1995 - Dov Chernichovsky

This report still serves as the foundation for still needed reforms of the Israeli Healthcare Systems. Published in 1990, was the basis for the Israeli National Health Insurance Law enacted on January 1,1995.The report is only available in hebrew. Added to the website upon the request of several inquiries.

The health indicators of Israel are high, while relative spending on healthcare is low. The enactment of the National Health Insurance Law (NHIL) in 1995 entitled all Israeli residents to free or nearly free health coverage via access to a socially determined “basket” of medical care. However, the NHIL recognizes that universal health coverage (UHC) transcends “the numbers,” or shares of population coverage. According to this law, UHC also embodies a series of qualitative attributes. This paper highlights the UHC attributes achieved in the Israeli healthcare system, beyond population coverage: equitable coverage, progressive contributions, access depending solely on medical need, accountability, and free choice. It also demonstrates particular implementation and continuance challenges: the lack of a firm state commitment to equitable UHC, leading to persistent disparities across Israel.

Historically, 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.