benefit from these services in different regions of the country. Therefore, not only increasing the resources and facilities of the health sector is important, but the distribution of these resources and facilities among different regions of the country is also of particular importance.
Method: This research is an applied and descriptive-analytical study that investigates and measures justice in the geographical distribution of health resources and facilities in from 2011 to 2020, using the Gini coefficient. The data used in this research were obtained from the statistical yearbooks of the Iranian Statistics Center, which included the number of general practitioners, the number of specialist doctors, the number of dentists, the number of laboratories, pharmacies and health centers in the public sector.
Findings: Based on the findings of the research, the resources of the health sector per ten thousand people for the period of 10 years (2010-2019) showed that the human resources and experts in the health field include the average number of general practitioners per ten thousand people in 2019, was equal to 1.98, which increased to 2 in 2019. The average number of specialist doctors per ten thousand people in2019 was 1.64, which increased to2.18 in 2019. That is, it has increased by about33% and the average number of dentists in2019 was equal to 0.62 per ten thousand people of the country, which has increased by 29% compared to 2019. Also, the average health facilities including pharmacies, laboratories and health centers in2010 were equal to 0.06,0.28, and 2.35, respectively, and in 2019, this standard for average pharmacies increased by 50%, the average number of laboratories and health houses have decreased by28.6 and11.5% respectively to 0.09, 0.2 and 2.08 per ten thousand people. The findings of the research for the Gini coefficient also showed that the Gini coefficient of general doctors, specialist doctors, and dentists in 2013 was equal to 0.19,0.21 and 0.18, respectively, and in 2019, the value of the Gini coefficient was22.22 respectively0.13 and 0.22 . According to the obtained Gini coefficient values, general practitioners, specialist doctors, and dentists show an equal and relatively balanced distribution situation. Based on the calculated Gini coefficients, despite the average increase in the number of general practitioners and dentists, the distribution situation has worsened, but the distribution situation of specialist doctors has improved with the average increase in the number of specialist doctors. Also, the Gini coefficient of pharmacy, laboratory, and health centers in 2013 was 0.38, 0.36 and 0.32, respectively, and in 2019, it reached 0.26, 0.44 , and 0.34, respectively. According to the values of the Gini coefficient obtained, they have had a relatively uneven distribution. The highest Gini coefficient is related to health centers, pharmacies, and laboratories, which show relatively unequal distribution. Among the investigated manpower indicators, the Gini coefficient of specialist doctors has decreased from0.21 to 0.13. Although the distribution of general practitioners and dentists shows a relatively equal distribution based on the values of the Gini coefficient, the numerical value of the Gini coefficient has been increasing during the period under review; therefore, based on the results obtained, the distribution situation has worsened.
Discussion: According to the results of the research, the Gini coefficient of the specialist doctors has decreased from0.21 to0.13 among the manpower distribution index. The results of this study are consistent with the results of Noori Hekmat et al. and Mosadegh Rad et al.’s studies. Of course, the value of the Gini coefficient for general physicians has been increasing during the period, which indicates the worsening of distribution and increased inequality. The Gini coefficient for dentists has varied between0.18 and 0.28, which shows a lower estimate than previous studies, which studies by Rezaei and Nouri, Rezaei et al., Karim Nejad et al., and Yahyavi Dizaj et al have reached the results similar to those of the current research. The average Gini coefficient of public sector laboratories was calculated to be0.35 and public sector pharmacies to be 0.32, which shows a relatively unequal distribution according to the average value of the Gini coefficient, which is consistent with the results of Yazdi Faizabadi et al.'s research. The Gini coefficient of 0.33 was obtained for health houses, which shows the relatively uneven distribution of this index, which is consistent with the results of Karim Nejad et al.'s research. The results of the current research confirm that although the average health resources and facilities have increased in most indicators in Iran, the distribution of these resources has worsened according to the numerical value of the Gini coefficient. Therefore, it is necessary to review the distribution of resources and health facilities in the society and providing and implementing solutions to improve the distribution of resources seem to be necessary as well. In addition, due to the lack of full access to the data of the private sector, only the public sector has been considered, so in some indicators, the Gini coefficient may be lower than the actual value because usually the private sector tends to operate in big cities and with more facilities, which affects the distribution of facilities and inequality.
Keywords: Gini coefficient, Lorenz curve, Inequality, Distribution of health resources
Ethical considerations
Authors’ contributions
All authors contributed in designing, running, and writing all parts of the research.
Funding
No direct financial support was received from any institution or organization for the preparation of this article.
Conflicts of interest
This article does not overlap with other published works of the authors.
Following the ethics of research
In this article, all rights related to research ethics have been respected.
