, Volume 17, Issue 5, pp 271-282

Utilization of pediatric health services in Jerusalem

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The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.

H. Palti is Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah Medical Organization, and Director, School of Public Health and Community Medicine, Hebrew University-Hadassah; Y. Neumark is instructor at the School of Public Health and Community Medicine, Hebrew University-Hadassah; M. Donchin is a member of the Department of Social Medicine, Hadassah Medical Organization; A.Y. Ellencweig is a member of the Department of Medical Ecology, Hebrew University-Hadassah.
Acknowledgement: The research on “Utilisation of health services” was supported by Hadassah Medical Organisation, The Jerusalem Municipality, the Ministry of Health and the Labour Sick Fund. It is the first in a series of papers on the utilisation of health services. Part of this publication is based on the MPH thesis of Y. Neumark tutored by H. Palti.