Income inequality among general practitioners in Iran: a decomposition approach

Saeed Lohivash,Mohsen Bayati,Arash Rashidian,Yaser Sarikhani

doi:10.1186/s12913-019-4473-7

Abstract

BackgroundGeneral practitioners (GPs) are among the most important resources of healthcare system and public health is considerably influenced by the function of this group. Income inequality among GPs considerably affects the motivation and performance of this group. The present study aims to examine the income inequality among Iranian GPs in order to provide the necessary evidence for health human resource policy.MethodsIn this cross-sectional study, the distribution of income and wage inequality among GPs was investigated using income quintiles. We also used the Dagum’s model to analyze the inequality between different groups of GPs through the decomposition of the Gini coefficient. Moreover, a regression model was used to determine the effective factors on GPs’ income.ResultsThe results of this study indicated that income and wages of GPs in the highest quintile were eight times more than those of doctors at the lowest quintile. Regression estimates showed that factors such as gender, practice setting, and activity as the family physician (P < 0.001) were effective on income of GPs; and also male and self-employed GPs had significantly more wage (P < 0.001). Total Gini coefficient of GPs’ income and wage were estimated at 0.403 and 0.412, respectively. Highest monthly income was found in GPs with 16–20 years practice experience ($8358) based on Purchasing Power Parity (PPP), male ($8339 PPP), and self-employed GPs ($8134 PPP) subgroup. However, the female ($5389 PPP) and single ($5438 PPP) GPs had the lowest income. Population share; income/wage share; income/wage mean; Gini coefficient; and within, between and overlap decomposed components of Gini coefficient are also reported for each GPs subgroups.ConclusionsWe found significant inequalities in income and wages among Iranian GPs. Adjustment of income based on working hours indicated that one of the most common causes of income inequality among GPs in Iran was different workloads among different groups. Since the motivation and function of physicians can be influenced by income inequality, policymakers in the health system should consider factors increasing such inequalities.

Highlights

General practitioners (GPs) are among the most important resources of healthcare system and public health is considerably influenced by the function of this group
Performance of health systems is deeply dependent on GPs, so that effectiveness of health systems in achieving their goals is to a large extent subject to adequate, well-qualified, and motivated GPs [2]
The results revealed an unequal distribution of income among GPs, so that the income of the highest quintile was 8.6 times higher than the first quintile

Summary

Introduction

General practitioners (GPs) are among the most important resources of healthcare system and public health is considerably influenced by the function of this group. Income inequality among GPs considerably affects the motivation and performance of this group. Health professionals and especially General practitioners (GPs) are among the most important resources of health systems [1]. Income inequality can provoke GPs to reduce quantity or quality of services which can threaten public health [3]. Inter-sectional income inequalities could encourage GPs to opt out of public health sector or health insurance schemes [9], or may increase rate of dual practice and it will restrict capacity of service delivery in public health section [10, 11]

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Results

Conclusion