Multidimensional vulnerability and financial risk protection in health in contexts of protracted conflict: Evidence from the Occupied Palestinian Territory

Abstract

ABSTRACTThis paper proposes a multidimensional vulnerability index for a setting of protracted conflict, which is applied to study the relationship between financial vulnerability and catastrophic healthcare expenditure (CHE) incidence in the Occupied Palestinian Territory in 2018. We find that our index better captures the extent of financial risk protection (FRP) compared to conventional measures of financial welfare. Results indicate that the most vulnerable groups experience a significantly higher likelihood of incurring CHE, and this likelihood is increased for those living in the West Bank compared to the Gaza Strip. We also find a lack of protection from existing insurance types against the risk of CHE. Our analysis provides valuable insights about key aspects, such as health financing and insurance bottlenecks, that will deserve careful policy attention in efforts to rebuild the Palestinian health system, following the Israel-Hamas war.KEY MESSAGESWhat is already known on this topic•In settings of protracted conflict, conventional welfare measures, such as household consumption expenditure, may not adequately capture the multifaceted nature of financial risk protection (FRP) in health.•There is a need for more comprehensive approaches to assess household vulnerability and FRP in such settings.What this study adds•We propose a novel multidimensional index of household vulnerability for populations in protracted conflict areas, applied to 2018 data from the Occupied Palestinian Territory.•Assessing FRP through this multidimensional lens reveals different patterns of exposure to financially catastrophic health expenditure (CHE) across sub-populations, which are not evident through traditional measures.•We find a positive association between CHE risk and greater vulnerability in both the West Bank and the Gaza Strip, with the most vulnerable groups likely to incur CHE regardless of insurance status.How this study might affect research, practice, or policy•Our vulnerability index predicts the risk of CHE across population sub-groups in a protracted conflict setting more effectively than traditional metrics, thereby offering better insights for health policy.•The analysis highlights particular policy aspects, such as health insurance arrangements, that will require addressing to “build back better” the Palestinian heath system following escalation of violent conflicts, damages caused to critical health service and social infrastructure, and different constraints on available policy options.