israeli arab 88.
(photo credit: Ariel Jerozolimski)
Although the 11-year-old national health insurance system was aimed at providing egalitarian health care for all sectors, Israeli Arabs were found in a new study to see medical specialists much less frequently and be less likely to undergo preventive screening than Israeli Jews. Arabs do, however, visit their primary care physician (general practitioner) more often than their Jewish counterparts.
A study on "Inequalities in Use of Health Services among Jews and Arabs in Israel" has just been published on-line in Health Services Research, based on a random telephone survey (data were gathered from the Israel National Health Survey) of 9,352 Israelis, with each sector interviewed in its own language by members of the same sector.
Dr. Orna Baron-Epel of the University of Haifa's School of Public Health stated that these differences could not be explained by differences in socioeconomic status or how healthy or sick people were, as the results were adjusted for sex, age, income, education, marital status and self-reported chronic diseases.
Less frequent use of specialists and preventive care among Israeli Arabs, said Baron-Epel, whose coauthors were Noga Garty and Israel Center for Disease Control director Prof. Manfred Green "may be due to culture, norms and behavior, or due to more subtle differences in access and quality in care."
Israeli Arabs, who comprise about a fifth of Israel's population, generally have lower socioeconomic status and poorer health than the Jewish population; their average life expectancy is about three years shorter than their Jewish counterparts and has not changed since 1995. More studies are needed to understand the reasons for these health care disparities, said Baron-Epel, but among the possible explanations include that Arabs generally live in rural villages where specialist care is unavailable, or that Israeli Jews overuse specialists because they are freely accessible in cities.
Baron-Epel said Arab behavior is similar to that of new immigrants who have too many worries to be concerned with disease prevention.
The authors said they couldn't assume from their results that Arabs were getting a lower quality of medical care, although other studies had shown that Israeli Arabs typically got fewer preventive screenings such as cholesterol tests, mammography and colonoscopy and were less often asked by doctors about their smoking and dietary habits.
"We are not talking about discrimination against Arabs," commented Ben-Gurion University Prof. Avi Porath, an expert in inequality in health services. "There are some things that can't easily be changed, such as inbreeding among Arabs that results in genetic diseases. But you can do something about chronic illnesses, which are acquired. The National Health Insurance Law succeeded, as it gave equal opportunity of access to the medical system."
"I don't think there is a lack of secondary care in the Arab sector," Porath added. "Primary care, in the family physician's clinic, is most important for prevention of disease, and very good primary care is what has made Israeli health care among the best in developed countries. But equality in access is not enough. Arab primary care doctors in the towns and villages must make a special effort to encourage their patients to change lifestyles and undergo screening for early diagnosis. The the cultural influences will be less important. If you explain prenatal care well to an Arab women, she will go and get it."
Asked to comment, Dr. Nihaya Daoud, an Israeli Arab from the joint Jewish-Arab village of Neveh Shalom who recently completed her doctorate at the Hebrew University Hadassah School of Public Health, told The Jerusalem Post that she thought economic considerations discouraged Arabs from going to specialists as much as Jews.
"They have to take off work and pay for transport to go to the city, and then there are copayments for consulting with specialists and for tests they order," she said.
When one family's son in a village becomes a doctor, all the members of the hamula (extended family) register with the health fund to which he is affiliated, Daoud noted. "The health fund thinks that placing a doctor in the village or town where he lives is the best way to serve the population because he is familiar with the residents and the culture.
But Arab women are often reluctant to undergo screening, such as mammography or Pap smears, from their village gynecologist, because they are almost all male doctors and members of their own hamula. Women don't want to expose their bodies to men who are relatives," she said. "My studies have shown that Arab women prefer going to a female Jewish gynecologist rather than to a male Arab one because modesty is more important to them than speaking the same native language."
Dr. Bruce Rosen, director for the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale Institute in Jerusalem, said it was an "important study." The results, he suggested, could partly be due to the shortage of specialists in Arab localities combined with difficulties faced - particularly for mothers of large families and without cars - in traveling to the larger cities, plus less "consumerism, awareness of and belief in the benefits of going to specialists."