Determinants of seeking needed outpatient care in Iran: results from a national health services utilization survey.
BACKGROUND
To assess the inequity in seeking needed outpatient services in Iran and to investigate its influential factors.


METHODS
The data were taken from a nation-wide Iranian health survey conducted in 2003. This study is based on individuals aged 15 years and over who had mentioned their need to seek outpatient care within two weeks prior to the day of the interview. The outcome was seeking needed outpatient care. The independent variables included respondents' age, gender, marital status, education, occupation, index of household economic status, health insurance status and residential place (urban vs. rural).


RESULTS
Sixty-nine point five percent of those in need sought outpatient care. The rich (OR: 2.38, 95% CI: 1.64 - 3.43) and the health insured (OR: 1.62, 95% CI: 1.25 - 2.08), the pensioners and the retired (OR: 2.26, 95% CI: 1.22 - 4.20), the housewives (OR: 1.77, 95% CI: 1.07 - 2.95) were more likely to seek outpatient care than other occupations. On the other hand, people living in remote rural areas (OR: 0.40, 95% CI: 0.28 - 0.57) were less likely to seek their needed outpatient care than those living in main rural areas and urban areas.


CONCLUSIONS
As in different parts of the world, differences in seeking needed healthcare still exist across different groups in Iran. Indeed, seeking outpatient care in Iran is related not only to health system functions--like health insurance and health facilities--but also on factors beyond the scope of health authorities such as economic status and occupation. This study can be instrumental for the recent five-year Economic, Social and Cultural Development Plan of Iran which identified the reduction of inequalities in social determinants of health [corrected]
Hosseinpoor
Ahmad-Reza
AR
Department of Equity, Poverty and Social Determinants of Health, Evidence and Information for Policy, World Health Organization, 20 Avenue Appia, CH 1211 Geneva 27, Switzerland. hosseinpoora@who.int
Naghavi
Mohsen
M
Alavian
Seyed Moayed
SM
Speybroeck
Niko
N
Jamshidi
Hamidreza
H
Vega
Jeanette
J
D000328:Adult; D000553:Ambulatory Care; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D007492:Iran; D012959:Socioeconomic Factors