Older Adult Health Following Greater Access to Secondary Health Care: Evidence from Bus Service Introductions to Arab Towns in Israel

How much can socioeconomically-based health disparities be attributed to differential access to secondary and specialist health care? We evaluate this question in the context of Arab-Jewish health disparities in Israel while exploiting the introduction of public transportation to Arab communities. Primary care health services are readily available within Arab towns and the introduction of bus services increased residents' access to secondary health services that are almost exclusively available only outside their towns. In the short term older adults reported higher probabilities of being diagnosed with common health conditions, such as heart problems or high cholesterol, and rare health conditions. In the longer term – more than two years following the initial introduction of public transportation to one's town – there were reductions in overweight and mostly null effects on diagnosis-based health conditions. Coupled with an analysis on mortality rates, our results suggest that the higher rates of chronic conditions in the short term are due to higher diagnosis rates rather than health deterioration. However, this effect is weaker in the long run when the benefits of greater access to health care facilities offset the higher diagnosis rates.