title: Varied utilisation of health provision by Arab and Jewish residents in Israel.
abstract: BACKGROUND
  Provision of healthcare is considered a basic human right. Delivery and uptake is affected by many complex factors. Routine vaccinations are provided free of charge in Israel to all residents. The Palestinian Israeli Collaborative Research (PICR) group conducted research on vaccine impact at eight primary care facilities in east Jerusalem (EJ) and central Israel (IL) which allowed assessment and comparison of interactions of these Arab and Jewish populations, respectively, with healthcare services.
  
  
  METHODS
  Families attending clinic with a child under five years old were invited to participate. Utilisation of healthcare was assessed using data from standardise questionnaires completed after enrolment, using proxies of vaccination status, antibiotic use, primary care physician and hospital visits as well as demographics such as household size. Differences between EJ and IL were assessed using chi squared tests; univariate analyses identified potential confounders which were tested in a multiple logistic regression model for any independent associations between region and outcome.
  
  
  RESULTS
  Children in EJ were significantly more likely to live in larger households, with tobacco smokers, to have been breastfed, hospitalised and used antibiotics recently than those in IL, who were significantly more likely to have recently seen a primary care physician (all p < 0.01). Receipt of routine vaccinations, given at well baby clinics, was similar between the regions at above 95% (p = 0.11), except for influenza which was delivered separately at primary physician clinics to 5% (EJ) and 12% (IL). Receipt of pneumococcal vaccine when paid for separately was significantly higher in IL than EJ (3% vs 31%). Multivariate analysis identified the most important independent predictors of these differences as region, age and household size.
  
  
  CONCLUSIONS
  Healthcare in Israel is of a very high standard, but it is not uniformly utilised within the community in all geographical areas, though in some key areas, such as uptake of most routine childhood vaccination, equality seems to be achieved. To ensure excellent healthcare is achieved across the population, inequalities must be addressed, for instance in health promotion and other activities, which could improve and normalise health outcomes.
authors.affiliation: Immunisation Department, Health Protection, Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK. jo.southern@phe.gov.uk.
authors.forename: Jo
authors.initials: J
authors.lastname: Southern
authors.affiliation: Jerusalem-Hashfela District, Macabbi Healthcare Services, Modiin, Israel. hector.ro@gmail.com.
authors.forename: Hector
authors.initials: H
authors.lastname: Roizin
authors.affiliation: Jerusalem-Hashfela District, Macabbi Healthcare Services, Modiin, Israel. danamoh@gmail.com.
authors.forename: Muhannad
authors.initials: M
authors.lastname: Daana
authors.affiliation: Infectious Disease Epidemiology Section, The Gertner Institute, Tel Hashomer, 52621, Israel. carmitr@gertner.health.gov.il.
authors.forename: Carmit
authors.initials: C
authors.lastname: Rubin
authors.affiliation: Jerusalem-Hashfela District, Macabbi Healthcare Services, Modiin, Israel. samhasleton@gmail.com.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hasleton
authors.affiliation: Jerusalem-Hashfela District, Macabbi Healthcare Services, Modiin, Israel. cohen_ady@mac.org.il.
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Infectious Disease Epidemiology Section, The Gertner Institute, Tel Hashomer, 52621, Israel. AvivaG@gertner.health.gov.il.
authors.forename: Aviva
authors.initials: A
authors.lastname: Goral
authors.affiliation: Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan, 52621, Israel. galia.rahav@sheba.gov.health.il.
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.affiliation: Jerusalem-Hashfela District, Macabbi Healthcare Services, Modiin, Israel. meirra@assuta.co.il.
authors.forename: Meir
authors.initials: M
authors.lastname: Raz
authors.affiliation: Infectious Disease Epidemiology Section, The Gertner Institute, Tel Hashomer, 52621, Israel. gili.regev.y@gmail.com.|Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan, 52621, Israel. gili.regev.y@gmail.com.
authors.forename: Gili
authors.initials: G
authors.lastname: Regev-Yochay
mesh_terms: D018912:Arabs / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*