58. Lennock, J. and Shubita, A. Health Insurance and Health Service Utilization in the West Bank and Gaza Strip. HDIP Health Policy Papers. Ramallah: HDIP, 1998: 162 pp.

This report documents the results of a survey of 1000 households from the West Bank and Gaza Strip, using a non-stratified cluster sampling. The aim of the study was to examine the governmental health insurance system and identify patterns of health service utilization. The survey results indicate a health insurance coverage of 42% among households and 37% among people surveyed. Only 33% of households were satisfied with the services available under the insurance scheme. About two thirds of households without insurance stated that they would like to have insurance. The main reason for non-enrollment was the high premium level. In terms of clinic use for curative services, care for chronic illnesses, antenatal or postnatal care, private clinics were the mostly used by households, followed by government clinics, UNRWA and NGO clinics, respectively. Determinants of use of government clinics were having government insurance and cost. The use of UNRWA clinics was determined by the free of charge services. Determinants of use of NGO clinics were the location, cost and availability of certain services. In terms of hospital use for curative services or for delivery services, government hospitals were mostly used, followed by NGO hospitals. The main determinant of using government hospitals was having insurance. Determinants of using NGO hospitals included cost of services, quality of care and availability of certain services. At the end of the report, a useful discussion of findings is provided, focusing on policy implications in terms of health insurance and service utilization.