The Palestinian Economy. Theoretical and Practical Challenges

Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 355
al. 1991). Availability refers to the extent to which various types of health care services
do exist, and if so, whether the distributions of these services throughout the different
areas in a country are appropriate, an issue related to the supply side of health care market
(Nia and Bansal 1997). Accessibility to health care is concerned with the ability of a
population to obtain a specified set of health care services; i.e., the degree to which
individuals are able to contact/reach the needed health services (Hamdan, Defever et al.
2003). In this context, geographic accessibility, referred to as spatial or physical
accessibility, is concerned with the complex relationship which exists between the spatial
separation of the population and the supply of health care facilities (Ebener, Morjani et al.
2005). Therefore, accessibility reflects the appropriateness of the distribution and
organisation of health care in a country. It is mainly affected by the way in which health
care is delivered (the structure of service, the physical allocation, means of transport,
etc.), and funded (insurance coverage, ability to pay, etc.), as well as by socioeconomic
elements (Ebener, Morjani et al. 2005). A number of recent studies commenting on the
delivery of health care in the local context of the OPT raised serious concerns about both
issues of availability and accessibility to health services (Hamdan, Defever et al. 2003;
Heilskov, Kjaeldgaard et al. 2006; Mataria, Khatib et al. 2009). The following subsection
provides a brief review of the concerns raised by these studies.
2.2.1. Spatial Distribution of – and Physical Accessibility to – Health Care
Overall, the distribution of health care facilities between and within the two Palestinian
regions: the WB and GS, was described as inappropriate and inadequate in terms of the
number, level and type of services (Hamdan, Defever et al. 2003). In fact, the specialinequalities
in the distribution of health care are, especially, pronounced in the case of
secondary and tertiary health care services rather than the primary services, which are
almost available throughout different areas. For instance, of the 22 hospitals in GS, 14 are
located in Gaza City, with the others located in the remaining 4 areas. Similarly, while the
centre of the WB has 20 hospitals, the Northern and Southern areas include 18 and 16
hospitals, respectively (HPU 2008a). The unequal distributions of health facilities in
favour of the central areas can be better marked in terms of number of beds per capita:
while Ramallah district and Gaza City have 1.1 and 2.1 beds per 1000 capita,
respectively, Salfeet district in the WB and Rafah City in the GS have only 0.2 and 0.5
bed per 1000 capita, respectively (HPU 2008a). Overall, the GS possesses 1.4 beds per
1000 capita whereas the WB has 1.2 beds per capita. This contradicts with the