Income-related inequalities in health and health services use in Israel

Background: Income-related inequalities in health and in health services use pose a disturbing and challenging issue in health systems, which are based on social health insurance such as Israel. Objective: To explore income-related inequalities in health and in health services use in Israel in 2009-2010. Methods: We used the Central Bureau of Statistics file, which linked information on 7,175 households (24,595 persons) from the 2009 Health Survey and the 2010 Incomes Survey. Raw and adjusted concentration curves and indices were calculated for ten chronic conditions (adjusting for age), visits to physicians and hospitalizations (adjusting for health and location). Results: There is no income-related inequality in asthma and in cancer. The income-related inequality in the remaining eight conditions is 'pro-poor', namely, they are more prevalent among poor households. The order of the level of inequality is (from the least unequally distributed): any condition, hypertension, heart diseases, diabetes, depression, respiratory diseases, digestive diseases, and the condition with the highest income-related inequality is activities of daily living (ADL) limitations. The income-related inequality in secondary physicians' services is 'pro-rich'. The income-related inequality in primary care is 'pro- poor'. Hospitalization days are significantly more unequally - 'pro-poor' - distributed in the population. Discussion: International findings are basically similar to the ones found in this paper. Three reasons are believed to have caused these income-related inequalities: the use of preventive services, health behavior and compliance with the doctors' directions; they might constitute a useful framework for strategizing interventions. The efforts of the Ministry of Health and of the sickness funds launched in 2010 to reduce inequalities should be evaluated by repeating the present analysis with newer data.