-
18 July 2023 | Country Update
Vision aids for children up to age 7 are now covered by National Health Insurance
7.2. Financial protection and equity in financing
The story regarding financial protection and equity is complicated and mixed. On the one hand, Israel has universal health care coverage, and all Israelis have a legal right to a broad benefits package. Moreover, the NHI system is financed predominantly via progressive taxation. In recent years, several steps have been taken to make the financing of NHI even more progressive: the ceiling on income liable to the NHI tax was increased; more protections from the burden of co-payments have been put in place for various vulnerable populations; and the capitation formula was updated to include “residence in the periphery” as a risk adjuster. Moreover, in recent years the scope of NHI has been increasing to include mental health care and dental care for children. In addition, since 2010 one of the Ministry of Health’s strategic objectives has been to narrow inequalities.
On the other hand, the following facts persist.
- Approximately 40% of THE is financed privately. Moreover, this rate is among the highest in the OECD countries, and it is growing (OECD, 2015).
- Private health care is financed regressively, with those in the lower income deciles spending a substantially greater proportion of their income than others on privately financed care. For example, in 2011 that figure was 17% for the lowest decile compared with 4% for the highest decile and 6% overall (CBS, 2013b).
- At the same time, the highest income decile spends on average four times more than the lowest decile on privately financed care (CBS, 2013b); it presumably also receives four times as much privately financed care.
- In 2014, 11% of Israelis reported foregoing a prescription drug or health care service because of cost, at least once during the previous year. In 2012, 25% of Israelis indicated that health care expenditure (including both private spending and the health tax) constituted a financial burden to a great or very great extent (Brammli-Greenberg & Medina-Artom, 2015).
- In 2012, 60% indicated a lack of confidence that, if they became seriously ill, they would be able to afford the necessary care (Brammli-Greenberg & Medina-Artom, 2015). That may be one of the main reasons why a relatively large, and still growing, percentage of Israelis have purchased VHI.
- Several key services, such as dental care for adults and LTC, remain outside the scope of NHI.
In light of all the above, it is difficult to give a simple summary statement about the extent to which the Israeli health system provides a good level of financial protection. Much depends on an assessment of the extent to which the benefits provided through privately financed care are vital for health and well-being. Many Israelis appear to think that they are, and they may well be correct, but more research is needed before that perception can be either confirmed or denied.
Children up to 7 years old will be covered for one pair of eyeglasses per year from 1 July 2023. Both the optical lenses and the frame are covered. The eligibility criteria require diagnosis with moderate to severe vision impairment (astigmatism or sphere component worse than +5D or −7D). Maximum waiting times are 30 days for visits to optometrists or ophthalmologists, and another 14 days for the delivery of the glasses.
This service was previously provided by the HPs’ voluntary health insurance. Now, the health plans will fund the service through National Health Insurance. Families are required to pay a co-payment (co-insurance) of 10%. This is capped at NIS 100 or less, depending on the level of visual impairment. Balance billing is also possible; patients can choose more expensive glasses than those covered by public funding and pay the difference.
The policy aims to improve financial access to care for lower-income families and reduce disparities.
Authors
References
MOH. (2023). Eligibility for glasses in the health services basket for children up to the age of 7. Circular of the VP for the supervision of the health insurance funds and other health services. Retrieved from: חוזר משקפיים לילדים עד גיל 7 (www.gov.il) https://www.gov.il/BlobFolder/policy/sbn01-2023/he/files_circulars_sbn_sbn01-2023.pdf.
Yanko, A. (2023). Subsidized glasses up to the age of 7? At the health plans it is already subsidized or free in the voluntary health insurance. Ynet: health. Retrieved from: https://www.ynet.co.il/health/article/hkguyypso.