en عمومى General مقاله اصیل Original Article <div style="text-align: justify;">Background: The economic toll of health issues related to carbon emissions is substantial, accounting for a significant portion of national healthcare expenditures. This research addresses the lack of studies on healthcare service quality and the local effects of carbon emissions.<br> Methods: This study employed spatial econometrics to investigate the direct and indirect effects of carbon emissions on the quality of health services across Iranian provinces from 2011 to 2021. This method was chosen for its ability to capture both within-province and between-province effects, which is crucial for developing robust health policies. The researchers created a comprehensive index for health service quality, incorporating input, output, and overall index, using the entropy method.<br> Results: The findings indicate that CO₂ pollutants negatively impact both the output and the overall health service quality index. Economic growth demonstrated a positive direct impact and a negative indirect (spillover) effect on both dependent variables. The divergent indicators of direct and geographical consequences of per capita output growth imply a multifaceted link between the two. This indicates that economic affluence in one province directly enhances the quality of its healthcare services. The quality of health services in nearby regions may suffer as a result. Moreover, the input index demonstrates a substantial positive effect, while inflation and inequality exhibit a detrimental effect on the quality of health services.<br> Conclusion: The study&rsquo;s findings suggest that improving the quality of health services requires a multifaceted approach, encompassing not only direct healthcare investments but also broader economic and environmental considerations.</div> Health services, Environmental pollutants, Iran 1 11 http://ehemj.com/browse.php?a_code=A-10-1-427&slc_lang=en&sid=1 Hadi Keshavarz Hd.keshavarz@pgu.ac.ir 100319475328460021243 100319475328460021243 Yes Correspondence to: Business and Economics School, Persian Gulf University, Bushehr, Iran Ramezan Hosseinzadeh ra.hosseinzadeh@eco.usb.ac.ir 100319475328460021244 100319475328460021244 No Faculty of Economic and Administrative Sciences, University of Sistan and Baluchestan, Zahedan, Iran Reza Bakhshi rezabakhshi1228@gmail.com 100319475328460021245 0009-0002-2781-826X No Faculty of Economics, Allameh Tabataba’i University, Tehran, Iran Amirreza Khademi Kolahloo a.khademikolahloo@mail.sbu.ac.ir 100319475328460021246 0009-0009-8454-3662 No Faculty of Economics and Political Science, Shahid Beheshti University, Tehran, Iran Reza Sadeghi r.sadeghi@sirums.ac.ir 100319475328460021247 100319475328460021247 No Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran