BGU | MY PATH, Haim Doron, MD

The reader might be wondering how such a thing as the abolition of the Parallel Tax happened in the State of Israel without a satisfactory response from the health system. As I understand it, the process leading up to the Arrangements Law of 1997 involved the Ministry of Finance’s advisor on health affairs going to a meeting of the Knesset’s Finance Committee where only the committee chair, Rabbi Avraham Ravitz, was present. The advisor explained to Ravitz that this was merely a technical change since the state budget would be allocating the identical sum, and the change in the funding source would only lower the cost of the work, which, we now know was erroneous. The chair, Ravitz, had replied to the Finance advisor: “I don’t understand a word you said, but if you say this is solely a technicality, then I accept it.” Ravitz then voted in favor of abolishing the Parallel Tax! Then, when the Minister of Health, Yehoshua Matza, 141 came and reported to the Ministry of Health’s health council that the Ministry of Finance was thinking of abolishing the Parallel Tax in the framework of the Arrangements Law, I was a member of the health council. My spontaneous response was, “The system will yet ‘sit shiva ’ (‘mourn’) on abolition of the Parallel Tax.” There were others who also spoke up against abolition of the Parallel Tax; and Minister of Health Matza took it upon himself to investigate what could be done. He returned to the council saying nothing could be done to roll things back. Thus, four scant years after passage of the historic 1994 legislation that launched a national public health insurance system in 1995, Israel’s national health insurance law underwent a change from a law that fulfilled the promise of social security in the health sector, to an insurance law that depended on, and was subject to, the whims of the state. It accelerated the slide towards the health system being managed by clerks in the Ministry of Finance. It’s hard to believe, but that’s the way it happened. Introduction of Supplemental Health Insurance Plans A so-called “achievement” of the Arrangements Law in 1998 was introduction of Supplementary Health Services ( Sherutei Briut Nosfim or SHABAN , in Hebrew). In practice, this was supplementary health coverage paid out-of-pocket for services above and beyond the basket of services covered by the law. The late, Prof. Zvi Adar, a member of the executive of the National Institute for Health Policy Research, and one of the best health economists in the country, branded the SHABAN “one of the fathers of the blasphemies of the health system.” Realities prove the truth of this charge. First of all, the SHABAN , in practice, divided insured person into those of means, and those without means. While it’s true that statistically, some 75 percent of the population pay for this additional medical insurance, such reports cover up the fact that in high socioeconomic geographic areas there may even be 90 percent enrollment in SHABAN ; but there are also problematic areas, not only from a socioeconomic standpoint but also when the yardstick is on medical grounds, factors that are often co-related with poverty, where the percentage of the population with such coverage is much lower. In essence, insured persons in Israel are divided into those with the ability to pay who have both public and supplementary insurance coverage, and those without the ability to pay who have only the public coverage. The Maccabi sick fund had a program called “Maccabi Shield” that was a form of supplementary insurance before SHABAN . As a result, Clalit introduced supplementary insurance in order to be able to compete with Maccabi. And, in the beginning, it was claimed that the SHABAN was designed only for non-essential, elective, health needs. But it was clear to me, that over the years this would come to include essential health needs, and so it was. According to a 2015 government statistical report, the percentage of the health budget coming from the private resorces stood at 38 percent; the SHABAN has made a huge contribution to this increase. We

141 Matza had been a Likud MK from 1988 to 2002, an accountant by training, who served on many economic committees and was Minister of Health between 1996-1999.

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