Association of health and food expenditures inequality with health outcomes: a case study on Iranian rural households.
BACKGROUND
Inequality in households' and individuals' consumption expenditures is one of the most important aspects of health status difference among households and individuals.


OBJECTIVE
We investigated the impact of some macro-economic factors specially inequality factors on the Iranian rural health status since 1986 through 2012.


METHODS
We conducted a longitudinal ecological and analytical study. The average sample size was 14602 households whom Iranian Statistics Center selected by a multi-stages clustering sampling approach. All required data has been collected from Iranian Statistics Centre and Deputy for Curial Affaires of Iranian Ministry of Health. We calculated the Gini coefficients for the rural food and health expenditures, then conducted a transloge autoregressive order one (AR1) to investigate the association between the Iranian rural households' key mortality rates and the food and health expenditure Gini coefficients, time trend, GDP per capita (PPP), and GDP per capita Gini coefficients.


RESULTS
The mean of Gini coefficients were 0.137 and 0.21 for the rural food expenditures inequality based on current and constant price, respectively. In addition, the mean of Gini coefficients were 0.26 and 0.31 for the rural health expenditures inequality based on current and constant price, respectively. The time trend, transloged form of Gini coefficients for health expenditures and GDP per capita Gini coefficients presented a significant negative correlation with transloged form of neonatal mortality rate. With regard to the transloged form of under five mortality we observed a significant negative correlation with time trend and transloged form of Gini coefficients for health expenditure and GDP per capita. Finally, there was a significant negative correlation between transloged forms of maternal mortality rate.


CONCLUSIONS
Iranian policy makers should consider the rural health and food expenditures inequality and try to adopt more effective policies and plans to decrease it. In addition, they should improve the macro-economic factors to improve the rural households' health status.
Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran.
Seyran
S
Naghdi
Hospital Management Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Hesam
H
Ghiasvand
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
Nasrin
N
Shaarbafchi Zadeh
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
Saeidreza
S
Azami
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
Tayebeh
T
Moradi
Health Expenditures; Health status; Socioeconomic Factors