en اقتصاد سلامت Health Economics پژوهشي Original Article <div style="text-align: justify;"><strong>Background and Purpose: </strong>Healthcare inequality remains a major challenge in Nigeria, particularly in rural areas where access to essential inpatient services is uneven and reliance on informal providers is common. Existing studies have largely focused on inequalities in specific services, with limited evidence of disparities across formal healthcare settings. This study aimed to examine income-related inequalities and horizontal inequities in access to inpatient healthcare in rural Nigeria.<br> <strong>Materials and Methods</strong>: Cross-sectional data from 624 households collected under the human capital research project were used. The data set contained detailed information on household demographics and socioeconomic characteristics as well as information on inpatient healthcare utilization. Income-related inequality in healthcare use was measured using the concentration index (CI), while horizontal inequity was assessed using need-standardized concentration indices derived through indirect standardization. A decomposition analysis of the CI was conducted to quantify the relative contributions of socioeconomic, demographic, and health-related factors to observed inequalities.&nbsp;<br> <strong>Results</strong>: Access to inpatient care was 81.4%, 49.9%, and 18.4% for public primary, secondary, and tertiary facilities, respectively, and 32.7% for private facilities. Access to public primary and secondary care decreased with wealth, whereas access to tertiary and private care increased. Significant pro-poor inequalities and inequities were observed for public primary (CI=&minus;0.1054, 95% CI, -0.1818, -0.029; HI=&minus;0.0374, P<0.05) and secondary care (CI=&minus;0.1063, 95% CI, -0.2047, -0.079; HI=&minus;0.0377, P<0.05), while significant pro-rich inequalities were found for tertiary (CI=0.2382, 95% CI, 0.1645, 0.3119; HI=0.3660, P<0.01) and private care (CI=0.1502, 95% CI, 0.0585, 0.2419; HI=0.218, P<0.01). Economic status and region of residence contributed most to observed inequalities.&nbsp;<br> <strong>Conclusion</strong>: Income-related inequalities in access to inpatient healthcare are mainly driven by economic status and region of residence, highlighting that policies aimed at reducing financial barriers (e.g. subsidized healthcare, insurance expansion) and region-specific interventions (e.g. improving rural healthcare infrastructure) are likely to be most effective in addressing these disparities.<br> &nbsp;</div> Health status disparities, Hospitalization, Public sector, Health services accessibility and concentration index (CI) 137 152 http://jhs.mazums.ac.ir/browse.php?a_code=A-10-1225-1&slc_lang=en&sid=1 Abdul Majeed Yaqoob yaqoobmajeed042@gmail.com 100319475328460015297 100319475328460015297 Yes Department of Economics and Development Studies, Faculty of Management and Social Sciences, Prime University Abuja, Abuja, Nigeria. Afees Salisu adebare1@yahoo.com 100319475328460015298 100319475328460015298 No Center for Econometrics and Applied Research (CEAR), Ibadan, Nigeria. Obumneke Ezie eobumneke@gmail.com 100319475328460015299 100319475328460015299 No Department of Economics, Faculty of Social Sciences, Bingham University, Karu, Nigeria.