Taub Center » Health

Israel’s Healthcare System

Dov Chernichovsky — Sun, 02 Oct 2011 08:18:00 +0000

Israel’s national healthcare system suffers from structural flaws to which the State has contributed. These include a lack of both the resources and the administrative flexibility to cope with rising demand for care as supply has declined. Rather than aiding the public part of the system to cope with the challenge, the State has exacerbated the situation by reducing the share of public funding and by encouraging the private insurance funds to provide these services. The result is an uncontrolled rise in service demand in the private part of the system that is largely met by personnel who are also employed in the public part.

Thus, not only has the healthcare system declined in efficiency, reflected in a relative inflation of healthcare prices due to double pay and waste, but the situation has also worsened in terms of income distribution and access to medical services. This deterioration also manifests in growing disparities between poor and rich, between central Israel and its periphery, and between incomes of interns, who cannot do privately paid work and those of specialists who can. Worst of all, early indications of these systemic flaws are becoming apparent at the public health level, as seen in a rise in infant mortality among the Bedouin of the Negev and other weaker groups in society.

This appears as a chapter in the Center’s annual publication State of the Nation Report – Society, Economy and Policy 2010.

Changes in Healthcare System Allocation to Promote Equality Between the Center and the Periphery. Is It for Real?

Dov Chernichovsky — Wed, 16 Mar 2011 08:37:56 +0000

Since the beginning of the year a new capitation formula has been in place for allocation of some NIS 27 billion to the healthcare system in Israel. This represents about 80 percent of the total public budget for financing medical services in Israel – the services given by the sick funds. The new formula is intended primarily to narrow the growing gaps between the Center and the periphery geographical regions. This much needed change would bring additional money and resources to the periphery. Unfortunately, the implementation of this change will not bring relief to the periphery mainly because it is not based on the representation of the different sick funds in the periphery, on their ability to compete, and their ability to move resources from the Center to the periphery while expanding their services.

A “Malignant Growth” in the Share of Private Expenditure for Healthcare and Its Price

Dov Chernichovsky — Sun, 25 Jul 2010 10:32:35 +0000

The achievements of the Israeli healthcare system – good according to all indicators, like the general health of the population, satisfaction with service and care, and cost of care – have been exposed in the past decade to an increasing risk following the steady decrease in the share of public funding of the system, and a corresponding rise in the share of private funding.

The situation exposes the system to increasingly to market failures and which are particularly problematic in Israel due to the unique arrangement whereby demand for privately funded services is encouraged in the publicly funded healthcare system through privately paid supplemental insurance. Standing to gain extra incomes from privately paid MDs leave unduly their publicly paid posts, establish potentially unneeded private practices, and possibly adopt unnecessary technology.

These changes are expressed in the relative inflation in prices of privately paid healthcare that is spilling over into the cost of the publicly funded system. This inflation indicates a loss of efficiency and declining equity in healthcare. The public pays more but does not receive more services, comparable to the increase in spending. In terms of equity, rising prices relative to other prices and income also decreases accessibility to services which is harmed to start with by the increasing need for private funding to buy care. More than this, these developments are likely in the end to harm the public’s health and public health achievements. This is the story of the United States versus the other developed countries including Israel up until now. Despite the superiority of the American system from the perspective of technology and the level of resources invested in healthcare, its outcomes are modest by every indicator. The “Americanization” of the financing of healthcare in Israel which is currently expressed in inflation and its implications, brings Israel closer to the inferior elements in the American system.

Dental Health: The Burden on Households – Implications for National Health Insurance

Guy Navon — Sun, 30 May 2010 06:00:18 +0000

Household expenditure on dental health care in Israel is regressive. The Israeli household stands before a dilemma: whether to forgo medical care, in most cases for children and the elderly, or to forgo some other need in order to pay for dental care.

Expenditure on private insurance is common amongst a very low percentage of households and primarily in the higher income quintiles. While it improves their situation it also serves to widen inequalities in access to treatment as well as income disparities and general demand. The lowest income quintiles cope with the expenditures for routine dental care – which represent some 7% of their overall household expenditure when they need treatment and especially treatment for children – and they are not able to deal with expensive treatments related to surgeries or reconstruction. The lowest two quintiles almost completely forgo dental health treatments.

The study recommends a process for including dental health care in National Health Insurance, with the required budgetary back-up that will be required. This process is likely to bring real relief in the medium and long-range in terms of an improvement in dental health in Israel and a savings in national expenditure for dental health.

In Hebrew only; English translation in preparation.

The Healthcare System

Dov Chernichovsky — Tue, 13 Apr 2010 10:04:43 +0000

The key characteristics of Israel’s health care system are the continued increase of the share of private funding in the overall funding of the health care system and provision of care. Private funding currently represents about 43 percent of the overall funding, the highest beyond the United States among the developed countries, and the highest among countries in which universal health insurance is legally guaranteed for all residents via National Health Services.

