Barriers of health equity in the Iranian health system from the medical ethics viewpoint

Davoud Nezamoleslami; Efat Mohamadi; Bagher Larijani; Alireza Olyaeemanesh; Masoumeh  Ebrahimi Tavani; Roya  Rashidpouraie; Fataneh Sadat Bathaei

doi:10.18502/jmehm.v15i14.11570

Davoud Nezamoleslami Phd Candidate in Medical Ethics, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Efat Mohamadi Assistant Professor, Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.
Bagher Larijani Professor, Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Olyaeemanesh Professor, Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran; National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Masoumeh Ebrahimi Tavani Assistant Professor, Group of Quality Improvement, Monitoring and Evaluation, Center for Health Network Management, Deputy for Public Health, Ministry of Health & Medical Education, Tehran, Iran.
Roya Rashidpouraie Researcher, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Fataneh Sadat Bathaei Researcher, Department of Medical Ethics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jmehm.v15i14.11570

Keywords: Health equity; Health services accessibility; Medical ethics; Health disparities.

Abstract

In order to lessen health inequalities, the obstacles to health equity will need to be identified. This study aimed at investigating the barriers to access to health-care services from the medical ethics point of view.

Data were collected through a qualitative study by performing semi- structured interviews. Purposive sampling was used to recruit participants involved in health provision and/or management. Content analysis was done using MAXQDA software.

Overall, 30 interviews were conducted. The content analysis of the interviews identified two themes including “micro factors” and “macro factors”, five sub-themes including “cultural, financial, geographical, social and religious barriers”, and 44 codes. Based on our findings, differences in individuals’ perceptions, cultural control, religious beliefs and social stigmas create cultural barriers. Financial barriers consist of the financial connection between service recipients and service providers, insurance premiums, and inadequate coverage of health-care services.

The most important geographical barriers identified in our study were differences in urbanization, inequality in various geographical areas, marginalization, and inequality in resource distribution. Finally, differences in the level of income, education and occupational diversity were among the social barriers.

Given the wide range of barriers to access to health-care services, a comprehensive plan covering various dimensions of health equity should be implemented. To this end, innovative and progressive strategies emphasizing the principles of equity and social equality should be developed.