title: Geographic distribution of need and access to health care in rural population: an ecological study in Iran.
abstract: BACKGROUND
  Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009.
  
  
  METHODS
  Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs) were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP), crude birth rate (CBR) and crude mortality rate (CMR) in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR.
  
  
  RESULTS
  There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared.
  
  
  CONCLUSIONS
  Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.
authors.affiliation: Division of Health Economics, Department of Clinical Sciences, Malmö; Skåne University Hospital; Lund University, MALMÖ SE-20502, Sweden. aliasghar.ahmad_kiadaliri@med.lu.se.
authors.forename: Aliasghar
authors.initials: A
authors.lastname: Ahmad Kiadaliri
authors.forename: Behzad
authors.initials: B
authors.lastname: Najafi
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli