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Give a Gift Subscription THE JEWISH NEWS

Israel's Health Care System
Is Due To Be Revamped

SIMON GRIVER SPECIAL TO THE JEWISH NEWS

FA

xperts and patients
agree that major
surgery is needed to
revive Israel's public
health service which is close
to bankruptcy and leaves
some citizens without health
insurance coverage or with
incomplete service. Health
Minister Haim Ramon has
formulated a national health
insurance bill to remedy the
situation, which he hopes to
push through the Knesset in
the coming months. But
political opposition, ironical-
ly from his own Labor party,
threatens the bill's passage.
Mr. Ramon is uncharacter-
istically circumspect about
his colleagues' resistance to
the bill. "I have no problem
with making amendments to
the bill that the party can
agree on," he says. "But I
hope that the final decision
will be for the good of the pa-
tient rather than the estab-
lishment."
Mr. Ramon's bill would
guarantee the right of every
Israeli citizen to streamlined
medical health services
through the health fund of his
or her choice. At present the
onus is on citizens to arrange
their own insurance and some
4 percent of Israelis, mainly
in the Arab sector, remain
without coverage. Ihstead of
allowing the various health
funds to set and collect their
own fees, the National In-
surance Institute would
automatically levy fees at
about 5.3 percent of income,
thus making sure everyone
joins.
This clause antagonizes the
powerful Labor-run Histadrut
Trade Union which runs the
country's largest health fund.
Its Kaput Holim Clalit (Gen-
eral Health Fund) has 3.7
million members represent-
ing 74 percent of the health
fund market. It also owns six
of the country's 26 hospitals.
If Mr. Ramon's bill becomes
law, the Histadrut would be
greatly weakened, not only
because it would no longer
control its own finances but
more significantly because
people who want to join
Kupat Holim Clalit now must
also join the Histadrut labor
federation, and monies go for
other than medical activities.
But Histadrut Secretary-
General Haim Haberfeld sees
nothing untoward in this con-
nection. "We are not a

sinister Bolshevik organiza-
tion," he insists. "We're a na-
tional institute that has serv-
ed the interests of the Jewish
state since before indepen-
dence. And we have built up
an impressive level of medical
care comparable to other
Western nations."
Professor Shmuel Penchas,
director-general of the
Hadassah Medical Organiza-
tion, also stresses the relative
quality of Israel's health care
system. "Remember that one-
third of U.S. citizens have no
health care insurance," he
relates. "That's more than 90
million people."
"It's true that in Israel we
have long queues for medical
service," he continues, "but
this stems from a scarcity of
resources in the past. We
must set our economic
priorities to reduce such in-
conveniences and maximize
fair and equal treatment."

A bill would
guarantee every
citizen health
care.

Professor Penchas, an
authority on the organization
and administration of health
services, was also one of the
architects of the proposed
health care legislation. He
sat on the government ap-
pointed Netanyahu Commis-
sion of Enquiry into the
Operation and Efficiency of
the Health Care System
which submitted its report in
1990.
This became the basis of
former Likud Health Minis-
ter Ehud Olmert's proposed
health care reform bill, which
failed to pass through the
Knesset before last June's
election. The widely held
assumption was that the new
Labor-led government would
amend the bill in order to pro-
tect the Histadrut's power.
But Mr. Ramon, always the
affable political maverick,
surprised everyone by propos-
ing a bill remarkably similar
to Mr. Olmert's "I have add-
ed clauses about the basket of
services" (which will include
routine and specialist treat-
ment, subsidized medication
and hospitalization coverage)
Mr. Ramon explains, "which
will ensure that the poorest

.

citizens receive fair treat-
ment."
Mr. Haberfeld, however,
thinks the bill will favor the
rich by enabling the more up-
market health funds (Mac-
cabi with 13 percent of
Israelis, Leumi 7 percent and
Meuhedet 6 percent), which
charge a higher fee but (
reputedly provide better ser-
vice, to prosper.
A clause in the new bill will
enable people to switch free-
ly from health fund to health
fund, something they are
unable to do at the moment.
Profesor Penchas observes
that the rich in Israel have
always received health care
privately. "And it is not un-
common for Israelis to go
abroad for special treatment,
like organ transplants," he
adds.
Indeed the Netanyahu
Commission noted that in
1988 the expenditure for
private health care in Israel
amounted to 23 percent of'_\/
total national health care ex-
penditure.
The bill proposes a new /
government establishing
health authority to regulate
that competition, and to sub-
sidize services for the elderly \
and chronically sick. "Kupat 1
Holim Clalit has the most to
gain from such compensation
because it has the highest
proportion of elderly mem-
bers," Ramon points out.
Such compensation, Mr. z
Ramon continues, would put )
an end to the current situa-
tion where Kupat Holim
Clalit keeps turning to the
government for ad hoc trans-
fers to pay off its debts. In
December alone, the govern-
ment gave Kupat Holom
Clalit $126 million, and the
health fund's total debts are
estimated at $750 million.
The Treasury also has res-
ervations about Mr. Ramon's
bill because of increased costs
of the government. But Mr. <
Ramon responds that $300
million will be saved each
year on collection dues
through one, rather than four,
organizations.
Professor Penchas advised
Mr. Ramon to compromise
with his opponents so that
the bill can be passed.
Despite the opposition, and
speaking in conciliatory
tones, Mr. Ramon expresses
optimism that 1993 will see
his bill passed into law. 0