Health care inequalities in Israel - The responsibility of the family physician

The National Health Insurance Law, which went into effect on January 1, 1995, requires the healthcare system to provide equitable, high quality health services to all residents of Israel. This study evaluated several health measures including life expectancy, infant mortality, chronic illness, oral health, mental health, health behaviors, and access to basic health services, and correlated them with demographic indicators such as religion, nationality, education, socio-economic status, cultural background, and place of residence. Individual co-payments for medical services included in the national health package have increased over the years since the National Health Law was enacted, and this has had a significant impact on the lower-income segments of the population. Today, the public sector contributes about two-thirds of the national health care expenses, while the proportion of private funding has been steadily climbing, and is now approximately one-third of the total national healthcare costs. This trend toward increasing costs for the private sector is expected to have a mounting negative impact on the equitable distribution of healthcare services. As it becomes increasingly difficult for the private individual to meet the required co-payments, his/her access to medical care will, of necessity, diminish. This phenomenon is evident in the increasing number of study participants who have chosen to forego healthcare services due to economic difficulties. As such, it is incumbent upon Social Service providers such as the Departments of Education and Welfare to play a more active role in decreasing the gaps. However, their responsibility does not in any way diminish the accountability of the healthcare providers from the Ministry of Health and the national HMOs, to the solo practitioner, to each contribute their own time and effort in the struggle to decrease the inequities in the provision of healthcare services that currently exist among different segments of the population.