|Year : 2013 | Volume
| Issue : 3 | Page : 163-166
Differentiation socioeconomic factors affecting utilization of health services during accidents in Isfahan in 2012
Mohamad Ranjbar Ezat-Abadi1, Farzaneh Rejalian2, Mohammad H Yarmohammadian3, Khedmati Ismail4, Maryam Mofid5, Omolbanin Atashbahar6
1 Student in Health Policy, Health College, Yazd University of Medical Sciences, Yazd, Iran
2 Master's Student, Healthcare Management, Yazd University of Medical Sciences, Yazd, Iran
3 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Research-Oriented PhD, Center for Health Research-Based Community Involvement, Tehran University of Medical Sciences, Tehran, Iran
5 Master's Student of Health Management, Faculty of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
6 Master's Student of Health Management, Health College, Yazd University of Medical Sciences, Yazd, Iran
|Date of Web Publication||20-Mar-2014|
Health College, Yazd University of Medical Sciences, Yazd
Source of Support: Shahid Saddoghi Yazd Medical Science University, Conflict of Interest: None
Context: Since the accident, including the most common causes of death and disability in the world is the impact of stress on various aspects of economic, social, comfort and safety, and public welfare. Aims: Factors affecting their economic, social, and health services following disasters can benefit from the provision of basic guidelines that may help to reduce the impact of disasters. Settings and Design: This study is descriptive and analytical that has been done sectionally in 2012. Materials and Methods: The study population was all households in Isfahan. Number of sample households is 1037 which was estimated using random cluster sampling. The questionnaire collected data were entered into the Statistical Package for Social Sciences (SPSS) software 16. Statistical Analysis Used: Household economic cluster was calculated by factor analysis method. Pearson correlation and ANOVA was used to determine the influence of socioeconomic status on health utilization and disease distribution. Results: Number of outpatient health service utilization during accidents has been affected by economic factors such as households with higher education, higher income, and greater coverage of these services (P < 0.05). However, the use of inpatient health services and costs was not under the influence by any components of socioeconomic factors. Conclusions: Socioeconomic inequalities in the incidence of accidents and utilization of health services during accidents are exact reflection of inequality in other society parts that this problem has negative influence on all the countries and health section.
Keywords: Accidents, equality, social and economic factors, utilization of health care
|How to cite this article:|
Ezat-Abadi MR, Rejalian F, Yarmohammadian MH, Ismail K, Mofid M, Atashbahar O. Differentiation socioeconomic factors affecting utilization of health services during accidents in Isfahan in 2012. Int J Health Syst Disaster Manage 2013;1:163-6
|How to cite this URL:|
Ezat-Abadi MR, Rejalian F, Yarmohammadian MH, Ismail K, Mofid M, Atashbahar O. Differentiation socioeconomic factors affecting utilization of health services during accidents in Isfahan in 2012. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2021 May 15];1:163-6. Available from: https://www.ijhsdm.org/text.asp?2013/1/3/163/129148
| Introduction|| |
Accidents are one of the major of noncommunicable epidemic in this century. And those are not only coincidences, but are one of the results of technology improvement.  According to statistics, injuries caused by accidents in different age groups are one of the five major reasons that lead to death in developed and developing countries. 
Accident is an unforeseen event whose loss is detectable. In other word, accident is an unforeseen event which is caused by humans, and its result is detectable damage.  Accidents like other phenomena of the industrial and technology age, have taken a variety of forms. Especially in recent decades, because of significant reduction in morbidity and mortality rates due to infectious diseases and nutritional, accidents have become very important health risk factor for the world. 
Studies show that development index consist of socioeconomic factors that included male and female literacy rates, employment rates, life expectancy at birth, and the average monthly household income will have a significant impact on reducing mortality.  So, we can expect that socioeconomic factors effected on mortality caused by accidents and utilization of health services too. 
Socioeconomic factors are known as a first cause of health or loss of it.  Socioeconomic factors included education, occupation, income, consumption expenditure, investment, property, gender, ethnic group, and place of residence.  The most effective factor of reducing inequality in the health service utilization and distribution of diseases and accidents is attention to socioeconomic factors. So today the main topics of health issues should change from medical issues to more social issues such as; utilization of health services in different socioeconomic classes, the way of participation in public and private section, wealth creation, empowerment, and social participation. 
