Socio-economic aspects of health service in the southern-periphery of Israel

Hasia Lubetzky, Shifra Shvarts, Galit Lubetzky, Lora Warshawsky-Livne

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

The southern peripheral area of Israel is characterized by a widely dispersed, culturally-diverse and polarized socio-economic population creating special needs in the healthcare delivery system. This chapter explores quantitatively the main issues influencing the delivery and use of the central health specialty clinics in Beer-Sheva (the main city in the southern-periphery). The findings were complemented by qualitative research that analyzed issues considered important by the population in regard to healthservice delivery. The quantitative study population consisted of patients that visited specialist clinics in a central medical care facility in Beer-Sheva between 2000-2005. The number of patient visits was analyzed (parametric and non-parametric) according to independent variables-population size, age-distribution, gender, family size, cars/household, socioeconomic-level and distance from Beer-Sheva. The findings show that the distance from Beer-Sheva and socio-economical-level have a negative correlation to the number of patient visits to the specialist clinics. The qualitative study consisted of interviews with public administrators, healthservice deliverers, and local residents (Jews and Bedouin). Using Extracting-Field-Theory and Content-Analysis, three main topics that represent "Socio-economic Aspects of Health Service in the Southern-Periphery of Israel", were identified: (1) Distance, an objective aspect measured in kilometers, includes other elements revealed in the interviews, such as the direct cost of travel to the clinics in Beer-Sheva, car availability, public transportation availability, distance from home to bus stop, time wasted in traveling, and affect on work and domestic routines. Residents living in different areas of the region relate differently to the travel issue to health clinics: A mother with a developmentally disabled child living in a rural town, thinks that "it is hard work" to get to the clinic; a family from kibbutz says that "Every time we needed follow-up, we made the visit into a fun outing in the big city". The Bedouin population living outside the recognized towns surrounding Beer-Sheva encounters the hardest difficulties and barriers in accessing health care in the main city. Public transportation is often not accessible and the low socio-economic level prevents private transportation. One interviewee explained: "I have to walk 4 kilometers with my child in my arms to the main road and then wait for someone to do me a favor and stop to give me a ride". These interviews indicate that distance does have impact on the use of health services, however economic level, accessibility and availability of transportation are just as important. (2) Level of social identification with the community is based on the individuals' sense of belonging to their local place of residence, the geographical area, and to the state. A virtual scale divides the population according to the variety of culture, and level of foreignness and belonging. At the high extreme are the Kibbutz-members: "The kibbutz-community is in many ways the highest level in Israel". The middle section contains Jewish and Bedouin communities, a woman from a recognized Bedouin town says: "If a woman has self-confidence she should have no problem doing anything she wants. I drive a car and can go easily to the market, medical care or anywhere I want". The low-extreme is the Bedouin from outside the recognized towns. One man says "It is a disgrace to ask a neighbor for help. I alone have to take care of my issues. Everything-alone". (3) The inequality of health services in the periphery in comparison with the center is an issue the interviewees included even though it was not in the scope of the interview. One mayor stated the general feeling of frustration of the population: "If I would sum all the budget promises given to me by the government, they would total the budget of the USA". On the other hand, many have a good personal feeling: "When we lived in the center it was good but here, we have a good life here...different attitude, better ...we feel we are in a good place". It is clear that a fitting health system in the periphery has to build programs that take into consideration the needs of specific communities, such as distance to health services, the socio-economic level, and culture.

Original languageEnglish
Title of host publicationSocioeconomic Status and Health Implications
PublisherNova Science Publishers, Inc.
Pages29-55
Number of pages27
ISBN (Print)9781621006756
StatePublished - 1 Dec 2012

ASJC Scopus subject areas

  • General Social Sciences

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