ArticleInternational journal for equity in health2024
Rural-urban inequalities in health care utilization in Bhutan: a decomposition analysis.
Article in International journal for equity in health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Urban-rural disparities in primary health care utilization in Indonesia: a cross-sectional study.Korean journal of family medicine · 2026Article
- Quality as part of universal health coverage in Bhutan: a narrative synthesis.The Lancet regional health. Southeast Asia · 2026Review
- Intersectionality of cancer disparities in south Asia.The Lancet. Global health · 2026Review
- Modeling determinants of accessibility for healthcare services in rural and urban areas of Dodoma, Tanzania.BMC public health · 2025Article
- Health inequalities for China's low-income population: trends, subgroup differences, and influencing factors, 2010-2022.Frontiers in public health · 2025Article
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3 authors at 2 institutions in 3 countries.
Funding
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Abstract
BACKGROUND AND
objectiveOn the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences.
methodsWe used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca-Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas.
resultsSignificant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural-urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services.
conclusionsWhile the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage.
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