Inequality in the distribution of resources in health care system by using the Gini coefficient and Lorenz curve (A case study of Sistan and Baluchestan province over a five-year period)

Objective(s): One of the most important goals of health systems is to provide equal access to health care services and fair distribution of their indicators. The aim of this study was to evaluate the inequality in access to human resources, health care, and hygienic services in 14 cities of Sistan and Baluchestan province. Methods: This was a descriptive study. Unequal access to health care services was assessed according to several items such as the number of physicians (general practitioner, pharmacist, and dentist), specialist physicians, paramedics, hospitals, active beds, laboratories, and pharmacies. The data was collected from the statistical yearbooks of the province. The Gini coefficient and Lorenz curve were the criteria to measure inequality. Data analysis and visualizations are performed in R software. Results: Based on the five years studied, the number of physicians, specialist physicians, hospitals, and active beds per ten thousand persons in 2019 has increased compared to 2014. There was no significant increase in other measures. The mean Gini coefficient for physicians, specialists, paramedics, hospitals, active beds, laboratories, and pharmacies was 0.106, 0.324, 0.132, 0.317, 0.336, 0.120, and 0.299, respectively. The highest rate of unequal access was related to specialist physicians and active beds. Furthermore, the lowest rate was related to physicians and laboratories. Conclusion: Gini coefficients for specialist physicians and active beds in 2019 compared to 2014 have decreased significantly over time. However, inequality in the distribution of these two health indicators was high. For other measures there were no significant decrease in the Gini coefficient. Thus, the finding suggests that the policy, by which the number of specialist physicians and physical resources of health (such as hospitals, active beds, and pharmacies) were increased, should be