The Palestinian Economy. Theoretical and Practical Challenges

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Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 381 A further breakdown of the I B into its respective components, as per Eq. (24), show that heterogeneity in practice associated with participation behaviour (the I PP ) is invariably responsible for most of the “additional” generated inequity by the I B index: for the three levels of health care, the (partial) contribution of I P is always significant and in a “pro-rich” direction, being in the range [0.010; 0.043 at p < 0.05], which amount to nearly 29% and 27% of the HI in case of primary-care, and about 20% of the HI index in all other cases. This suggests that for a given need and other individual characteristics, the wealthier groups are more likely to seek health care than the disadvantaged SES groups. The picture is somewhat different for heterogeneity in behaviour related to conditional usage part (the I CC ). Although, they appear to be fairly modest compared to the I PP , the partial contributions of the I CC index are significantly negative in the case of primary-care [–0.005 and –0.003 at p < 0.05], whereas they remain significantly positive for all other cases, within the range [0.022 and 0.0142 at p < 0.05]. This indicates that, given the decision of seeking health care treatment being made, the wealthier groups appear to be more users (or receive more) of both secondary and tertiary-care, whereas the disadvantaged SES groups appear to be more users (and receive more) of primary-care. However, the pro-poor contribution of the I CC in the case of primary-care remains fairly small to counterbalance the pro-rich contribution of the I PP . In addition, as soon as the “other” variables’ parameters are allowed to vary, the pro-poor contribution of the I CC in the latter case is more than offset by a pro-rich contribution of heterogeneity in behaviour related to the “other” socioeconomic factors (the I SEC ). Indeed, the contributions of heterogeneity in behaviour linked to the “other” socioeconomic factors (the I SEC ) emerge without exception significantly positive, within the range [0.001; 0.012 at p < 0.05] and account for about 16% and 13% of the HI in the case of primary-care. But they appear much less in all other cases: between [8% and 1.3% of the HI]. Lastly, it is worth noting that the contribution of the residual terms (the I R ), which is defined as inequity due to unobserved heterogeneity, appear to be quite small compared with all other estimates: for all the cases we study, they are between [0.0002; 0.0040]. While the I R captures the remaining discrepancies between the (observed) measured inequality in the utilisation distribution (the I y ) and those obtained from all the simulated-distributions of utilisation, the small values of the I R indicate a considerable precision in the decomposition framework, as well as a high explanatory power of the regression model we used to get the parameter estimates.
382 Abu-Zaineh – Mataria 5. Discussion In this study we sought to extend the analysis of inequality in health care utilisation beyond the standard methods that have dominated the literature. A more elaborated decomposition approach that allows rectifying the commonly used standard decomposition methods has been attempted. The microsimulation-based decomposition was applied to various levels of health care proper to health care delivery in the two Palestinian regions: the WB and GS. Results presented in the paper shed lights on the degree of inequality associated with each level, as well as the factors underlying horizontal inequity. Results revealed that socioeconomic inequalities were responsible for the majority of inequity in the utilisation of all levels of health care. Using microsimulation, the decomposition approach was able to identify the contribution of each socioeconomic variable integrated in the model. On the whole, income itself was found to be invariably the most important contributor to the pro-rich inequity. We know that income is more likely to have an impact on utilisation in countries where either financial or non-financial access costs differ by income levels (van Doorslaer, Wagstaff et al. 2000). In addition, the more unequally the income is distributed, the stronger its contribution to inequality in utilisation would be – as we also know from the results of international comparisons of equity in health (van Doorslaer, Masseria et al. 2006). The degree of income inequality in the two Palestinian regions were found in (Abu-Zaineh, Mataria et al. 2008) to be quite high. Perhaps equally noteworthy, is the variation in the contribution of income by levels of care, which was found to be large enough to counterbalance the pro-poor distribution of need for the costly care – secondary and tertiary-levels – compared to primary-level. The decomposition analysis clearly confirmed the importance of heterogeneity in behaviour in generating inequity in health care utilisation. In effect, by estimating separately the model for each SES group, the microsimulation exercise was able to detect potential differences in utilisation behaviour amongst different subgroups of population. By so doing, we have shown that about 30% of horizontal inequity was due to heterogeneity in behaviours with respect to the rank in income distribution. As noted earlier, this feature of inequity could not be explicitly elucidated in previous research where the standard methods were applied. Interestingly, the breakdown of behaviour by participation and conditional usage demonstrated that, without exception, the probability
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The Palestinian Economy Theoretical
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© Gianni Vaggi - Marco Missaglia -
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VOLUME II
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246 Zagha 1. Introduction The local
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248 Zagha and groups in political d
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250 Zagha drawbacks in the politica
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252 Zagha it is not surprising that
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254 Zagha economy (including expend
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256 Zagha social norms sharply dist
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258 Zagha Bird (1995) puts it, info
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260 Zagha intergovernmental fiscal
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262 Zagha low rate flat tax levied
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264 Zagha need to be given access t
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266 Zagha Such failures are found i
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268 Zagha 4.1.3. The Relationship b
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270 Zagha a final account report of
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272 Zagha 4.1.6. Functions of LGUs
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274 Zagha • Management of LGU ass
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276 Zagha Figure 2: Local Governmen
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278 Zagha In summary, what the data
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280 Zagha on the cash basis. Almost
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282 Zagha Figure 7: Business Opinio
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284 Zagha within the Palestinian na
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286 Zagha Table 5: Number of NGOs i
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288 Zagha Fiscal decentralisation i
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290 Zagha Burki, J., Perry, G., Dil
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292 Zagha Palestinian Legislative C
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Issues, Performance and Trajectorie
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Proceedings “The Palestinian Econ
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The Effect of the Israeli-Palestini
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The Palestinian Economy. Theoretical and Practical Challenges

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