title: A national survey of ethnic differences in knowledge and understanding of supplementary health insurance.
abstract: Knowledge and understanding of what health insurance covers is an important public health issue. In Israel, whereas national health insurance covers all residents, optional supplemental health insurance (SHI) can be purchased from the healthcare providers, for additional, special services. The purpose of this study was to identify disparities between Jews and Arabs in their knowledge and understanding of SHI.
  
  
  
  National, cross-sectional, telephone survey using a structured questionnaire, among random samples of 814 Jews and 800 Arabs. Knowledge and understanding of health insurance was assessed by a score based on correct answers to 8 questions. Log-linear regression was used to estimate association between health insurance knowledge and population group, after controlling for potential confounding independent variables.
  
  
  
  Ninety one percent of Jews and 62% of Arabs reported owning SHI. Among both groups, knowledge levels were low on a 0-8 scale. However, the average score for Jews was statistically higher (Mean = 3.50, S.D = 1.69) as compared with Arabs (Mean = 2.78, S.D = 1.70) (p< 0.001). The adjusted health insurance knowledge score was significantly higher among Jews than Arabs (Prevalence ratio = 1.10; 95% CI = 1.06-1.13), indicating that differences remain even after controlling for socio-demographic characteristics and SHI ownership.
  
  
  
  There is a large gap between the public's understanding of what is covered by SHI and the services that it covers in practice. Low SHI knowledge and understanding may lead to frustration, and limit access to additional health care among populations that suffer from socio-economic inequalities. These findings emphasize the need to provide clearer and more culturally sensitive information on health insurance coverage.
authors.affiliation: School of Public Health, University of Haifa, Abba Hushi 199, Haifa, Israel.
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
authors.affiliation: School of Public Health, University of Haifa, Abba Hushi 199, Haifa, Israel.
authors.forename: Samah
authors.initials: S
authors.lastname: Hayek
authors.affiliation: Faculty of Nursing, The Yezreel Valley College, Afula, Israel.
authors.forename: Jalal
authors.initials: J
authors.lastname: Tarabeia
authors.affiliation: Triangle Research and Development Center, Kfar Kara, Israel.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yehia
authors.affiliation: School of Public Health, University of Haifa, Abba Hushi 199, Haifa, Israel.
authors.forename: Neta
authors.initials: N
authors.lastname: HaGani
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs / Q000523:psychology; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007348:Insurance, Health; D007557:Israel; D007585:Jews / Q000523:psychology; D019359:Knowledge; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013689:Telephone