title: Informal politics and inequity of access to health care in Lebanon.
abstract: BACKGROUND
  Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care.
  
  
  METHODS
  This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety.
  
  
  RESULTS
  We note a significantly positive association between political activism and the probability of receiving health aid (p < .001), with an OR of 4.0 when comparing individuals with the highest political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of "universal coverage" exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families.
  
  
  CONCLUSIONS
  Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population.
authors.affiliation: Program in Health Care Financing, Harvard School of Public Health, 124 Mount Auburn Street, Suite 410, Cambridge, MA 02138, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Chen
authors.forename: Melani
authors.initials: M
authors.lastname: Cammett
mesh_terms: D000328:Adult; D000367:Age Factors; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011057:Politics; D012067:Religion; D012737:Sex Factors; D012959:Socioeconomic Factors