Researchers: Dani Filc ¹, Nadav Davidovitch ¹, Gabi Bin Nun ¹

Background: Since the legislation of the 1998 Arrangement law that allowed the public health funds to sell additional services, we witnessed a significant increase in the percentage of owners of complementary insurance and the blurring of the boundaries between the public and the private sectors.

Objectives: To analyze the reasons for the increase in the ownership of private insurance in Israel, focusing especially on those sold by the health funds.

Method: Mix-methods research, combining surveys of physicians and members of health funds with in-depth interviews with physicians and patients.

Findings: The basic scheme of the insurance sold by the sick funds became the norm, erasing the boundaries between them and the public insurance. The patterns of ownership of the different kinds of private insurance indicate inequality in access. Physicians’ dissatisfaction with the public system and with their working conditions are significant variables (p<0.001) for refering patients to the private system. The qualitative research showed that physicians refer patients to the private system in order to help them better navigate the system, while at the same time improving their source of income.

Conclusions: Budget constraints and the blurring of the boundaries between public and private transformed patients and physicians into entrepreneurs within a system characterized by uncertainty.

Recommendations: 1. Improving working conditions in the public system (e.g. “full-timers”model).
2. Improving trust (e.g. allowing choice of physician within the public system).
3. Increasing the funding of the public system.

Research end date: 04/2019