Article - Dov Chernichovsky

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Health AffairsHistorically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel’s health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

ספר זה ניתן להשגה תמורת דמי משלוח (50ש"ח) בלבד.

Scaling Up Affordable Health Insurance

This book takes the reader on a fascinating historical and global voyage of the pivotal role that health insurance played in expanding access to health care and protecting households from the impoverishing effects of illness from the late 19th to early 21st centuries.

During the early evolution of health insurance at the end of the 19th and beginning of the 20th centuries, the nascent health insurance programs were initiated by professional guilds and communities that helped their members and households weather the loss of income from a breadwinner or critical member of the family rather than pay for health care itself.

When medical interventions became more effective in preventing and treating diseases, the European friendly societies and sickness funds also started to pay for health care itself in addition to the income support they provided to households with sick family members. The state initially played only a marginal role in partially subsidizing premiums for the poor or paying for almshouses and poorhouses.

As time progressed, the role of the state in providing health insurance became more prominent, to the point where in some countries, like the United Kingdom and the great experiment in the former Soviet Union, health insurance was—for a period of time—eliminated altogether. In recent years, even such “noninsurance” countries have reintroduced health insurance for complimentary, supplementary, and even primary coverage.

Although some developing countries tried to leapfrog this process and introduce national health systems or national health insurance programs without fi rst building the social and physical infrastructure that is needed for such systems to work, most low- and middle-income countries are retracing the historical experiences of Europe, North America, and Australia.

The contributing authors conclude this book with a proposal for a new paradigm for health insurance—a pluralistic multipillar system in which both the private sector and the state play a crucial role and in which expansion of health insurance coverage is accompanied by a parallel investment in service delivery to ensure that lofty ideals about equity are matched by access to quality services
on the ground.

I congratulate the contributing authors for the overarching research that went into this volume and the invaluable lessons for developing countries trying to improve health care for their populations.

Willem van Duin
Chairman of the Executive Board of Directors, Achmea
Member of the Board, International Federation of Health Plans

  • Country: General
  • Publication Year: 2013
  • Type of Media: Book