Patient demands for ethnic-based separation in public hospitals in Israel: patients' and practitioners' perspectives

Segregation within the healthcare system is commonly associated with disparities in the utilization of health services and in the outcomes of medical care. In Israel, the Jewish majority and the Arab minority populations are treated in the same healthcare organizations. Nevertheless, demands for ethnic separation in inpatient rooms are raised at times by patients, despite the principle of prohibiting discrimination between patients on the grounds of religion, race, sex and nationality. The study sought to examine patients' attitudes regarding separation between Jews and Arabs in inpatients rooms, and to discover the coping strategies employed by healthcare practitioners.

A mixed methodology was employed. We conducted a survey of a representative sample of the Israeli population (N = 760); and held 50 in-depth interviews with nurses, physicians and managers employed in 11 public hospitals in Israel.

In the representative sample survey, 30% of Jews and 21% of Arabs agree that patients should be allowed to choose to be placed in an inpatient room in which only patients of their own ethnic group are hospitalized. Among both Jews and Arabs, a high level of religiosity and a low level of education predict this position. Most Jews (80%) and Arabs (71%) do not agree that the entire healthcare system should be ethnically separated. The in-depth interviews revealed evidence of demands for ethnic separation made at times by Jewish patients, which are often met by the nurses. In some cases, nurses separate Jewish and Arab patients of their own accord. They do this either to promote cultural compatibility between patients or to avoid unnecessary tension and confrontations. In some cases, this step may constitute discrimination against Arab patients. Managers and senior physicians, for their part, are generally unaware of this ethnic separation, or deny that it takes place.

Ethnic separation in inpatient rooms does take place some of the time and this runs contrary to the ethos of neutrality in medicine. We recommend implementation of a specific national policy that prohibits ethnic-based separation in hospitals' inpatient rooms. Better communication is required to ensure that policy decisions are clearly conveyed to the wards and that segregation does not become institutionalized.