عدالت در توزيع تخت هاي بيمارستاني شهر تهران: گزارش كوتاه

Equity of hospital bed distribution in Tehran city: brief report

عدالت در سلامت "دسترسي مردم به خدمات سلامت و استفاده از آن براساس نياز، پرداخت هزينه هاي سلامت براساس توان مالي و برخورداري از سطح سلامتي قابل قبول" است. هدف اين پژوهش سنجش عدالت در توزيع جغرافيايي تخت هاي بيمارستاني شهر تهران بود. روش بررسي اين پژوهش توصيفي و مقطعي در ارديبهشت 1398 انجام شد. ميزان عدالت در توزيع تخت هاي بيمارستاني با استفاده از منحني لورنز نمايش و با استفاده از ضريب جيني محاسبه شد. از نرم افزار (EXCEL software, Microsoft company, Washington, USA) براي تحليل داده ها استفاده شد. يافته ها: تعداد 1/6 بيمارستان به ازاي هر صد هزار نفر جمعيت و 2/8 تخت بيمارستاني به ازاي هر هزار نفر جمعيت در سال 1395 در شهر تهران وجود داشت. مناطق شهري 6، 12 و 3 بيشترين تعداد تخت بيمارستاني به ازاي جمعيت را داشتند. ضريب جيني توزيع تخت هاي بيمارستاني در شهر تهران برابر با 0/619 بود. نتيجه گيري: توزيع تخت هاي بيمارستاني در شهر تهران با استفاده از شاخص جيني ناعادلانه بود.

Health equity is “having fair access to healthcare, utilizing it according to actual needs, paying for it based on financial capacity and finally, having an acceptable level of health”. Health equity is an underlying principle of the universal declaration of human rights. Equitable distribution of hospital beds increases people’s access to healthcare services and as a result, improves their health status. This study aimed to examine the equity in the geographic distribution of hospital beds in Tehran city, Iran. Methods The data for this descriptive and cross-sectional study were obtained from the Ministry of Health and the Iranian statistics center in April 2019. All hospitals in Tehran city were included in this study. Lorenz curve and the Gini coefficient were used to measure the equity in the geographic distribution of hospital beds. Excel software was used for data analysis. Results Tehran city had a population of 8,693,706, and 142 hospitals with 24,535 beds in 2016. There was 1.6 hospitals per 100,000 people and 2.8 hospital beds per 1000 people in this city. Nearly half of the hospitals were private (49%) and the remaining were public or semi-public. About 77% and 23% of hospitals were general and specialized respectively. Almost half of the hospitals are more than 40 years old. The average number of beds in hospitals was 173. The Gini coefficient was 0.619 for hospital bed distribution among Tehran districts. Districts 6, 12 and 3 have had the highest hospital beds per 1000 people. Districts 6 had 23% of the total hospitals and 24% of the hospital beds. Conclusion The geographic distribution of hospital beds in Tehran city is not equitable. Hospital services should be accessible based on actual need rather than on the ability to pay. Achieving health equity is a prerequisite of universal health coverage. Hence, healthcare policymakers should reduce or eliminate the existing disparities and inequalities in access to hospital beds.