Assessing socioeconomic health care utilization inequity in Israel: impact of alternative approaches to morbidity adjustment

<p/> <p>Background</p> <p>The ability to accurately detect differential resource use between persons of different socioeconomic status relies on the accuracy of health-needs adjustment measures. This study tests different approaches to morbidity adjustment in explanation of health care utilization inequity.</p> <p>Methods</p> <p>A representative sample was selected of 10 percent (~270,000) adult enrolees of Clalit Health Services, Israel's largest health care organization. The Johns-Hopkins University Adjusted Clinical Groups^®were used to assess each person's overall morbidity burden based on one year's (2009) diagnostic information. The odds of above average health care resource use (primary care visits, specialty visits, diagnostic tests, or hospitalizations) were tested using multivariate logistic regression models, separately adjusting for levels of health-need using data on age and gender, comorbidity (using the Charlson Comorbidity Index), or morbidity burden (using the Adjusted Clinical Groups). Model fit was assessed using tests of the Area Under the Receiver Operating Characteristics Curve and the Akaike Information Criteria.</p> <p>Results</p> <p>Low socioeconomic status was associated with higher morbidity burden (1.5-fold difference). Adjusting for health needs using age and gender or the Charlson index, persons of low socioeconomic status had greater odds of above average resource use for all types of services examined (primary care and specialist visits, diagnostic tests, or hospitalizations). In contrast, after adjustment for overall morbidity burden (using Adjusted Clinical Groups), low socioeconomic status was no longer associated with greater odds of specialty care or diagnostic tests (OR: 0.95, CI: 0.94-0.99; and OR: 0.91, CI: 0.86-0.96, for specialty visits and diagnostic respectively). Tests of model fit showed that adjustment using the comprehensive morbidity burden measure provided a better fit than age and gender or the Charlson Index.</p> <p>Conclusions</p> <p>Identification of socioeconomic differences in health care utilization is an important step in disparity reduction efforts. Adjustment for health-needs using a comprehensive morbidity burden diagnoses-based measure, this study showed relative underutilization in use of specialist and diagnostic services, and thus allowed for identification of inequity in health resources use, which could not be detected with less comprehensive forms of health-needs adjustments.</p

Building a conceptual framework for determining individual differences of accessibility to tourist attractions

This paper introduces a conceptual framework for determining individual differences of accessibility to tourist attractions. The framework includes three components: factors affecting accessibility to tourist attractions; the individual characteristics of tourists, such as age, gender; and other explanatory variables that assist in explaining why accessibility to tourist attractions varies. This research indicates that measures of accessibility should include not only commonly used factors such as socio-demographic variables and distance, but also the facilities available at various attractions, management and operational aspects relating to the attraction (what we term "functions"), and the infrastructure used to move between specific attractions (what we term "connectivity of networks"). A case study of the Ningaloo Coast region was conducted to identify individual difference in evaluation of accessibility to tourist attractions. We show that the evaluation of accessibility varies among tourist groups due to their spatial abilities, individual values and needs, and preparatory set

LABOR DEMAND AND THE WAGE GAP IN THE WEST BANK AND GAZA STRIP

The returns to schooling for Palestinian men in the West Bank and Gaza Strip declined sharply from 1981 to 1987 but recovered slightly from 1987 to 1991. This article examines the degree to which these returns were associated with the demand for Palestinian labor. Contrary to previous research, the current study finds that labor demand and not just the increased schooling of Palestinians determined the returns to schooling. Specifically, increased demand for unskilled Palestinian labor in Israel and decreased demand for Palestinian workers in other Arab states combined to explain one-fifth to one-quarter of the decline in the wage gap from 1981 to 1987. Copyright 2001 Western Economic Association International.