Mohsen Bayati

Determinants of life expectancy in eastern mediterranean region: a health production function.

BACKGROUND Determinants of health or health production function in health economics literature constitute noticeable issues in health promotion. This study aimed at estimating a health production function for East Mediterranean Region (EMR) based on the Grossman theoretical model. METHODS This ecological study was performed using the econometric methods. The panel data model was used in order to determine the relationship between life expectancy and socioeconomic factors. The data for 21 EMR countries between 1995 and 2007 were used. Fixed-effect-model was employed to estimate the parameters based on Hausman test. RESULTS In estimating the health production function, factors such as income per capita (β=0.05, P<0.001), education index (β=0.07, P<0.001), food availability (β=0.01, P<0.001), level of urbanisation (β=0.10, P<0.001), and employment ratio (β=0.11, P<0.001) were specified as determinants of health status, proxied by life expectancy at birth. A notable result was the elasticity of life expectancy with respect to the employment rate and its significance level was different between males (β=0.13, P<0.001) and females (β=0.08, P>0.001). CONCLUSION In order to improve the health status in EMR countries, health policymakers should focus on the factors which lie outside the healthcare system. These factors are mainly associated with economic growth and development level. Thus, the economic stabilisation policies with the aim of increasing the productivity, economic growth, and reducing unemployment play significant roles in the health status of the people of the region.

Inequalities of general physicians and specialists visits’ utilization and its determinants in Iran: a population based study

Purpose – The purpose of this paper is to study, inequalities between general physicians’ and specialists’ visits in Shiraz. Also, the factors effecting the utilization of visits were determined. Design/methodology/approach – Concentration index and curves, ranked by income and quality of life were used to estimate the amount of inequality in the utilization of services. Health utilization data which had been gathered already were used for this purpose. Poisson regression was used to construct the models. Findings – Results of the study showed that, inequalities in specialists’ visits were higher than GPs’. Complementary insurances users and females used more specialist services. People with higher quality of life utilized fewer GPs’ and specialists’ services. Originality/value – New evidences about inequality in health services utilization and its components in Iran was surveyed.

Effect of Iranian Economic Reforms on the Social Equality and Equity in Healthcare Financing: A Segmented Regression Analysis

Objectives One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Target income and its determinants for general physicians: An instrumental variables approach

ABSTRACT The economic behavior of physicians has a considerable effect on healthcare expenditure. A well-known theory for explaining physicians’ behavior is the target income hypothesis. In this theory, the main issue is concerned with how physicians set their desired income. Therefore, in this study the level and determinants of Iranian general practitioners’ (GPs’) desired income were analyzed. Respondents consisted of 666 GPs. We used instrumental variables (IV) as predictors of actual income in order to address endogeneity and possible measurement error in it. The monthly mean (standard deviation) of target income and the actual income of Iranian GPs were 4877.4 (3445.7) and 2188 (1768.9) USD. The actual income was the most important determinant of target income. GPs with higher economic expectations, as well as GPs dissatisfied with their current professional financial status, and GPs that had a greater willingness to save money set higher target incomes in order to respond to these expectations, to compensate their financial dissatisfaction, and to address the economic instability and financial risk of their practice. Focusing on financial incentives only in the short term can change their behavior, however in the long term, policies related to controlling desired income with focus on views factors can be helpful.

GEOGRAPHICAL DISPARITIES IN THE HEALTH OF IRANIAN WOMEN: HEALTH OUTCOMES, BEHAVIORS, AND HEALTH?CARE ACCESS INDICATORS

Background: Womens health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of womens health and health care in Iran. Methods: Using the Mosss model (2002) as a comprehensive framework of determinants of womens health, including “geopolitical environment,” “culture, norms, sanctions,” “womens roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and womens deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of womens health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in womens health at a provincial level.