Equity on access to health care services among COVID-19 cases and related deaths in Iran: a sub-national survey

Health inequalities can determine the risk of diseases and the measures employed to prevent and treat diseases when they occurs. The COVID-19 pandemic has played an important role in creating and reinforcing numerous health inequalities across the globe. This study aimed at investigating inequalities in access to health services in patients with COVID-19 and mortality caused by it at the provincial level of Iran.

This descriptive cross-sectional study assessed all provinces of Iran for a number of hospital measures, including total hospital beds, ICU beds, the number of CT scans, and the number of specialists and nurses. To determine the effect of hospital infrastructure and facilities on death and hospitalization, the Pearson correlation coefficient was used. Multivariate linear regression was employed to determine the relationship and significance of the variables, and the Gini coefficient and the Lorenz curve were used to measure inequalities in the distribution of facilities and infrastructures.

The results showed that on the basis of hospital facilities, the rate of hospitalization and death due to COVID-19 can be predicted by 96%. Increasing ICU beds increased hospitalization and death by 1.16 and 0.97 respectively. Also, for every increase in the number of doctors and nurses, the chance of hospitalization increased by 0.423 and decreased by 0.741 respectively. Isfahan, West Azerbaijan, Yazd, Kermanshah and Zanjan provinces had the lowest Gini coefficient in bed distribution.

The distribution of resources among provinces is not fair. Therefore, in order to achieve universal health coverage and comply with the leveling of service provision, it is necessary to make policies and plans according to the needs of the society and allocate resources based on the needs and burden of the disease.