The right to health in Israel between solidarity and neoliberalism

The National Health Insurance Law (NHIL), which came into force on January 1, 1995, marked the transformation of the Israeli health system from a Bismarck-style social insurance model of health care to a mixed model in which Sick Funds remained the providers of most health services, but the role of insurer was transferred to the state, which also assumed the responsibility for the funding of the Health Services Basket. The post-1995 Israeli health care system has been described as reflecting a hybrid Bismarck-Bevridge model. Prior to 1995, both health insurance and health care services in Israel were for the most part provided by four Sick Funds. The 1994-1995 reform did not abolish the Sick Funds, but transferred the financial responsibility for health care to the state and made health insurance mandatory and universal. The NHIL created a triad relationship in which the state is responsible for the financing of the Health Services Basket, the Sick Funds are responsible for the provision of health services, and residents are entitled to the health services. In theory this structure separates the financial relationship between the resident and the state (to which he or she pays the health tax) from the clinical relationship that exists between the resident and the Sick Funds that provide health services. Financial relationships exist between the Sick Funds and the state, and the latter is mandated by statute to finance the health basket. This triad relationship is premised on the statutorily guaranteed severance between the payment for health insurance and the receipt of health services. This premise, fully endorsed, would treat health, and specifically health care, as a right, insofar as it would create equal access to health services, based on need as opposed to graded access, based on the ability to pay. However, as discussed in Subsection 6.1.1.3, a number of legislative reforms enacted shortly after the adoption of the NHIL changed the financing structure of the health system in a manner that deviated from its original premise and promise. They reduced the state's responsibility and shifted much of the burden to patients in the form of direct out-of-pocket payments, thus creating a situation in which, despite the semblance of a “universal” system, access is often conditioned on payment.