This matter promotes national and international commitment to increase the equity of indexes in utilization of healthcare regardless of socioeconomic status of household.  This study aimed to identify gaps and differences between different socioeconomic groups in access to health services to recognize inequity and inequality causes, so this will reduce inequities in utilization of health services.  Many studies show that lower socioeconomic classes compared with higher socioeconomic groups are at greater risk in mortality rate and these differences have been increasing in recent decades. 
In this regard, in 2004, World Health Assembly emphasized on establishing the World Commission for surveying socioeconomic factors affecting health and in 2005, this Commission officially began operating. It was decided during a 3-year period, offer instructions for policy-making in order to improve health and reduce health inequalities, particularly in relation to socioeconomic factors. 
Social, cultural, and economic factors have a significant impact on accidents especially on conflicts. Analysis of this study shows that at first most conflicts occur in people who have the least amount of education means that they just could read and write. Second, statistics of conflicts between workers were very higher. And finally, it is more common in poorer areas. 
Khosravi's study as a title of "Epidemiology study of domestic accidents" has reported significant relationship between age, gender, and geographic region with cause of accident, type of event, and organ affected. It also stated that the most vulnerable age groups were 0-14 and 15-24 years. Also is reported that there is a significant relationship between gender and cause of accidents as well as gender and the type of accidents. 
Robert Leu's study as a title of "Assessment of income-related inequalities in the utilization of health services" in Switzerland show that the average visits among families with lower socioeconomic status reported 1.3 times per year, but among families with better socioeconomic was 1.8 time per year that show inequality in visits of specialists were more than others. The average of inpatient bed days for the poorest group was 1.27 and for richest group was 0.95. As stated by Leu, education and health insurance had the greatest impact on increasing inequality. 
Regard to the impact of socioeconomic factors on access of families to health services can predict that also at the time of accident demographic and socioeconomic variables will be effective at health service utilization. So this study has been able to investigate the access to health services during accident. Accidents have destructive effects on various aspects of economic, social, comfort and safety, and public welfare. So determination of socioeconomic factors affecting healthcare utilization following the occurrence of accidents can be effective to offer the basic solutions to reduce the impact of accidents and destructive effects.
The method of survey
This research has been a descriptive and analytical study in 2013. The study population included all residents of Isfahan. Tools for data collection was a questionnaire which had three parts: Questions on demographic and socioeconomic factors (Retrieved from standard questionnaire (SES)) and questions on utilization of health services at the time of accidents. Socioeconomic status questionnaires retrieved from socioeconomic inequality of mental health study with concentration index approach that has been done by Khedmati in Tehran in 2012. 
Healthcare service utilization questionnaire is retrieved from inequality in the use of healthcare services and expenditures study for different situations and providers of health that has been done by Onwujekwe et al., 2011.  Sample of study was estimated to be 1037 families and the method of sampling for both variables was randomized cluster. In this way based on municipal zoning, 14 clusters selected and a household was randomly selected in each cluster.
Then 74 families on the right were studied. Questionnaire of household socioeconomic status was completed by questioner by interviewing the householders. Also for completing the health problem questionnaire and utilization of health services at the time of the accident and injury, a person who was aware of family's healthy issues was interviewed.
In this study, events including car accidents, burns, assaults, domestic accidents, and injuries at work were studied. After receiving the questionnaire, data were entered into the statistical software Statistical Package for Social Sciences (SPSS) 16 and then economic clustering was performed by factor analysis. Then one-way analysis of variance (ANOVA) test and Pearson was used to determine the relationship between the utilization of health services and the distribution of accidents among the study population was done according to socioeconomic status.
| Result|| |
5.7% of the study population is referred for outpatient services due to accidents in the past 6 months. Also 3.4% of the population has been hospitalized to receive services due to accidents in the past year. Percentage of people who are receiving outpatient services divided by the type of medical centers at the time of accidents and incidents in 2013 is shown in [Table 1].
|Table 1: Percentage of people receiving outpatient services divided by the type of medical centers at the time of accidents and incidents between Isfahan's residents in 2013|
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Referral of the study population for receiving outpatient services after the accidents, including car accidents, burns, assaults, domestic events, and injuries at work did not have meaningful difference between different income groups, 14 districts of Isfahan, mother's education, paternal occupation, economic quintile, and the type of insurance (P > 0.05). The only variable that had an effect on referring to health centers after the accident was education of householder (P < 0.05).
