Assessment of Horizontal Inequity in Eye Care Utilization in the Iranian Middle-aged Population.

Akbar Fotouhi,Maedeh Raznahan,Mohammadhassan Emamian,Hojjat Zeraati,Hassan Hashemi

doi:10.4103/jovr.jovr_221_17

Abstract

Purpose:The present study was designed to determine the extent that horizontal inequity was realized regarding eye care utilization in a middle-aged population as well as factors affecting this equity.Methods:Data were obtained from a population-based study (Shahroud Eye Cohort Study) in 2009 that included 5190 participants from 40 to 64 years of age. Horizontal inequity was determined based on the following variables: (i) economic status, (ii) eye care service needs, (iii) non-need variables, and (iv) eye care utilization (visiting an ophthalmologist or optometrist). Decomposition analysis of the concentration index based on a nonlinear model and indirect standardization was used to ascertain the contribution of each factor in inequity of eye care utilization.Results:After adjusting for need variables, the results of our study demonstrated that horizontal inequity in eye care utilization in a middle-aged Iranian population remained positive and significant (horizontal inequity: 0.19; 95% confidence interval: 0.17–0.23) indicating that use of services was focused among participants with a better financial situation. Furthermore, decomposition analysis demonstrated that educational level and economic status had the greatest contribution (54.1% and 41.1%, respectively) in comparison to other variables.Conclusion:This study demonstrated that horizontal inequity exists in eye care utilization among the middle-aged Iranian population.

Highlights

The aim of this study was to measure horizontal inequity in eye care utilization in a middle‐aged Iranian population (40–64 years) using data from the first phase of the Shahroud Eye Cohort Study (ShECS) and to approximate the contribution of each variable to inequity based on the horizontal inequity index
To the best of our knowledge, this is the first study examining inequity based on the definition of horizontal equity and a decomposition analysis of inequity in eye care utilization in a middle‐aged (40–64 years) population through a population‐based study
Our study demonstrated that inequity existed in eye care utilization based on horizontal inequity, which is inconsistent with O’Donnell et al.’s definition of equity: that is, equal treatment for equal medical need.[33]

Summary

Introduction

According to the Iranian health sector evolution plan, the same holds true for Iran.[1,2,3,4,5] one of the items proposed by the International Agency for the Prevention of Blindness and the World Health Organization (WHO) in a document entitled “Universal eye health: a global action plan 2014–2019” for reducing avoidable blindness is equity in access to, and utilization of, eye care services.[6]

Objectives

Methods

Findings

Conclusion