Socioeconomic Inequalities in Healthcare and Rehabilitation Expenditure: An Analysis of Costs for People With Disabilities in Iran Publisher



Z Najafi ZAHRA ; E Najafi ELAHE ; R Bidhendiyarandi RAZIEH ; S Soltani SHAHIN ; M Basakha MEHDI ; K Abdi KIANOUSH
Source: Middle East Journal of Rehabilitation and Health Studies Published:2025

Abstract

Background: Technological advancements, demographic shifts, and lifestyle changes have led to increased healthcare expenditures, making access to healthcare services more challenging. People with disabilities, who frequently require specialized healthcare and rehabilitation services, encounter substantial financial and structural barriers to access. Economic and social inequalities significantly influence access to rehabilitation services, often preventing individuals with disabilities, particularly in developing countries, from utilizing these services due to financial constraints and inadequate insurance coverage. Objectives: This study aims to examine socioeconomic inequalities in healthcare and rehabilitation expenses for persons with disabilities in Iran, highlighting the financial burden and disparities in access to essential services. Methods: This descriptive-analytical quantitative study utilized secondary data from a national survey conducted in 2020. The analysis employed the Gini coefficient and Concentration Index to assess socioeconomic inequalities. The dataset included responses from 483 adults with physical disabilities who were members of the Iranian Disabled Community and had participated in the original survey through a structured electronic questionnaire. The data were analyzed using Stata software. Results: The average total cost was 24,600,000 Iranian Tomans (PPP 270.09$ US), indicating significant economic pressure on individuals with disabilities. The Gini coefficient, nearing 0.90, reflects severe inequality in the distribution of total healthcare and rehabilitation expenditure among people with disabilities. This inequality implies that some individuals face high expenses for these services, while others pay much less. The Concentration Index based on income was positive, indicating that inequality favors higher-income groups, while based on educational status, inequality favors individuals with lower education levels. Conclusions: The findings reveal a significant level of inequality in healthcare and rehabilitation expenditure for individuals with disabilities. These expenses are typically high and can be particularly burdensome for this population, many of whom face challenges related to inadequate education and insufficient income. These findings emphasize the necessity of targeted policy interventions to alleviate financial barriers and ensure equitable access to rehabilitation services across socioeconomic groups. Such policies could enhance health outcomes and improve the quality of life for individuals with disabilities. © 2025 Elsevier B.V., All rights reserved.