The healthcare experiences of Arab Israeli women in a reformed healthcare system.
Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries.


OBJECTIVE
To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL).


METHODS
The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village.


RESULTS
Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare.


CONCLUSIONS
We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.
Elnekave
Eldad
E
Howard Hughes Medical Institute--National Institutes of Health, 1 Cloister Court, Bethesda, MD 20814, USA. eldad.elnekave@tufts.edu
Gross
Revital
R
D000328:Adult; D000368:Aged; D018912:Arabs / Q000523:psychology*; D005191:Family Characteristics / Q000208:ethnology; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D007557:Israel; D007585:Jews / Q000523:psychology*; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D017060:Patient Satisfaction / Q000208:ethnology*; D010817:Physician-Patient Relations; D011209:Power, Psychological; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D012931:Social Environment; D016387:Women's Health / Q000208:ethnology*