The Palestinian Economy. Theoretical and Practical Challenges

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Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 343 1. Introduction Although huge literature has been accumulating over the last two decades to assess inequalities in access to – and utilisation of – health care services in the context of developed countries (Wagstaff, Van Doorslaer et al. 1991; van Doorslaer, Wagstaff et al. 1992; van Doorslaer, Wagstaff et al. 2000; Waters 2000; Wagstaff, van Doorslaer et al. 2003; van Doorslaer and Masseria 2004; Wilkinson and Pickett 2006), little efforts were devoted to assess inequalities in health care delivery in the context of developing countries. In addition, the very few studies (e.g., Baker and Gaag 1993; Pannarunthai and Mills 1997; Cissé, Luchini et al. 2007) that attempted to incorporate this endeavour have resorted to a “classical” approach that serves, at its best, to provide aggregate “descriptive” results on the degree of inequalities prevailing in a given distribution, with no attempts being made to unveil the latent factors that may possibly contribute to these inequalities. Furthermore, while the available literature offers a variety of tools and methods for assessing inequalities in health care delivery (e.g., van Doorslaer, Wagstaff et al. 1992; Wagstaff and van Doorslaer 2000b; Waters 2000; Gravelle 2003; Huber 2006; van Doorslaer, Masseria et al. 2006), the variability of available approaches, the inconsistency of presented results, and the controversial policy debates characterising this field of research, all call for more attention to identifying and endorsing the appropriate approach for studying inequalities in health care delivery. Undeniably, the variability in the approaches used may be due, in large part, to the diverse dimensions chosen to appraise inequalities, the specific indicators used to apprehend these dimensions, and the different theories of “distributive and social justice” underpinning the adopted approach (Gauthier 1983; Mooney 1987; Le Grand 1991; Culyer and Wagstaff 1993; Gerdtham, Johannesson et al. 1999; Macinko and Starfield 2002). Indeed, considerable disagreement exists among economists (cf. Wagstaff and van Doorslaer 2000a, for a review) on how inequalities in health care utilisation can be identified, measured and valued, something which resulted in an ample amount of theoretical and empirical literature – originated for most part from developed countries – however, with few consistent findings. These findings suggest possible pathways by which inequality in health care use might be generated and perpetuated (Macinko and Starfield 2002). The extent of inequalities in access to – and utilisation of – health care services has shown to differ according to the measurement of need (e.g., subjective selfreported vs. objective indicators of ill-health), the types of health care services (e.g., medical specialists vs. general practionners), and due to the inclusion or not of potential
344 Abu-Zaineh – Mataria confounding factors related to demographic and socioeconomic characteristics of users (Gakidou, Murray et al. 2000; Shi and Starfield 2000; van Doorslaer, Wagstaff et al. 2000; van Doorslaer, Masseria et al. 2006). Yet, in spite of such divergence, recent empirical studies conducted in the context of developed countries continue to demonstrate persisting inequalities in health care delivery (van Doorslaer, Koolman et al. 2004). Moreover, such inequalities have been recorded in several European countries, where the majority of health care services are channelled on the basis of some “egalitarian” principles that entail health services allocation based on needs rather than abilities-to-pay (van Doorslaer and Wagstaff 1993). This finding was frequently attributed to some contextual characteristics and systemic features (Navarro 1999; Gravelle and Sutton 2001; van Doorslaer and Masseria 2004). It is, on the other hand, true that even if all obstacles (financial and non-financial) to access health care were completely removed, there would be no guarantee for inequalities in health and health care use to be completely removed; i.e., achieving perfectly equal distribution of health care (Bole and Bondeson 1991; McIntyre and Mooney 2007). This is because another reason behind the omnipresent inequalities can be related to alternate individual behaviour vis-à-vis health and health care that might result from disparate genuine preferences and choices (Le Grand 1987). Therefore, defining and operationalising the notion of Horizontal Equity (HE), i.e., equal treatment for equals, 1 without taking into account potential confounding factors related to the individual’s own characteristics would result in inconsistent findings (Gravelle 2003; Schokkaert and van de Voorde 2004). Indeed, those individual characteristics are known to influence the preferences of individuals, and hence, are reflected in their behaviour in demanding health care; over and above the additional role played by the intrinsic characteristic of the health care system in influencing individual demand. Consequently, observed behaviours can be the direct result of genuine individual preferences rather than an inequality feature embedded in the system. The latter two factors as related to the demand and supply sides of the health care market were usually not taken into account in the current literature on assessing horizontal inequity in health care demand. Ideally, one would like to study equity in health care use by taking into account individual preferences that are explained by utilitarian economic theory (Stiglitz 1982), or through placing the full empirical analyse in the context of a social welfare maximisation 1 In this context “equals” is defined in terms of “need” exactly, prompting the elaboration of the distinction between equality and equity.
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The Palestinian Economy Theoretical
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© Gianni Vaggi - Marco Missaglia -
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VOLUME II
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246 Zagha 1. Introduction The local
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248 Zagha and groups in political d
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250 Zagha drawbacks in the politica
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252 Zagha it is not surprising that
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254 Zagha economy (including expend
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256 Zagha social norms sharply dist
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258 Zagha Bird (1995) puts it, info
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260 Zagha intergovernmental fiscal
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262 Zagha low rate flat tax levied
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264 Zagha need to be given access t
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266 Zagha Such failures are found i
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268 Zagha 4.1.3. The Relationship b
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270 Zagha a final account report of
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272 Zagha 4.1.6. Functions of LGUs
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274 Zagha • Management of LGU ass
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276 Zagha Figure 2: Local Governmen
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278 Zagha In summary, what the data
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280 Zagha on the cash basis. Almost
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282 Zagha Figure 7: Business Opinio
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284 Zagha within the Palestinian na
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286 Zagha Table 5: Number of NGOs i
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288 Zagha Fiscal decentralisation i
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290 Zagha Burki, J., Perry, G., Dil
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Proceedings “The Palestinian Econ
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Labour Force Instability and Employ
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424 Olivera provisions - in particu
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426 Olivera Figure 1: Economic Grow
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428 Olivera 3. Traditional economic
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430 Olivera costs and lower market
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The Palestinian Economy. Theoretical and Practical Challenges

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