The Palestinian Economy. Theoretical and Practical Challenges
The Palestinian Economy. Theoretical and Practical Challenges
The Palestinian Economy. Theoretical and Practical Challenges
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Assessing the Causes of Inequality in Health Care<br />
Delivery System in Palestine<br />
Mohammad Abu-Zaineh <strong>and</strong> Awad Mataria <br />
Abstract: Income-related inequalities <strong>and</strong> horizontal inequities in health care<br />
utilisation have recently been widely studied using linear additive models of<br />
decopmostion. This paper applies new methods of decompostion “by<br />
factors”, based on microsimulation technique. Besides avoiding the<br />
“unavoidable price” of linearity restriction that is imposed by the “st<strong>and</strong>ard”<br />
method, the microsimulation-based decompostion enables to duck the<br />
potentially contentious role of heterogeneity in genuine individuals’<br />
behaviour in the analysis of inequality, as well as the institutional features<br />
<strong>and</strong> practices driving inequity. <strong>The</strong> decomposition method is applied to twostage<br />
utilisation (the probability of usage <strong>and</strong> the conditional usage – using<br />
the combined Logit-zero truncated Negbin models) for three levels of health<br />
care delivery: primary, secondary <strong>and</strong> tertiary, particular to the specific<br />
context of the two occupied territories of Palestine (OPT): the West Bank<br />
(WB) <strong>and</strong> Gaza Strip (GS). <strong>The</strong> data are taken from the first national survey<br />
on health care use <strong>and</strong> expenditure, which provide detailed information about<br />
utilisation <strong>and</strong> morbidity. Our empirical results suggest that the worse-off do<br />
have disproportionately greater need for all levels of care, but with the<br />
expectation of primary-level, access to – <strong>and</strong> utilisation of – all levels of care<br />
appear to be significantly higher for the better-off. <strong>The</strong> incremental<br />
examination through microsimulation has made it possible to separately<br />
identify the relative contributions of factors driving such pro-rich patterns.<br />
While much of this inequity appear to be caused by omnipresent socioeconomic<br />
inequalities (by income), detailed analysis attributes a non-trivial<br />
part (circa 30% of the observed horizontal inequities) to heterogeneity in<br />
behaviour with respect to the rank of individuals in the income distribution.<br />
<br />
Department of Economics/Faculty of Commerce <strong>and</strong> Economics, Birzeit University. e-mail:<br />
mzaineh@birzeit.edu; mohammad.abu-zaineh@inserm.fr, alternate e-mail: mzaineh@gmail.com<br />
Corresponding author<br />
Institute of Community <strong>and</strong> Public Health, Birzeit University. e-mail: awad@birzeit.edu; alternate e-mail:<br />
amataria@gmail.com
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