Decomposing Inequality in Health Care Utilisation in The Occupied Palestinian Territory: A Micro-Simulation Approach

Presenter: Mohammad Abu-Zaineh, Birzeit University

Abstract

Income-related inequalities and horizontal inequities in health-care utilisation have recently been widely studied using linear additive models of decopmostion. This paper applies new methods of decompostion “by factors”, based on microsimulation technique. Besides avoiding the “unavoidable price” of linearity restriction that is imposed by the “standard” method, the microsimulation-based decompostion enables to duck the potentially contentious role of heterogeneity in genuine individuals’ behaviour in the analysis of inequality, as well as the institutional features and practices driving inequity. The decomposition method is applied to two-stage utilisation (the probability of usage and the conditional usage – using the combined Logit–zero truncated Negbin models) for three levels of health-care delivery: primary, secondary and tertiary, particular to the specific context of the two occupied territories of Palestine (OPT): the West Bank (WB) and Gaza Strip (GS). The data are taken from the first national survey on health care use and expenditure, which provide detailed information about utilisation and morbidity. Our empirical results suggest that the worse-off do have disprportinately greater need for all levels of care, but with the expection of primary-level, access to – and ustilisation of – all levels of care appear to be significantly higher for the better-off. The incremental examination through microsimulation has made it possible to separately identify the relative contributions of factors driving such pro-rich patterns. While much of this inequity appear to be caused by omnipresent socio-economic inequalities (by income), detailed analysis attributes a non-trivial part (circa 30% of the observed horizontal inequities) to heterogeneity in behaviour with respect to the rank of individuals in the income distribution. The latter finding, which cannot be explicitly envisaged by the standard decomposition, corroborates earlier evidence on the importance of considering such axis in order to provide a more convincing decomposition, and for judging equity performance of health system. Several policy-relevant factors, which have to be taken into account for any future attempt aiming at limiting the existing inequalities in the current health care delivery systems of the OPT are discussed and identified.