Israel does have a National Health Insurance Law, but although it allows every resident of the country to receive services from one of the HMOs, the level of health services is not equal and is affected, among other things, by economic and geographic conditions. More precisely, the poor and residents of the periphery receive less. With rising prices, there is a real fear that many more will have to forgo medications and treatments.
Information from the National Insurance Report and Latet's Alternative Report,
According to the Central Bureau of Statistics, from 2000 to 2019, the average expenditure on health among Israeli households increased by 61.2 per cent per month (from 595 NIS to 959 NIS). In contrast, total expenses during this period increased by only 22.7%. In the 2021 Social Security Poverty and Inequality Report, published in January this year, more than 26 per cent of households indicated that they are unable to cover all monthly expenses, 10.6 per cent have foregone medical care and 6.9 per cent cannot afford prescription drugs.
The figures are even more depressing when looking at Latet's 2022 Alternative Poverty Report, according to which over two-thirds of aid recipients said they had been forced to forgo purchasing medication or necessary medical treatment. In Israel, therefore, the poor are sicker, but cannot afford adequate medical care.
Without a clear outline, poverty will deepen, photo: Roni Shaitzer
The National Health Insurance Law was enacted in 1992 and its purpose was to create conditions that would ensure that every citizen could receive health services in an equal, accessible and high-quality manner. More than 30 years later, the right to the highest level of health seems to remain in the hands of the rich. Although the Ministry of Health set itself a goal in 2010 to reduce inequality, and indeed a number of steps have been made in this regard, when looking at the data, it is impossible not to ask whether enough has been done and what more can be done to reduce the gaps.
Data collected by Latet show that national expenditure on health remains low relative to the average in Western countries. In 2019, expenditure was 7.5 per cent – 15.7 per cent lower than in OECD countries, where expenditure stands at 8.9 per cent. In addition, private expenditure on health in Israel constituted over a third (about 35.2%) of national expenditure, and compared to the average in Western countries, this is a significant gap. When examining the distribution of health expenditure among households, by income quintiles, health expenditure increases as the quintile increases.
Fear that many more will have to give up medication and treatments, Photo: Dudu Greenspan
The lot of the poor: they call it poverty diseases
According to Latet report, an average of NIS 1,699 is spent on health in the highest quintile, compared to NIS 508 in the lowest quintile and NIS 878 in the middle quintile. The rich spend 3.3 times more on health than the poor. In the field of mental health, even more extreme gaps are revealed. Per capita expenditure in the highest quintile is 5.1 times higher than in the lowest quintile and 4 times higher than in the middle quintile.
When the mental health system in Israel collapses, waiting lines are long (an average of 150 days) and there are no therapists, only those who can afford to pay thousands of shekels a month turn to private mental health treatment. People of lower socioeconomic status, who according to the data cope more with mental difficulties, do not receive the treatment they need.
The gaps between the classes are deepening because of the cost of living, photo: Dudu Greenspan
Certain diseases are also the lot of the poor – they call them poverty diseases. People living in economic distress are more exposed to morbidity due to the reality of their lives, and they will have no choice but to forgo medication and beneficial medical treatment, which will lead to even more damage to their health.
Diseases such as diabetes, hypertension and high cholesterol, as well as mental illnesses, are more common among poor populations. According to Latet's report, nearly a third of aid recipients suffer from high blood pressure, compared to 12.5 per cent of the general population; About a quarter have diabetes, compared to 11% in the general population; and 15.2 per cent suffer from mental disabilities – 4.5 times more than the general population.
Eran Weintraub, CEO of Latet, Photo: Shlomi Mizrahi
The large gaps are reflected in health insurance and the ability to pay for them. As stated, in Israel every person is entitled to basic health insurance – this means that there is partial coverage and a requirement for a co-payment for medications and treatments.
According to the Central Bureau of Statistics expenditure survey, the higher one climbs in income deciles, the greater the share of expenditure on health insurance. In the top decile, the share of those holding supplementary health insurance is 95%, while in the bottom decile it is only 55%. The basic health insurance of the health plans and the requirement to pay deductibles lead to the waiver of health services and thus widen the gaps.
"Needs to be addressed"
"The clearest expression of life in poverty is the daily necessity to make painful concessions," says Latet Executive Director Eran Weintraub. "The increase in the prices of foodstuffs, energy, and interest rates in the economy erodes the already limited purchasing power of disadvantaged populations. Without a plan to reduce poverty, alongside an immediate struggle against the cost of living, poverty will deepen and lead to thousands more families falling into economic distress."
Perpsor Hagai Levin, Photo: Yossi Zeliger
"Disease prevention narrows gaps," says Prof. Hagai Levin, chairman of the Israel Medical Association's Association of Public Health Physicians. "Preventive measures are needed, both in the area of diseases and in the issue of deductibles for medical care. The Health Insurance Law is fundamentally correct – it relies on justice and mutual aid and provides a broad response."
"The problem is that there is no update mechanism for worn out services. The picture is complex and related to access to care and the quality of medical care. The state must identify the populations in need of a tailored response and reach them. It is inexpensive, but requires tailored attention to needs. Unfortunately, this lack of attention in order to take the necessary actions, identify the barriers and remove them."
"Poverty kills," explains Prof. Nadav Davidovitch, head of Ben-Gurion University's School of Public Health, "from the difficulty of purchasing healthy food to coping with morbidity due to the need for a deductible. These are not decrees of fate, but the product of a policy that is aware of the need to narrow the gaps. The public health system is crying out for more resources. There is a national plan that must be implemented, accompanied by sectors and government ministries."
Wrong? We'll fix it! If you find a mistake in the article, please share with us