title: Health inequalities and development plans in Iran; an analysis of the past three decades (1984-2010).
abstract: BACKGROUND
  Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues.
  
  
  METHODS
  This study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984-2010. The analysis included 308,735 urban and 342,532 rural households.
  
  
  RESULTS
  The results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in the gap between urban and rural areas. Furthermore, inflation has affected the poor more than the rich. The Kakwani progressivity index in all years is positive, averaging 0.436 in rural and 0.470 in urban areas during the time period of analysis. Compared to inequality in income distribution over the last 30 years, health expenditures continuously show more inequality and progressivity over the same period of time.
  
  
  CONCLUSIONS
  According to the result of our study, during this period Iran introduced four National Development Plans (NDPs); however, the NDPs failed to provide sustainable strategies for reducing inequalities in health care expenditures. Policies that protect vulnerable groups should be prioritized.
authors.affiliation: Health Policy and Management Department, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, Maryland 21205, USA. hzare1@jhu.edu.
authors.forename: Hossein
authors.initials: H
authors.lastname: Zare
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Trujillo
authors.forename: Julia
authors.initials: J
authors.lastname: Driessen
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Ghasemi
authors.forename: Gisselle
authors.initials: G
authors.lastname: Gallego
mesh_terms: D057217:Economic Development; D005191:Family Characteristics; D005382:Financing, Personal; D005102:Health Expenditures; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends; D006801:Humans; D007182:Income; D007492:Iran; D009313:National Health Programs; D011203:Poverty; D012424:Rural Population; D012922:Social Change; D012923:Social Class