Investigation of the influence of public expenditure on health lends support to the opinion
that equitable distribution of financial resources would help to reduce inequities in health.
This thesis set out to establish inequities in access to health care and health outcomes
across the provinces of Iran and explore equitable resource allocation models to contribute
to the reduction of health inequities. Inequities were measured based on the relationship
between a range of health indicators and socioeconomic status in the provinces.
Information on mortality, morbidity, and socioeconomic factors were taken respectively
from the Death Registration System, Health Profile in Iran (2003), and Iran's 2006 census.
There were significant relationships between mortality and socioeconomic indicators across
the provinces, with the larger rates of mortality in the worst-off provinces. Coronary risk
factors (diabetes, high serum cholesterol) were significantly associated with socioeconomic
factors; with higher prevalence of the risk factors in the well-off provinces. There were also
significant relationships between access to health services (hospital delivery and
vaccination) and socioeconomic status; with lower access in the worst-off provinces. The
resource allocation models based on population size and age/sex structure changed the
health expenditure in favour of the well-off provinces to contribute to the reduction of
inequities in morbidities. However, models based on mortality and deprivation changed the
expenditure towards the worst-off provinces, in order to bridge the inequities in mortality
and access to health services. Equity targets set, based on a combination of age/sex,
mortality, and deprivation, indicated that nineteen provinces had received a share of
expenditure higher than the equity target, with the largest in Mazanderan and seven
provinces received a share lower than the target, with the largest in Tehran. A five-year plan
was developed to move the expenditure from the hyper-financed provinces to the underfinanced
ones.