Healthcare Needs and Services Utilization Among Older People in Iran: A National-Level Analysis of Socioeconomic Inequalities

Abstract

Background and Aims: With the aging population and the corresponding increase in health service needs due to chronic diseases and age-related conditions, understanding health services utilization rates and the factors influencing them is crucial for providing better care. This study aims to investigate inequalities in inpatient and outpatient health services utilization among Iranian older adults.

Methods: This secondary analysis was based on primary data from the national survey of IrUHSS conducted in 2016. The study population consisted of 8205 older adults aged 60 and over, drawn from participants across the country. Data were collected through personal and household questionnaires, gathering information on participants’ needs for, referrals to, and utilization of inpatient and outpatient health services. Logistic regression analysis was used to determine the associations between the utilization of inpatient and outpatient services by older adults and their individual characteristics. Principal component analysis (PCA) was utilized to assess socioeconomic inequalities and construct the wealth score. The concentration index (CI) was employed to measure socioeconomic inequities in health service utilization using R software.

Results: Out of 8205 participants, 1411 (17.2%) individuals reported needed inpatient services during the last year, and 3152 (38.4%) ones required outpatient services at least once in the last 2 weeks. High utilization rates were observed for both outpatient (98%) and inpatient (97%) services. Significant associations were identified between outpatient service utilization and education level, supplementary insurance coverage, and gender. Inpatient service utilization was linked to supplementary insurance and age. Equity was observed in outpatient service utilization regardless of socioeconomic status (CI = 0.01993), while inpatient services showed inequity, with utilization concentrated among the wealthiest individuals (CI = 0.2477).

Conclusion: The findings indicated that older adults with better socioeconomic status had higher utilization rates for inpatient health services, highlighting inequality in access. These results underscore the urgent need for health policymakers to consider the socioeconomic status of older adults when designing interventions, ensuring equitable access to health services.