Introduction: This study takes a comparative frame work look at provinces, classified into the groups in need of healthcare services, to assess the relationship between the groups’ needs to healthcare services and the utilization of these services within health insurance program, from   1383 to-1388. The objective of this assessment was to explore the changes, came out of the development of health insurance services, in the affected provinces regarding their needs to such services and their utilization of them

Methods: This study is of descriptive- statistical analysis nature.  Life expectancy data at birth as the indicator of need to healthcare services, and the utilization of such services as an indicator were estimated. Furthermore a regression correlation study between the variables of needs and, the correlation coefficients for each group were conducted.

Results: The comparison of the groups’ correlation coefficient between the need and utilization variables indicated that the coefficients for the groups are not the same. The vertical equity constraint, defined as utilization of health care services is consistent with the need to these services, requires the same value of correlation coefficients for all provinces.

Conclusion: This study indicated that the development of health insurance services in Iran, in 1383-1388, did not achieve the vertical equity requirement among the provinces that were grouped in terms of need to healthcare services. The justification that the need to health care services did not achieve its objective was because of the effects of social determinant of health to in the first year implementation of a five year plan.