The Palestinian Economy. Theoretical and Practical Challenges

Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 371
quintile is twice the public admission probability in the two regions. The estimated CIs
for each type of admission confirm the above patterns: for all types of admissions, except
public-admissions, indices are significantly positive [CI 0 at p < 0.05], suggesting
inequalities favouring the rich in the probability of utilisation of secondary (inpatient)
care in both private and NGOs sectors and in the two regions. By contrast, the CI’s of
public-admission in the two regions are positive and significantly different from zero [CI
0 at p < 0.05], suggesting inequality in admission to public sector favouring the poor.
Turning, lastly, to tertiary-level, significant pro-rich inequalities are detected in both
regions: results clearly show that the probabilities of utilisation of tertiary-care are higher
in the higher-income quintiles – as demonstrated by the positive gradients by quintile –
and the significantly positive values of CI at p < 0.05. Lastly, no significant differences
are found in the pro-rich patterns of utilisation of tertiary-level between the two regions:
the CI of tertiary care in the WB [CI = 0.761] is only slightly higher than that of the
tertiary care in GS [CI = 0.676].
The results presented above are all based on the actual distribution of health care
utilisation (the probability of any use). The reported CIs summarise, therefore, the degree
to which there is inequality (in the probability of use) with respect to income. The degree
of inequalities detected in the distribution of each level of health care may, however,
reflect differences in need by income – i.e., justifiable inequalities –, and therefore, can
not be interpreted as inequitable. In the following sub-Section, the overall income relatedinequality
for the total number of visits are measured and fully decomposed following the
methods described in Section 3.2.
4.2. Decomposition Results
The full decomposition results based on microsimulation exercise are presented in Table
4.1 The overall measured inequality in the utilisation of different levels of health care
(called I y ) is split, first, as per the identity defined in Eq. (20), into two broad categories
of inequality: the first measures the contributions of need factors (as captured by
morbidity and demographic indicators) – i.e., the justifiable part of inequality – (called
I N ), and the second measures the contribution of other non-need factors – i.e., the
unjustifiable part of inequality – (called I NN ). The latter, which also provides us with a
measure of the HI, is, then, disentangled, as per Eq. (23) and (24), in terms of two
meaningful parts: (a) the part of inequity due to the (unequal) distributions of socioeconomic
variables by income (called I V ), and (b) the part of inequity due to heterogeneity