The “Americanization” of the Israeli healthcare system is reflected at this stage in growing gaps in access to care and loss of income protection as well as efficiency, which can be measured by the developing inflation in the system. This reality is not reflected as yet in public health indicators. The growing gaps between the United States and the 22 high income OECD countries in favor of the latter may be signaling what can be expected in Israel in terms of its achievements in the health of its population. Against this backdrop, the efforts by the large health care service providers to deepen their focused activities in closing the gaps stand out.

This paper appears in the Center’s annual publication - State of the Nation Report – Society, Economy and Policy 2009.

Health Inequality: Policy Analysis and Recommendations for the Israeli System

Tuvia Horev — Thu, 16 Oct 2008 12:08:52 +0000

This work analyzes differences between a number of industrialized countries in their level of commitment to dealing with health inequalities, in their strategic approaches and in the variety of means and methods that they have taken and in particular, their choice of target populations, the monitoring mechanisms and their choice of indicators and goals. The study also presents achievements in light of the goals set. Based on this analysis, alternative policies are suggested for the Israeli health system.

On the basis of extensive data published in various countries and by a variety of organizations, the author presents a model that classifies the methods used by several industrialized countries for dealing with their health inequality issues. The material is intended to widen the base of knowledge and to present it to policy makers in Israel as well as the authorities and organizations responsible for health services provision on both the national and organizational level. Beyond the data analysis, emphasis was placed on presenting sources for readily accessible data from different countries for use by policy makers and administrators in need of further information.

The Public Supervision of Sick Funds in Israel

Dov Chernichovsky — Sun, 17 Feb 2008 10:44:22 +0000

Taub Center researchers point to the need to strengthen the accountability of Israel’s Sick Funds, the absence of which harms their ability to serve the public faithfully. The study presents three alternative management models that would increase the public’s ability to supervise the Sick Funds in accordance with the principles of proper public administration and the National Health Insurance Law.

The study, prepared by experts in economics, public policy and law, Prof. Dov Chernichovsky, Dr. Shlomo Mizrachi and Attorney Zvi Frankel, stresses the public character of Sick Funds, their legal and public responsibility and the need for this to be expressed in the regulations and management of the funds. The study stresses the fact that the Sick Funds avoid their responsibility towards the public by failing to provide regular reports of their activities and by their lack of public accountability. The research suggests several alternatives for remedying this situation including changes in the management structure of the funds and, in particular, issues relating to the appointment and functioning of the fund’s boards of directors.

Health System Finance in Israel 1995-2005: Aspects of Poverty, Progressivity and Cost Containment

Dov Chernichovsky — Mon, 03 Dec 2007 12:04:16 +0000

This study by Professor Dov Chernichovsky looks at the changes in the mix of public and private funding of health care in Israel over the last decade. The uniqueness of the study lies in its examination of the consequences of increased private funding, how catastrophic spending is pushing some families into poverty, and the contribution of increased private funding of health care to inflation.

Inequality in Health and in the Health System

Leon Epstein — Mon, 03 Sep 2007 12:22:54 +0000

The World Health Organization declared in 1978 that health is a basic human right and that it is the responsibility of governments to insure the health of its citizens (Alma-Ata). Many countries have struggled with health inequalities and have taken steps to lessen them. Britain has both recognized the problem and enacted legislation and programs to lessen the health gaps between sub-populations. This monograph examines health statistics and the widening gaps between geographical areas in Israel as well as between socio-economic groups in their abilities to access quality health care and makes concrete recommendations for dealing with this growing and problematic social issue.

Oral and Dental Health — The Responsibility of the State towards its Citizens

Tuvia Horev — Tue, 03 Jul 2007 12:41:26 +0000

Although investment in oral health in Israel in terms of national expenditure and manpower is relatively high, the results are fairly poor. Morbidity is high and the disparities between population groups are substantial. Public spending on dental health care is the lowest among Western countries. Oral and dental health is an integral part of overall health and morbidity in this area represents a drain on the individual and on society as a whole. Most European countries have recognized their obligation and have included dental care in their national health insurance plans and as part of their basket of services, something that eases accessibility to receiving care and narrows the gaps between population groups.
The authors state that the time has come to fulfill the intentions of the law regarding dental care for school age children by adding dental care to the basket of services that are stipulated under the National Health Insurance Law. They recommend widening the basket of services for dental care to other population groups (such as the elderly) through a relatively modest budget increase. They also suggest establishing an epidemiological dental data base with on-going follow-up of individuals and cases, as well as widening educational work with populations, training more manpower in dental health care services and increasing the flouridization of water in Israel.