The Palestinian Economy. Theoretical and Practical Challenges

Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 363
number of visits/days) of three levels of health care: primary, secondary and tertiarylevel.
The recall period was 12 months for the secondary-level (for which a distinction
was made between outpatient-clinic and inpatient-hospital admission), but this was
shorter for tertiary-level (6 months), and primary-level (one month). For both levels of
care: primary and secondary (outpatient-clinic), no distinction was made by type of health
professional providing care (i.e., GP vs. SP). However, for each level of care, a
distinction was made in terms of type of sector/provider used (Public, Private, and NGOs)
and type of services/treatments sought/received (e.g., referral, follow-up, diagnostic tests,
medications, surgery, etc.). Data on health care expenditures incurred as per level of care,
type of care, and services providers were also reported in the HCEU survey. For the
purpose of this analysis, health care utilisation (the dependent variable) is proxied by the
physical units of utilisation – i.e., number of visits. The latter is separately computed for
each level of health care: primary, secondary and tertiary. Utilisation of the secondarylevel
are distinguished and separately computed as outpatient-visits vs. inpatientadmissions.
Lastly, no attempt is made in this essay to aggregate the various types and
levels of care into one measure counting overall volume of utilisation. The latter is not
preferred, since it involves “adding apples and oranges” by pro rata scaling up or down
the different types of medical care (van Doorslaer and Masseria 2004).
The measurement of need for health care used in this study is apprehended through a
wide set of explanatory variables including morbidity indicators and demographics (age
and sex). As for morbidity variables, the HCEU-2004 survey offers a detailed list of
illnesses (up to 20 diseases and health problems) declared by respondents, at the
beginning of the reference period, based on self-reported morbidity. From this detailed
data, a set of dummy variables are constructed to indicate the presence of each type of
morbidity/health problems as per individual case. These include: chronic and longstanding
diseases (e.g., cancer, diabetes, obstructive pulmonary disease, heart disease and
kidney disease, etc.); acute diseases; injury/accident; mental and psychological problems.
In addition, the number of diseases is computed from the list of illnesses declared by the
respondents. Finally, four age groups and dummies for gender are included in the
measurement of “need” to reflect the variations in the above indicators across
demographic groups.
As for non-need indicators, a number of explanatory variables, which are shown to
affect utilisation patterns, are integrated in the analysis (van Doorslaer, Koolman et al.
2004). Among the potential list of variables incorporated in the regression analysis are:
education (level of education completed); activity status (employed, unemployed, retired,