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

Keren Semyonov-Tal

doi:10.29333/ejecs/628

Authors

Keren Semyonov-Tal Tel-Aviv University http://orcid.org/0000-0002-2866-7515

DOI:

https://doi.org/10.29333/ejecs/628

Keywords:

health disparities, ethnic inequalities, residential segregation, emergency medicine

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.

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Author Biography

Keren Semyonov-Tal, Tel-Aviv University

Phd student, Labor studies

References

Armstrong, J. (2019). “The Reward was Worth the Sacrifice”: How Membership in Black Greek Letter Fraternities (BGLFs) Redefines Black Men’s College Experiences. American Journal of Qualitative Research, 3(1), 1-19. https://doi.org/10.29333/ajqr/5808 DOI: https://doi.org/10.29333/ajqr/5808

Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo Jr, C. A. (2003). A conceptual model of emergency department crowding. Annals of Emergency Medicine, 42(2), 173-180. https://doi.org/10.1067/mem. 2003.302 DOI: https://doi.org/10.1067/mem.2003.302

Baker, F. A., Taher, R., Ganayem, M., Mari, A., & Kopelman, Y. (2020). Ethnic disparities in colorectal cancer outcomes: A population study from Israel. Ethnicity & Health, 1-11. https://doi.org/10.1080/13557858.2020.1795630 DOI: https://doi.org/10.1080/13557858.2020.1795630

Blanchard, J. C., Haywood, Y. C., & Scott, C. (2003). Racial and ethnic disparities in health: An emergency medicine perspective. Academic Emergency Medicine, 10(11), 1289-1293.‏ https://doi.org/10.1197/S1069-6563(03)00501-3 DOI: https://doi.org/10.1197/S1069-6563(03)00501-3

Bowen, S. (2001). Language barriers in access to health care. Health Canada.‏

Carter, R. T., Lau, M. Y., Johnson, V., & Kirkinis, K. (2017). Racial discrimination and health outcomes among racial/ethnic minorities: A meta‐analytic review. Journal of Multicultural Counseling & Development, 45(4), 232-259.‏ https://doi.org/10.1002/jmcd.12076 DOI: https://doi.org/10.1002/jmcd.12076

Chaou, C. H., Chen, H. H., Chang, S. H., Tang, P., Pan, S. L., Yen, A. M. F., & Chiu, T. F. (2017). Predicting length of stay among patients discharged from the emergency department—using an accelerated failure time model. PloS one, 12(1), e0165756. https://doi.org/10.1371/journal.pone.0165756 DOI: https://doi.org/10.1371/journal.pone.0165756

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28, 1504-1510.‏ https://doi.org/10.1007/s11606-013-2441-1 DOI: https://doi.org/10.1007/s11606-013-2441-1

Daoud, N., Soskolne, V., Mindell, J. S., Roth, M. A., & Manor, O. (2018). Ethnic inequalities in health between Arabs and Jews in Israel: The relative contribution of individual-level factors and the living environment. International Journal of Public Health, 63, 313-323.‏ https://doi.org/10.1007/s00038-017-1065-3 DOI: https://doi.org/10.1007/s00038-017-1065-3

Dehon, E., Weiss, N., Jones, J., Faulconer, W., Hinton, E., & Sterling, S. (2017). A systematic review of the impact of physician implicit racial bias on clinical decision making. Academic Emergency Medicine, 24(8), 895-904. https://doi.org/10.1111/acem.13214 DOI: https://doi.org/10.1111/acem.13214

Feikin, D. R., Nguyen, L. M., Adazu, K., Ombok, M., Audi, A., Slutsker, L., & Lindblade, K. A. (2009). The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Tropical Medicine & International Health, 14(1), 54-61.‏ https://doi.org/10.1111/j.1365-3156.2008.02193.x DOI: https://doi.org/10.1111/j.1365-3156.2008.02193.x

Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. JAMA, 283(19), 2579-2584.‏ https://doi.org/10.1001/jama.283.19.2579 DOI: https://doi.org/10.1001/jama.283.19.2579

Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 355(3), 229-231.‏ https://doi.org/10.1056/NEJMp058316 DOI: https://doi.org/10.1056/NEJMp058316

Guagliardo, M. F. (2004). Spatial accessibility of primary care: Concepts, methods and challenges. International Journal of Health Geographics, 3(1), 3. https://doi.org/10.1186/1476-072X-3-3 DOI: https://doi.org/10.1186/1476-072X-3-3

Harris, R. B., Stanley, J., & Cormack, D. M. (2018). Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data. PloS one, 13(5), e0196476.‏ DOI: https://doi.org/10.1371/journal.pone.0196476

Hatab, N., & Kagya, S. (2011). Health Inequalities between Arabs and Jews in Israel. The Israel Democracy Institute. (Hebrew).