The numbers of people who have more education were more at the time of accidents. The highest rate of referral to health centers at the time of accident was belonging to the group who had the college educations. The cost of outpatient services for people who suffered accidents, did not have meaningful difference between different groups of income, education, and occupation of householders. Affecting factors on household spending for outpatient services during accidents were insurance type and household economic quintiles. The highest rate of spending for health between uninsured populations has been (560,000 Rials) and the lowest rate of spending between the populations covered by health care insurance has been (87,220 Rials). The highest rate of spending for health has been during the households with the fifth quintile economic (872,270 Rials). Spending for receiving outpatient treatment during the accidents divided by economic quintile of Isfahan's residents is shown in [Table 2].
|Table 2: Household spending for receiving outpatient treatment during the accidents divided by economic quintile of Isfahan's resident in 2013|
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Referral of the study population to medical center during accident for hospitalizing did not have meaningful difference between socioeconomic variables studied, including different income groups, 14 districts of Isfahan, education of householders, parental occupation, economic quintile, and the type of insurance.
Percentage of people who received hospitalized services divided by the type of medical centers at the time of accidents and incidents between Isfahan's residents is shown in [Table 3].
|Table 3: Percentage of people who received hospitalized services divided by the type of medical centers at the time of accidents and incidents between Isfahan's residents in 2013|
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Household spending for receiving hospitalized services at the time of accidents did not have meaningful different between different income groups, 14 districts of Isfahan, education of householders, parental occupation, economic quintile, and the type of insurance.
| Discussion|| |
All kinds of dangers and accidents that are caused by technology, contact with nature, work, and daily activities; may have primary, secondary, and tertiary effects. Initial medical examinations can have a significant impact on reducing the secondary and tertiary effects and avoid many of disability and physical impairment.  Conflicts and accidents that are the most important cases of accidents in our country can potentially cause a high depreciation of manpower, waste of work time, deformity, and disability. 
Therefore, access to healthcare services regardless to socioeconomic variables has an important impact on preventing destructive complications and disability after the accidents. All studies only examined the demographic and socioeconomic variables in distribution of accidents. In these studies, cultural factor to promote the intellectual, economic, and social awareness are effective to reduce the accidents. 
In addition to prevent the incidence of accidents; access to healthcare services can also prevent the harmful effects of accidents. According to the results of the present study, education of householders had affected referral of the families for outpatient services at the time of accident. As it was mentioned, primary healthcare in minor injuries that do not require hospitalization is essential for prevention of disability. 
Economic quintile has a direct relationship on household spending for outpatient services at the time of accidents; while that has not effect on hospitalization costs. This difference has been due to attention and Obligation to provide health care to emergency cases. Attention to provide the health services at the first level of injuries; help prevent the Damage that can lead to death and Disability. So the insurance system could cover this gap.
Having covered by insurance system prevents individual from direct payments. This issue caused the families who were not covered by any insurance organization had to pay more than them. Due to the effect of economic situation of families on outpatient visits, less visits can be expected by poor families at the time of accident.
Hidayat et al.,'s study; "The impact of public health insurance on equity in access to outpatient care in Indonesia"; has reported that health insurance has a significant effect on improving access to public and private services.  Qajar et al.,'s study in 2011 stated that the share of spending for health services in the families headed by women were significantly less than families headed by men.  Hayati in another study generally pointed that household income, type of basic and complementary insurance, the number of visiting physicians, and location of families have impact on utilization of healthcare services. 
Socioeconomic development are known as an important tool for reduction of economic, social, and sexual inequity in access to healthcare, use of services, and the results of healthcare utilization.  Health services are important as a strategic commodity contained subsides in Iran and essential needs for public. Health services are complex and multifactorial issues that solving the imperfections and problems of this system needs national commitment and attention of all officials, health practitioners, other institutions, and related organizations. 
Intersectional cooperation is a continual requirement of health development and this matter is too important for reducing the mortality and morbidity caused by accidents. Finally, it can be stated that socioeconomic inequalities in the incidence of accidents and health service utilizations at the time of accidents are results and reflections of inequality in other sections that those affect all parts of the country and not just the health section. 
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[Table 1], [Table 2], [Table 3]