The Health Services in Israel: The Prospects for the 1990's / שירותי הרפואה בישראל, מבט על שנות ה-90
Rapid changes have been gathering momentum in the Israeli health service system since the beginning of the decade. The changes are mostly directed toward limiting the role of government in providing medical care to the population as a whole, and to relegateing a major part of this role to individual... Ausführliche Beschreibung
|1. Person:||דורון, אברהם|
|Weitere Personen:||Doron, Abraham verfasserin|
in Biṭaḥon sotsyali : ketav-ʿet be-nośʾe revaḥah u-viṭaḥon sotsyali , No. 38 (1992), p. 5-26
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Rapid changes have been gathering momentum in the Israeli health service system since the beginning of the decade. The changes are mostly directed toward limiting the role of government in providing medical care to the population as a whole, and to relegateing a major part of this role to individual respobsibility and to the private market. Until recently it has been accepted in Israel that the provision of medical care could not be left to the free market, but should rather be provided by collective intervention. The collective provision of medical care was organized on a partly voluntary basis in non-profit, consumer-organized and oriented, sick-funds (Kupot Holim). The Kupot Holim health insurance system covered about 94% of the Israeli population and provided most medical services to their insured members at no cost, at the point of use. Recently, however, the ruling political and economic elites, as well as the medical establishment, have taken a different view of the existing system and are agressively advocating changes which include the abandonment of the Kupat Holim system and granting free market forces a larger role in the provision of medical care. Two major Governmental Commissions, the Trainin Commission and the Netanyahu Commission, recently studied the organization of medical care in Israel and recommended introducing private practice into publicly-owned and operated hospitals and other health care facilities. The Netanyahu commission also recommended abolishing the sick funds as consumer organizations and replacing them by a national health insurance scheme, under which the existing sick funds could compete with others as contractual providers of medical care. The Minister of Health adopted these recommendations and has been actively pursuing policies to implement them. Currently there is a fierce ongoing political debate on these envisaged changes, The issues being debated are whether medical care will continue to be accessible at no cost at the point of use to all, or whether a new two-tier system of medical care will be established, which will mostly serve those who are able to pay for medical care, and a second-class service for the poor unable to pay for the health care they may require. The paper examines three possible scenarios of the form which the organization of health care services in Israel could take in the years to come. One: the existing system of the Kupot Holim will continue to operate with minor changes only, and on condition that it will increase the participation of its consumer-members in operating the system, and will simultaneously improve the services it provides to its members. Two: the establishment of a national health insurance scheme operated by the government will replace the Kupot Holim system. Under such a scheme, the policy-making power with regard to the provision of medical care will eventually gravitate into the hands of a small group of senior officials of the Treasury and the medical profession. These two groups are openly hostile to the provision of free medical care to the population at the point of use. The availability and access of free medical care to the population as a whole, and especially to low-income population groups, will be seriously curtailed according to this scenario. Three: the gradual privatization of the health care system and the transfer of its core to the private market. In reality, a process of creeping privatization is already taking place in the existing system and this process has been accelerated in the last few years. Increased user charges, a growth in private health insurance schemes and private practice in public facilities, are all an integral part of the growing pressures for privatization. It is almost certain that privatization will not improve accesisibility to medical care to most of the population nor will it better serve their health needs. It is difficult to predict which of these scenearios, if any, will indeed serve as the basis for the future organization of the Israeli health care system. It seems that only the Kupot Holim system, if sufficiently improved, carries with it the promise of a continues consumer orientation and equitable provision and distribution of medical care. The more powerful groups in Israeli society are, however, mostly opposed to this scenario and are supporting the others. The situation as viewed at the present is therefore not a promising one.