Benefit Packages of Sick Funds in Israel / סל שירותי הבריאות בקופות-החולים בישראל

• Published in: ביטחון סוציאלי 1991-04 (36), p.92-105
• Main Authors: ברנע, תמרה, Barnea, Tamara
• Format: Article
• Language: Hebrew
• ISSN: 0334-231X

The question of the composition of the basic benefits package which is supplied to most residents of Israel through one of the four sick funds (Klalit, Maccabi, Meuchedet, and Leumit), has recently taken on special significance in light of three factors: the difficulties encountered by the health system in financing and supplying health services; the desire to institute reforms such as the National Health Insurance Law; and the rapid pace of changes in the field, such as the growth of private medicine and the expansion of supplementary and private insurance. This paper surveys the services provided by the sick funds within the medical insurance system operating today in Israel. It also describes the recent development of supplementary and private insurance. The analysis shows that nearly all residents have access to a wide range of health services through the basic insurance of the four sick funds and the country's laws and institutions. There is no binding law or regulatory code with regard to the composition of the basic benefits package that the sick funds must supply to their member, or with regard to the balance between the sick funds' revenues and service-related expenditures. The wording of the sick funds' regulatory codes is general and makes the composition of the basic basket of covered services unclear. The regulatory codes do not reflect all the members' benefits. The manner in which benefits are realized is at the discretion of the sick funds. Each sick fund has different conditions which restrict membership (such as age, health condition, work status, organizational affiliation); some populations are not eligible for full health insurance (e.g. parent and pensioners insurance), some conditions are not covered and payment of related medical costs depends on the good will of the sick fund or the Ministry of Health (such as hospitalization resulting from criminal violence or psychatric hospitalization in an acute-care hospital). Certain health services are not included in the benefits package of some of the sick funds (for example, flu shots for the elderly, medical aids, dental care) and others are covered only partially or "if possible", sometimes using both medical and social criteria (for example, assistance by the sick funds in nursing care, personal care, community-based psychiatric services, recuperation, expensive medication). The benefits package does not specify a maximum waiting time for service supply, so the sick funds are not oblig