Method: This research is an applied and descriptive-analytical study that investigates and measures justice in the geographical distribution of health resources and facilities in from 2011 to 2020, using the Gini coefficient. The data used in this research were obtained from the statistical yearbooks of the Iranian Statistics Center, which included the number of general practitioners, the number of specialist doctors, the number of dentists, the number of laboratories, pharmacies and health centers in the public sector.
Findings: Based on the findings of the research, the resources of the health sector per ten thousand people for the period of 10 years (2010-2019) showed that the human resources and experts in the health field include the average number of general practitioners per ten thousand people in 2019, was equal to 1.98, which increased to 2 in 2019. The average number of specialist doctors per ten thousand people in2019 was 1.64, which increased to2.18 in 2019. That is, it has increased by about33% and the average number of dentists in2019 was equal to 0.62 per ten thousand people of the country, which has increased by 29% compared to 2019. Also, the average health facilities including pharmacies, laboratories and health centers in2010 were equal to 0.06,0.28, and 2.35, respectively, and in 2019, this standard for average pharmacies increased by 50%, the average number of laboratories and health houses have decreased by28.6 and11.5% respectively to 0.09, 0.2 and 2.08 per ten thousand people. The findings of the research for the Gini coefficient also showed that the Gini coefficient of general doctors, specialist doctors, and dentists in 2013 was equal to 0.19,0.21 and 0.18, respectively, and in 2019, the value of the Gini coefficient was22.22 respectively0.13 and 0.22 . According to the obtained Gini coefficient values, general practitioners, specialist doctors, and dentists show an equal and relatively balanced distribution situation. Based on the calculated Gini coefficients, despite the average increase in the number of general practitioners and dentists, the distribution situation has worsened, but the distribution situation of specialist doctors has improved with the average increase in the number of specialist doctors. Also, the Gini coefficient of pharmacy, laboratory, and health centers in 2013 was 0.38, 0.36 and 0.32, respectively, and in 2019, it reached 0.26, 0.44 , and 0.34, respectively. According to the values of the Gini coefficient obtained, they have had a relatively uneven distribution. The highest Gini coefficient is related to health centers, pharmacies, and laboratories, which show relatively unequal distribution. Among the investigated manpower indicators, the Gini coefficient of specialist doctors has decreased from0.21 to 0.13. Although the distribution of general practitioners and dentists shows a relatively equal distribution based on the values of the Gini coefficient, the numerical value of the Gini coefficient has been increasing during the period under review; therefore, based on the results obtained, the distribution situation has worsened.
Discussion: According to the results of the research, the Gini coefficient of the specialist doctors has decreased from0.21 to0.13 among the manpower distribution index. The results of this study are consistent with the results of Noori Hekmat et al. and Mosadegh Rad et al.’s studies. Of course, the value of the Gini coefficient for general physicians has been increasing during the period, which indicates the worsening of distribution and increased inequality. The Gini coefficient for dentists has varied between0.18 and 0.28, which shows a lower estimate than previous studies, which studies by Rezaei and Nouri, Rezaei et al., Karim Nejad et al., and Yahyavi Dizaj et al have reached the results similar to those of the current research. The average Gini coefficient of public sector laboratories was calculated to be0.35 and public sector pharmacies to be 0.32, which shows a relatively unequal distribution according to the average value of the Gini coefficient, which is consistent with the results of Yazdi Faizabadi et al.'s research. The Gini coefficient of 0.33 was obtained for health houses, which shows the relatively uneven distribution of this index, which is consistent with the results of Karim Nejad et al.'s research. The results of the current research confirm that although the average health resources and facilities have increased in most indicators in Iran, the distribution of these resources has worsened according to the numerical value of the Gini coefficient. Therefore, it is necessary to review the distribution of resources and health facilities in the society and providing and implementing solutions to improve the distribution of resources seem to be necessary as well. In addition, due to the lack of full access to the data of the private sector, only the public sector has been considered, so in some indicators, the Gini coefficient may be lower than the actual value because usually the private sector tends to operate in big cities and with more facilities, which affects the distribution of facilities and inequality.
Keywords: Gini coefficient, Lorenz curve, Inequality, Distribution of health resources
Ethical considerations
Authors’ contributions
All authors contributed in designing, running, and writing all parts of the research.
Funding
No direct financial support was received from any institution or organization for the preparation of this article.
Conflicts of interest
This article does not overlap with other published works of the authors.
Following the ethics of research
In this article, all rights related to research ethics have been respected.
Type of Study: orginal |
Received: 2022/10/30 | Accepted: 2023/03/7 | Published: 2023/05/9
Received: 2022/10/30 | Accepted: 2023/03/7 | Published: 2023/05/9
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