BGU | MY PATH, Haim Doron, MD

The law states that the insured persons will have free choice of the fund they are interested in, with the ability to transfer from fund to fund. This was a logical decision to prevent “cream skimming” by a fund. 135 According to the law, every resident was entitled to a basic basket of services. The basket was based on the basket of health services of Clalit. This fact is a testament to Clalit’s basket being seen as balanced from both a medical and an economic standpoint. Indeed, I feel that Clalit’s conduct in this respect was always fair and fitting on both counts. The law stated that collection of tax would be carried out through the National Insurance Institute, based on the income of the insured. Indeed, this decision both reduced collection costs and made health premiums more progressive. The law stipulated that division and allocation of fiscal resources to the sick funds would be calculated per capita . 136 However, despite the great importance of the Parallel Tax as a source of funding to underwrite the sick funds, there was a flaw in allocation. Initially, the Parallel Tax would be allocated only according to the number of members, while ignoring the factor of age. This was the practice for many years until finally they began to take age into account. According to the law, the state budget would be the source of supplementary funding to underwrite health insurance. It would not be the prime source of funding. This did not remain the case. The law set down a mechanism for changing the basket of health services and provision of its components based on quality of service, with acceptable standards of accessibility for all insured persons in terms of time and distance. There had always been criticism of Clalit about why it established clinics in every community, moshav, or kibbutz. The truth is that this policy, the configuration of Clalit operations, became one of the advantages of the National Health Insurance Law. A word about the Basket of Health Services Committee: When that committee meets annually to discus the basket, taking into account technological and other changes and developments in the health realm, it is functioning as a serious body that operates well. The committee does its work faithfully, squarely facing difficult quandaries of what to add. It makes decisions that encompass the philosophical-moral plane, not just the medical and fiscal perspective. But by transforming the state budget into the prime financing source of the health basket, instead of the Parallel Tax, this good and important committee has been required to compete with endless other pressing needs for state funding. This has made it impossible for the Basket of Health Services Committee to fulfill its function properly for lack of a budget of the size it needs to carry out its mission. With these principles, the National Health Insurance Law in its original form, prior to undergoing changes and amendments, was solidly on the side of public medicine. It sounded like competition for members among the sick funds would be according to the quality of their service -- that the sick fund with the best medical services, the best access, and highest quality would enjoy public admiration and attract more members. Also, importantly, clause 52.2 of the Low mandated establishment of a National Institute for Health Policy Research. This did come to pass, and the Institute has played a cardinal contribution, encouraging health management and development of health research that subsequently have been reflected in an impressive improvement in the management of health services in Israel. 135 A sick could could practice “cream skimming” by having selective criteria to allow only the more profitable clientele, e.g., young, healthy, or well-off people, to be accepted as members of that fund. 136 Per capita , from the Latin: Payment per person or capitalization, employed as a formula for setting allocation of sources of funding for the four sick fund ‘service providers’ under the National Health Insurance Law. Under this formula, allocation of funds to each of the four sick funds is shared proportionally by the number of individuals covered by each sick fund, factoring in the age of each insured person and other additional factors updated from time to time.

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