The Palestinian Economy. Theoretical and Practical Challenges

Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 375
As shown above, although the distributions of need serve to push the distribution of
utilisation of the three levels of health care in a pro-poor direction, the divergence
between overall use-inequality index (I y ) and the distributions of need (I N ) is, however,
remarkable. The discrepancies between the “actual” and the “need-expected”
distributions of utilisation indicate, therefore, the direction and magnitude of Horizontal
Inequity (HI) index – defined as inequality not due to income-related differences in need,
and computed as in Eq. (22) – i.e., by subtracting the contribution of need factors from
the total inequality. Results on the HI index, which are also presented in Figure 4.1 with
the corresponding 95% BTS confidence intervals, show that in all the cases, the values of
HI index appear to be positive, in the range of [0.039; 0.213], and statistically
significantly different than zero at p < 0.05. For all levels of health care, the WB region of
the OPT shows significantly higher HI index values than GS. However, in the two
regions, the magnitudes of HI index across the three levels of health care show generally
similar patterns: the HI values are greater (i.e., very pro-rich) in the case of tertiary-care
[HI = 0.2126 and 0.1945, for the WB and GS, respectively] and secondary-inpatient case
[HI = 0.0954 and 0.0484, for the WB and GS, respectively], while they appear to be
smaller (i.e., less pro-rich) in the case of primary-care [HI = 0.0398 and 0.0357 for the
WB and GS, respectively], and secondary-outpatient case [HI = 0.0789 and 0.0413 for
the WB and GS, respectively].
The above suggest that, for a given level of need, the better-off make greater use of,
and receive in proportion more, health care than the “poor”. Results, which hold true for
all levels of health care, clearly indicate significant contributions of “other” non-need
factors (I NN ) in generating the total level of inequality in utilisation. As illustrated above,
the observed non-zero values of HI index can be mechanically disentangled in terms of
two parts, I V and I B , reflecting, respectively, two distinct channels of influence: the
effects (on ŷ) operating through the inter-personal variations in the x k ’s across income
(the I V ), and the effects operating through the inter-group variations in the estimated
parameters across income range (the I B ). Detailed results on each part of the
decomposition are also presented in Table 4.1. Broadly interpreted, the I V would tell us –
for all x k combined (or for each x k in turn) – the extent to which the observed inequality
(in ŷ) is due to socioeconomic inequalities, whereas, the I B show – for a given level of
need – the extent to which inequalities in ŷ are due to heterogeneity in behaviour (or
practice) of the socioeconomic groups.