The Palestinian Economy. Theoretical and Practical Challenges

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Proceedings “The Palestinian Economy: Theoretical and Practical Challenges” 385 structure towards a more equitable ex-ante mode of financing. Yet, it may be worthwhile, for policy makers in the oPt, to highlight the fact that the partial contributions of location of residence, which seems to reflect not only the disparities in the availability of healthcare services, but also the geopolitical situation in the two parts of the oPt, do play a significant role in explaining the degree of inequity. Although, we need to point out that under the current conditions of “bantustanisation” the issue of accessibility to available services remains a political one, a critical need is there to identify appropriate polices capable of achieving a more balanced-geographical allocation of health care services. Inter-providers and inter-sectors interactions can also play an important role in reducing the adverse impact of such situation on health care use-inequity. Lastly, our findings on the heterogeneity in behaviour, whilst corroborate earlier evidence (Huber 2006) on the importance of taking into account such axis for judging equity performance of health systems, are rather less important compared to the contribution by socioeconomic factors which appear to further reinforce the pro-rich inequitable trends in the case of the oPt. A crucial question is, of course, whether the “remaining” systematic differentials in behaviour are irrelevant from an equity point of view because they may merely reflect differences in individuals’ genuine preferences and tastes vis-à-vis health-care, or whether these use patterns do reflect important preferential practices by providers, which may translate into the less well-off receiving lower standards of care than the better-off. Given the two-stage interpretation, our analysis was indeed able to signal potentially discriminatory practice by providers in favour of the poor for primary care and in favour of the rich for other cases. Nonetheless, our analysis was not capable of shedding light on whether and to what extent any inequities in health care usage, do translate into differences in health gains, and consequently, into inequities in health outcomes. Available evidence ( Alter, Naylor et al. 1999) suggests that they often do. Indeed, it seems likely that the “excess-use” of the better-off would not merely reflect quicker accessibility, but also higher quality of treatment, and apparently, better health gains compared to poor. Future research may focus on developing, implementing and evaluating policy interventions to reduce the observed unequal distributions in the two parts of the oPt.
386 Abu-Zaineh – Mataria References Abu-Zaineh, M., Mataria, A., et al., (2008). Equity In Health Care Financing in Palestine: the Value-Added of the Disaggregate Approach. Social Science & Medicine vol. 66 (11), pp. 2308-2320. Aho, G., Lariviere, S. et al., (1997). Manuel D’analyse de la Pauvreté: Application au Bénin. UNDP, Université de Laval. Alter, D.A., Naylor, C.D. et al., (1999). Effects of Socioeconomic Status on Access to Invasive Cardiac Procedures and on Mortality after Acute Myocardial Infarction. New England Journal of Medicine, vol. 341, pp. 1359-1367. Baker, L.J., Gaag, v.d. (1993). Equity in Health Care and Health Care Financing: Evidence from Five Developing Countries Equity in the Finance of and Delivery of Health Care. In: van Doorslaer, E., Wagstaff, A., Rutten, F., (Eds.), An International Perspective. Oxford: Oxford University Medical Publications. Barghouthi, M., Lennock, J., (1997). Health in Palestine: Potential and Challenges. MAS Discussion Papers. Ramallah (Palestine), Palestine Economic Policy Research Institute (MAS). Benham, L., Benham, A., (1975). Utilization of Physician Services across Income Groups. Equity in Health Services. R. Andresen. Cambridge Mass: Ballinger. Bole, T.J., Bondeson, W.B., (1991). Rights to Health Care. Dordrecht, Boston: Kluwer Academic Publishers. Buntin, M.B., Zaslavsky, A.M., (2004). Too Much Ado about Two-Part Models and Transformation? Comparing Methods of Modeling Medicare Expenditures. Journal of Health Economics, vol. 23 (3), pp. 525-542. Cissé, B., Luchini, S., et al., (2007). Progressivity and Horizontal Equity in Health Care Finance and Delivery: What about Africa? Health Policy, vol. 80, pp. 51-68. Clarke, P.M., U.-G. Gerdtham, et al., (2003). A Note on the Decomposition of the Health Concentration Index. Health Economics, vol. 12 (6), pp. 511-516. Culyer, A.J. (1980). The Political Economy of Social Policy. Oxford: Martin Robertson.
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The Palestinian Economy Theoretical
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246 Zagha 1. Introduction The local
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