title: Trends of geographic inequalities in the distribution of human resources in healthcare system: the case of Iran.
abstract: BACKGROUND
  Considering the scarcity of skilled workers in the health sector, the appropriate distribution of human resources in this sector is very important for improving people's health. Having information about the degree of equality in the distribution of health human resources and their time trends is necessary for better planning and efficient use of these resources. The aim of this study was to determine the trend of inequality in the allocation of human resources in the health sector in Tehran between 2007 and 2013.
  
  
  METHODS
  This cross-sectional study was conducted in Tehran Province in Iran. The inequality in the distribution of human resources (specialists, general practitioners, pharmacists, paramedics, dentists, nurses and community health workers (Behvarz)) in 10 cities in Tehran Province was investigated using the Gini coefficient and the dissimilarity index. The time trend of inequality was examined by regression analysis. The required data were collected from the statistical yearbook of the Iran Statistics Center (ISC).
  
  
  RESULTS
  The highest value of the Gini coefficient (GC) was related to nurses (GC = 0.291) in 2007. The highest value of the Gini coefficient was related to nurses and Behvarzs in 2008 and 2009, respectively. The distribution of specialists had the highest inequality in 2010 (GC = 0.298), 2011 (GC = 0.300) and 2013 (GC = 0.316). General practitioners had the lowest Gini coefficient for 2007, 2008 and 2012. Nurses for 2009 and Behvarzs for 2010, 2011 and 2013 had the lowest value of Gini coefficient. The dissimilarity indexes for specialists and general practitioners were 26.64 and 8.72 in 2013, respectively. The means of this index for included resources were 31.35, 18.27, 16.91, 22.32, 15.82, 26.74, and 24.33, respectively. The time trend analysis showed that the coefficient of time was positive for all of the human resources, except Behvarzes, and only the coefficient of general practitioners was statistically significant ( p<0.01).
  
  
  CONCLUSIONS
  Over time, inequalities in the distribution of resources in the health sector have been increasing. By developing the private sector and considering the trend of this sector to operate in the more developed regions, health policy makers should continually evaluate the distribution of human resources, and they should arrange a specific plan for the allocation of human resources in the health sector.
authors.affiliation: Ph.D., Assistant Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sara Emamgholipour
authors.initials: SE
authors.lastname: Sefiddashti
authors.affiliation: Ph.D. of Health Services Management, Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
authors.affiliation: Ph.D. Student in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Ghazanfari
authors.affiliation: M.Sc. in Medical Informatics, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Zhila
authors.initials: Z
authors.lastname: Kazemi
authors.affiliation: Ph.D. Student in Health Economics, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Satar
authors.initials: S
authors.lastname: Rezaei
authors.affiliation: Ph.D. Student in Health Economics, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Ph.D. Student in Health economics, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali Kazemi
authors.initials: AK
authors.lastname: Karyani
keywords: Dissimilarity index; Gini coefficient; Human Resources; Inequality; Iran; Tehran Province