Herring, A., Wilper, A., Himmelstein, D. U., Woolhandler, S., Espinola, J. A., Brown, D. F., & Camargo Jr., C. A. (2009). Increasing length of stay among adult visits to US emergency departments, 2001–2005. Academic Emergency Medicine, 16(7), 609-616.‏ https://doi.org/10.1111/j.1553-2712.2009.00428.x DOI: https://doi.org/10.1111/j.1553-2712.2009.00428.x

Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126-136. https://doi.org/10. 1016/j.annemergmed.2008.03.014 DOI: https://doi.org/10.1016/j.annemergmed.2008.03.014

Israel Ministry of Health. (2010). Health inequalities and ways to cope with it. Israel Ministry of Health.

James, W. Y. (2019). Imprint of Racism: White Adult Males’ Transformational Experience from Racial Antipathy to Racial Reconciliation. American Journal of Qualitative Research, 3(1), 93-116. https://doi.org/10.29333/ajqr/5813 DOI: https://doi.org/10.29333/ajqr/5813

Ku, L., & Matani, S. (2001). Left out: Immigrants’ access to health care and insurance. Health Affairs, 20(1), 247-256.‏ https://doi.org/10.1377/hlthaff.20.1.247 DOI: https://doi.org/10.1377/hlthaff.20.1.247

Kyriacou, D. N., Ricketts, V., Dyne, P. L., McCollough, M. D., & Talan, D. A. (1999). A 5-year time study analysis of emergency department patient care efficiency. Annals of Emergency Medicine, 34(3), 326-335. https://doi.org/10. 1016/S0196-0644(99)70126-5 DOI: https://doi.org/10.1016/S0196-0644(99)70126-5

LaVeist, T. A. (2005). Disentangling race and socio-economic status: A key to understanding health inequalities. Journal of Urban Health, 82(3), iii26-iii34.‏ https://doi.org/10.1093/ jurban/jti061 DOI: https://doi.org/10.1093/jurban/jti061

Lewin-Epstein, N., & Semyonov, M. (1993). The Arab minority in Israel's economy: Patterns of ethnic inequality. Routledge.‏

Lubetzky, H., Friger, M., Warshawsky-Livne, L., & Shvarts, S. (2011). Distance and socio-economic status as a health service predictor on the periphery in the southern region of Israel. Health Policy, 100(2-3), 310-316.‏ https://doi.org/10.1016/j.healthpol.2010.09.006 DOI: https://doi.org/10.1016/j.healthpol.2010.09.006

Mackenbach, J. P., Stirbu, I., Roskam, A. J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., & Kunst, A. E. (2008). Socio-economic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468-2481.‏ https://www.nejm.org/doi/full/10.1056/nejmsa0707519 DOI: https://doi.org/10.1056/NEJMsa0707519

Manor, O., Eisenbach, Z., Israeli, A., & Friedlander, Y. (2000). Mortality differentials among women: The Israel longitudinal mortality study. Social Science & Medicine, 51(8), 1175-1188.‏ https://doi.org/10.1016/S0277-9536(00)00024-1 DOI: https://doi.org/10.1016/S0277-9536(00)00024-1

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Services Research, 15(1), 371. https://doi.org/10.1186/s12913-015-1024-8 DOI: https://doi.org/10.1186/s12913-015-1024-8

Ministry of Health, State of Israel. (2016). Inequality report. (Hebrew).

Miro, O., Antonio, M. T., Jimenez, S., De, A. D., Sanchez, M., Borras, A., & Millá, J. (1999). Decreased health care quality associated with emergency department overcrowding. European Journal of Emergency Medicine, 6(2), 105-107. DOI: https://doi.org/10.1097/00063110-199906000-00003

Monheit, A. C., & Vistnes, J. P. (2000). Race/ethnicity and health insurance status: 1987 and 1996. Medical Care Research and Review, 57(1_suppl), 11-35. DOI: https://doi.org/10.1177/1077558700057001S02

Morrill, R. L., Earickson, R. J., & Rees, P. (1970). Factors influencing distances traveled to hospitals. Economic Geography, 46(2), 161-171.‏ https://doi.org/10.2307/142624 DOI: https://doi.org/10.2307/142624

Moskop, J. C., Sklar, D. P., Geiderman, J. M., Schears, R. M., & Bookman, K. J. (2009). Emergency department crowding, part 1—Concept, causes, and moral consequences. Annals of Emergency Medicine, 53(5), 605-611. https://doi.org/10. 1016/j.annemergmed.2008.09.019 DOI: https://doi.org/10.1016/j.annemergmed.2008.09.019

