Inequality in Medical Care in Israel : Arabs and Jews in the Jerusalem District of the General Sick Fund

Background. Differences in health and health services use among different ethnic groups within populations have been always a major concern in democratic societies. Past research has documented the gaps both in health and in services utilization between the Israeli Arab and Jewish populations. Method. This paper studies the 1993 utilization of health services by a sample of 70,000 Arabs and Jews insured by the General Sick Fund (Clalit), the biggest sick fund in Israel, in the Jerusalem district. The Arab population consists of Palestinian residents of greater East Jerusalem and Israeli Arabs, offering a unique opportunity to study the health care use of the three population groups. Results. The results show that, while the mean annual cost of care per user is the same for Jews and Arabs, Arabs insurees are dramatically less likely to use medical services, controlling for age, gender, income, chronic conditions and settlement size. This was found true for both ambulatory and in-patient care and, in particular, for elderly persons. The Israeli Arabs are the most intensive users of care compared to the Jews and the Palestinians. Conclusion. The gaps in utilization can be attributed to differences in accessibility, traditionalism and social and cultural assets. Early findings following the implementation of the National Health Insurance Law in 1995 indicate that some differences in accessibility to and use of medical services between Arabs and Jews have been reduced. The founding of the Palestinian Authority Council will hopefully further enhance the use of medical care and the health state of the Palestinian population