title: Determinants of inequity in health care services utilization in markazi province of iran.
abstract: BACKGROUND
  National and international statistics from Iran have indicated that progresses and achievements have been made for most health indicators, but there are differences in some indicators in special groups and at the provincial level.
  
  
  OBJECTIVE
  Our aim was to assess the main predictors of inequity in seeking Health Care Utilities (HCU) locally.
  
  
  METHODS
  Data gathered from the HCU survey, which was conducted in the Markazi province of Iran during 2008, was used in the present study. A systematic sampling method, based on the Iranian household framework, was applied in order to choose 758 households as well as 2711 individuals. The household wealth index constructed by Principle Component Analysis (PCA) and robust login link function in Generalized Estimation Equation (GEE) model were used in order to determine the predictors of inequity.
  
  
  RESULTS
  66.4% of those in need sought outpatient health care from which 97.7% received appropriate services. After adjustment for the clustering effect of household as well as confounding effect of the covariates, GEE model showed that there were inequities in HCU for females (OR = 2.44, CI; 1.24- 4.81) and subjects with inpatient need (OR = 2.14, CI: 1.23-3.72). Being in the lowest quintile of household wealth index was associated with the lower use of outpatient health services (OR = 0.45, CI; 0.23- 0.88).
  
  
  CONCLUSIONS
  In spite of improvements in the national health indicator, different groups of people use health care services differently, but these inequities in HCU are related to social and individual factors. Also, it is clear that health sector facilities and the accessibility to health services are not the only predictors.
authors.affiliation: Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Hassanzadeh
authors.affiliation: Department of Epidemiology, School of Health, Qom University of Medical Sciences, Qom, IR Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Mohammadbeigi
authors.affiliation: Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, IR Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Eshrati
authors.affiliation: Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rezaianzadeh
authors.affiliation: Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Rajaeefard
keywords: Iran; Quality Indicators, Health Care; Utilization