Mowery, N. T., Dougherty, S. D., Hildreth, A. N., Holmes, J. H., Chang, M. C., Martin, R. S., Hoth, J. J., Meredith, J. W., & Miller, P. R. (2011). Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients. The Journal of Trauma, 70(6), 1317–1325. DOI: https://doi.org/10.1097/TA.0b013e3182175199

Nazroo, J. Y. (2003). The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. American Journal of Public Health, 93(2), 277-284.‏ https://doi.org/10.2105/AJPH.93.2.277 DOI: https://doi.org/10.2105/AJPH.93.2.277

Nirel, N., Pilpel, D., Rosen, B., Zmora, I., Greenstein, M., & Zalcberg, S. (2000). The accessibility and availability of health services in the south of Israel: Has the gap between the south and other regions in Israel been reduced in the wake of the National Health Insurance Law. The Myers-JDC-Brookdale Institute.‏

Padela, A. I., & Punekar, I. R. (2009). Emergency medical practice: Advancing cultural competence and reducing health care disparities. Academic Emergency Medicine, 16(1), 69-75. https://doi.org/10.1111/j.1553-2712.2008.00305.x DOI: https://doi.org/10.1111/j.1553-2712.2008.00305.x

Pines, J. M., Localio, A.R., & Hollander, J. E. (2009). Racial disparities in emergency department length of stay for admitted patients in the United States. Academic Emergency Medicine, 16(5), 403-410.‏ https://doi.org/10.1111/j.1553-2712.2009.00381.x DOI: https://doi.org/10.1111/j.1553-2712.2009.00381.x

Richardson, L. D., Babcock Irvin, C., & Tamayo‐Sarver, J. H. (2003). Racial and ethnic disparities in the clinical practice of emergency medicine. Academic Emergency Medicine, 10(11), 1184-1188.‏ https://doi.org/10.1197/ S1069-6563(03)00487-1 DOI: https://doi.org/10.1197/S1069-6563(03)00487-1

Riley, A. R. (2018). Neighborhood disadvantage, residential segregation, and beyond—Lessons for studying structural racism and health. Journal of Racial & Ethnic Health Disparities, 5(2), 357-365.‏ https://doi.org/10.1007/s40615-017-0378-5 DOI: https://doi.org/10.1007/s40615-017-0378-5

Saabneh, A. M. (2015). Arab–Jewish gap in life expectancy in Israel. The European Journal of Public Health, 26(3), 433-438.‏ https://doi.org/10.1093/eurpub/ckv211 DOI: https://doi.org/10.1093/eurpub/ckv211

Semyonov, M., Lewin-Epstein, N., & Bridges, W. P. (2011). Explaining racial disparities in access to employment benefits. Ethnic & Racial Studies, 34(12), 2069-2095. https://doi.org/10.1080/01419871003687552 DOI: https://doi.org/10.1080/01419871003687552

Semyonov, M., Lewin-Epstein, N., & Maskileyson, D. (2013). Where wealth matters more for health: The wealth–health gradient in 16 countries. Social Science & Medicine, 81, 10-17. https://doi.org/10.1016/j.socscimed.2013.01.010 DOI: https://doi.org/10.1016/j.socscimed.2013.01.010

Shuval, J. T. (1990). Health in Israel: Patterns of equality and inequality. Social Science & Medicine, 31(3), 291-303.‏ https://doi.org/10.1016/0277-9536(90)90276-X DOI: https://doi.org/10.1016/0277-9536(90)90276-X

Sprivulis, P. C., Da Silva, J. A., Jacobs, I. G., Jelinek, G. A., & Frazer, A. R. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Medical Journal of Australia, 184(5), 208-212. https://doi.org/10.5694/j.1326-5377.2006.tb00203.x DOI: https://doi.org/10.5694/j.1326-5377.2006.tb00203.x

Thomas, J. W., Guire, K. E., & Horvat, G. G. (1997). Is patient length of stay related to quality of care? Journal of Healthcare Management, 42(4), 489-507.

Williams, D. R., & Collins, C. (1995). US socio-economic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21(1), 349-386.‏ http://www.jstor.org/ stable/ 2083415 DOI: https://doi.org/10.1146/annurev.so.21.080195.002025

Williams, D. R., & Collins, C. (2016). Racial residential segregation: A fundamental cause of racial health disparities. Public Health Reports, 116(5), 404-416. https://doi.org/10.1093/phr/116.5.404 DOI: https://doi.org/10.1016/S0033-3549(04)50068-7

Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health & Social Behavior, 51(1_suppl), S15-S27.‏ https://doi.org/10.1177 /0022146510383838 DOI: https://doi.org/10.1177/0022146510383838

Zuvekas, S. H., & Taliaferro, G. S. (2003). Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996–1999. Health Affairs, 22(2), 139-153. https://doi.org/10.1377/hlthaff.22.2.139 DOI: https://doi.org/10.1377/hlthaff.22.2.139