The Palestinian Economy. Theoretical and Practical Challenges

Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 383
of participation was much more important than the conditional usage in generating the
observed patterns of inequities. Also of note, the decomposition revealed almost similar
patterns across levels of care regarding the direction of each part’s contribution: the
behaviour associated with both participation and conditional usage emerged to be in a
pro-rich direction. Notable exceptions to this prevalent pro-rich behaviour were observed
in the case of primary-level, where a pro-poor behaviour stems from the conditional
usage part.
Generally interpreted, the results on heterogeneity in behaviours may signal
differences in individuals’ preferences, at a given need, lower-income groups may have
lower preferences toward health than the better-off, and in the perceptions towards the
benefits associated with treatment (Dormont, Grignonc et al. 2006). The method
presented in this paper was capable of shedding light on this issue. Indeed, this method,
which is in the sprit of the work by Oaxaca (1973), has been recently applied to assess the
threat of aging on health expenditure (e.g., Dormont, Grignonc et al. 2006), and
inequality in health care utilisation (e.g., Huber 2006) in France. In the latter paper, a
microsimulation exercise was conducted to assess the effects of heterogeneity in
behaviour on inequity in access to GP and SP care. The author has shown that about half
of the horizontal inequity was due to heterogeneity in behaviour relative to the rank of
individuals in the income distribution. Turning to our health care delivery system, the
general findings on the importance of heterogeneity in behaviour are to some extent
consistent with the simulations reported by others (Huber 2006), even if the extent to
which heterogeneity in behaviour induce inequity in the two Palestinian regions appears
to be comparatively lower than those reported for France. This indicates that the bulk of
inequitable patterns of accessibility to health care among different socioeconomic groups
in the OPT are due to the other explanatory factors. Nevertheless, some other important
differences, which dramatically contrast the finding reported in the above study, arise: in
the two Palestinian regions, heterogeneity in behaviour attributed to the second-stage of
the decision process for the utilisation of all levels of health care, except primary-level,
were shown to have a pro-rich character. It is, as noted earlier, as far as the supply side is
concerned, such a pro-rich bias in the (subsequent) utilisation of both levels of secondaryand
tertiary care may be related to specific characteristic of delivery system proper to
these services. The opposite can be said with respect to access to primary-level: by far the
pro-poor behaviour of (subsequent) utilisation is more influenced by providers’ behaviour