The Palestinian Economy. Theoretical and Practical Challenges

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Abu-Zaineh – Mataria
than the patients; this may be interpreted as some sort of positive discrimination by the
primary-level providers of lower socioeconomic groups.
Other potentially equity-relevant practices at the supply side may help explain why
higher- and lower-income groups appear to be treated differently at the same level of
need. First, secondary and tertiary care are provided through a limited number of
hospitals (78 hospitals in the oPt), with significant differences in the utilisation patterns
by providers exist: while hospitals run by the public sector (21 hospitals) are over-utilised
(with bed occupancy rate of 80%), those run by the non-governmental sector (28
hospitals) are found under-utilised (HPU 2008a). These differences may reflect unequally
inter-referral patterns or unequally access for patients belonging to different income
groups: for a given need, better-off patients are referred to other (non-governmental)
hospitals – where higher costs are incurred. Secondly, in the two Palestinian regions,
there is a clear shortage in tertiary care services; consequently aboard-referrals are
pursued for several cases (Hamdan, Defever et al. 2003). Given the fact that patients
may not all be equally entitled, some of the inequitable patterns observed at the tertiarylevel
may be due to the (unequal) accessibility to aboard-referred services among
different income groups. Thirdly, primary care has long been considered (NHP 1994) as
the backbone of the Palestinian health care system, and a strategy towards the
achievement of affordable health care for all of segments of the population was put in
place (NSHP 1999a). Indeed, such practices in favour of the poor were partly reflected
in our results, which demonstrated a pro-poor behaviour with respect to conditional
usage of primary care.
6. Conclusion
This paper provides the first analysis of inequality of health care utilisation in the two
parts of the oPt. Indeed, whereas equity objective was frequently incorporated in the
subsequent National Health Plans of the oPt (NHP 1994; NSHP 1999a), there has been no
evidence against which to evaluate the equity performance of the health system. Our
analysis presents some indications about the sources of inequalities and alludes to a set of
potential policies necessary to overcome them. Among the potential policy measures is
the reduction in direct cost burden associated with the provision of these services. This
might be achieved through gradually shifting from the regressive ex-post payments