title: Horizontal inequity in access to outpatient services among Shiraz City residents, Iran.
abstract: BACKGROUND
  lack of access to health services has been mentioned as one of the main causes of health inequity in health system. The aim of this study was to measure horizontal inequity in access to outpatient services in Shiraz.
  
  
  METHODS
  This household survey was conducted among 1608 participants above 18 years in Shiraz in 2012. Four-stage sampling was used. According to high amount of zero-valued of outpatient services utilization, Zero inflated regression model was established. We computed concentration index (CI) for determining actual (CIM) and indirect standardized utilization (CIIS) of outpatient services in order to compute horizontal inequity index (HII). The results were analyzed using Stata software, version 8.
  
  
  RESULTS
  The CIM was not statistically significant (-0.016, 95% CI: -0.097, 0.066). But the CIIS was statistically significant and favored the rich (0.06, 95% CI: 0.010 to 0.001). The horizontal inequity index was -0.076.
  
  
  CONCLUSIONS
  There was no inequality in actual amount of outpatient utilization, maybe High subsidization to health care by government in public sector, high insurance coverage, low prices of health services in the public sector, quality of services and opportunity cost of high income groups were the reasons for our results.
authors.affiliation: Department of Health Care Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Kavosi
authors.affiliation: Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Mohammadbeigi
authors.affiliation: Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran. vajihe_ramazani@yahoo.com.
authors.forename: Vajihe
authors.initials: V
authors.lastname: Ramezani-Doroh
authors.affiliation: Department of Health Care Management School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Hatam
authors.affiliation: Health Management and Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abdosaleh
authors.initials: A
authors.lastname: Jafari
authors.affiliation: Department of EDC, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Azarmidokht
authors.initials: A
authors.lastname: Firoozjahantighi
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007492:Iran; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D017150:Public Sector; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Access to Health Care; Healthcare Inequalities; Iran; Outpatient Health Services; Utilization