Equity in the allocation of hospital beds in Iran: a systematic review and meta-analysis

Equitable access to healthcare is a fundamental human right. As capital intensive infrastructures, hospitals consume 40-50% of health expenditure in low and middle-income countries. However, inequities in the allocation of hospital beds compromise efficiency, accessibility and outcomes. This study aimed to systematically review and meta-analyze the available evidence on the allocation of hospital beds in Iran and to quantify the inequality with established indices.

A systematic review has been done in accordance with the principles of PRISMA, and the search process was conducted in international (PubMed, Scopus, Web of Science, EMBASE, CINAHL, DOAJ, MEDLine) and Iranian (SID, BKNS, Magiran) databases, and studies published from 2000 to 2025 in English and Persian language. Eligible studies reported quantitative measures of the allocation of hospital beds using inequality indices. Study quality was evaluated by using the Joanna Briggs Institute checklist. Meta-analysis was conducted using random effects and quality effects models, with heterogeneity being tested by Cochran's Q, I2, and H2.

Thirty studies were eligible for inclusion (16 English, 14 Persian). Eight studies contributed 18 effect sizes for meta-analysis. The pooled Gini coefficient was 0.24 (95% CI: 0.20-0.28), and this indicates relative equity across the country, though heterogeneity was very high (I2 = 96.3%). Quality-effects modelling produced a very similar, higher estimate 0.26 (95% CI: 0.21-0.30). At the provincial level, Gini values were found to be between 0.229 (South Khorasan) and > 0.50 (Sistan and Baluchestan, Bushehr), showing the existence of important regional differences. City level inequalities were greater where values of 0.46 and 0.68-0.70 were found in Tehran and Shiraz, respectively, compared to those in Shanghai and Shenyang.

While there is national equity in the allocation of hospital beds in Iran there are significant sub-national (provincial and urban) inequities. Addressing these requires equity-focused planning, monitoring and prioritization of disadvantaged regions.