The Palestinian Economy. Theoretical and Practical Challenges

380
Abu-Zaineh – Mataria
Gaza Strip (GS)
Tertiary-care
Secondary-care
(inpatient)
Secondary-care
(outpatient)
Primray-care
Need
Income
Education
Insurance
Activity status
Marital status
Place of Resid.
Participation
Condit. usage
Other socioecon.
Residual
-0.15 -0.10 -0.05 0.00 0.05 0.10 0.15 0.20 0.25
Figure 2b: Contribution to inequality
Turning to the second part of our decomposition, results, which are also presented in
Table 4.1 and Figures 4.2 (a-b), clearly show that, in all the cases, the contributions to
inequity attributed to heterogeneity in behaviour with respect to the SES of groups are far
from being negligible: the I B index, which emerges globally “pro-rich”, amounts to nearly
30% of the total measured inequity (the HI index). Generally, this means that, given need
and other individual characteristics, SES groups do behave differently with respect to
both the “initial” decision of seeking health care, and the conditional “subsequent”
contacts, and that this behaviour has a “pro-rich bias”. Indeed, the (partial) contribution of
heterogeneity in behaviour (the I B index) to the total measured inequity is captured –
separately from the distribution of explanatory variables by income – by the transition
from a distribution where all SES subgroups, irrespective of their rank in the income
distribution, are assumed to face the same parameter vectors (i.e., by imposing
homogeneity in behaviour as embodied in parameters) to a distribution where these
parameters are allowed to vary by income level. Therefore, the results on the estimated
values of the I B index, as measured by the systematic deviations of the specific-group
parameters from the population-wide effect, clearly reveal, not only the prevalence of
heterogeneity in practice for a given need, but also a “pro-rich” character of such practice.
Hence, this may also be interpreted, as before: inequity in utilisation of health care would,
ceteris paribus, be about 30% lower, if there were no heterogeneity in behaviour across
income – or if the effects of both need and non-need factors did not vary by SES.