Can greater access to secondary health care decrease health inequality? Evidence from bus line introduction to Arab towns in Israel

Abstract

Health inequality can affect economic productivity, labor force participation, or the intergenerational transmission of poverty. Health disparities based on socioeconomic ranking are widely documented, but there is also growing evidence of disparities based on geographic locality. This paper investigates a potential contributing factor to socioeconomic and geographic-based health inequality: access to secondary health care. We exploit bus line introductions to Arab towns in Israel, which substantially increased secondary health care access among a mostly disadvantaged population, and find that older adult reporting of chronic health conditions increased in the short term. However, this effect fades away in the long run. We argue that greater chronic condition rates in the short term reflect higher diagnosis rates resulting from increased access to health care professionals rather than health deterioration. This effect weakens in the long run when the benefits of greater access to health care offset the higher diagnosis rates.