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Wednesday 26th October 2016

Israeli Arabs screen less than Jews

10th November 2006

23102006_arabwomangym.jpgTwelve years after Israel's national health insurance law was passed to ensure equal access to medical services, a new study has found that Israeli Arabs see medical specialists and undergo preventive screening much less often than Israeli Jews.

However, Arabs, who make up a fifth of Israel's population, do visit their primary care doctor more often than their Jewish counterparts, says the study, which was published online ahead of print publication on 25 September in Health Services Research.

The study's lead author, Orna Baron-Epel, of the University of Haifa's School of Public Health, said these differences, which could not be explained by socioeconomic or health status, were not due to discrimination against Arabs. Less frequent use of specialists and screening by Israeli Arabs "may be due to culture, norms, and behaviour or more subtle differences in access and quality in care," she said.

Average life expectancy among Israeli Arabs is about three years less than that of Jews, and the gap has remained steady since national health insurance was instituted. Arabs, many of whom live in rural villages, tend to have a lower socioeconomic status and poorer health than Jewish people. Arab men smoke more than Jewish men, and the prevalence of genetic diseases is higher, because of a high rate of consanguinity.

Dr Baron-Epel said further study is needed to establish the reasons for these healthcare disparities but one factor is that Arab villages have fewer medical specialists and urban Jews may overuse specialists because they are freely accessible. Like new Jewish immigrants to Israel, Arabs may have too many economic worries to be concerned with disease prevention and early diagnosis, she said.

But the authors and other experts said they cannot assume from their results that Arabs are getting a lower quality of medical care. Avi Porath, of Ben-Gurion University, an expert on quality indicators of health care, insisted that Israeli medical institutions did not discriminate against Arabs.

Professor Porath said, "There are some things that can't easily be changed, such as consanguinity, but you can do something about chronic illnesses. Primary care is most important for disease prevention, and its high quality is what has made Israeli health care among the best in the world.

"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. If you explain prenatal care well to an Arab woman, she will go and get it."

Leon Epstein, an expert in health service inequality at the Hebrew University of Jerusalem's Braun School of Public Health, said the law encouraged the four public health insurers to expand their services in Arab communities and that "most of the doctors there are Arab." He added, "But Jewish specialists must get more training for serving patients with different culture and beliefs."

Nihaya Daoud, an Arab woman with a recent PhD from the School of Public Health in Jerusalem, said economic considerations discouraged Arabs from seeing specialists in their local city, as it required taking time off work, bus fares to the city, and copayments for consultations and tests.

And some Arab women did not like to go to the local village doctor for reasons of modesty, she said. Arab doctors often worked in the village where they were raised and belonged to the same extended family as their patients. Arab women were reluctant to discuss problems or undergo intimate examinations by doctors in their extended family.

"My studies," said Dr Daoud, "have shown that Arab women prefer a female Jewish gynaecologist to a male Arab one because modesty is more important to them than speaking the same native language."

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