Ethnicity, Spatial Segregation and Length of Stay in Emergency Medicine Departments: The Case of Israel

Abstract

The present paper examines the sources of disparities between Arabs and Jews and between residents of the periphery and residents of the urban center in the length of stay (LOS) in emergency departments (ED) in Israeli hospitals. Israel is a society where all residents are covered by National Health Insurance and have equal access to emergency medicine; thus, no disparities in emergency treatment are expected. Data were obtained from the 2015 “Survey of Satisfaction with Hospitalization in Emergency Medicine Departments” in Israel. The analysis reveals that LOS is considerably shorter for Arabs than for Jews and among residents of the periphery than residents of the urban center. After considering patterns of residential segregation (as well as socio-demographic attributes and indicators of the medical condition) and controlling for perceived waiting time (triage), the LOS disparity between Arabs and Jews vanishes. The findings lead to the conclusion that disparities in LOS in Israeli EDs do not stem from differential treatment by the medical staff but can be fully attributed to patterns of spatial segregation. Differential allocation of medical resources by the state to urban-center regions, compared to peripheral regions, seems to be the source of LOS disparities in emergency departments in Israeli hospitals.