In February 2010, a special inter-ministerial committee tasked with determining the budget allocation for Israel’s Health Maintenance Organizations (HMOs) announced the inclusion of ACRI’s recommendations, specifically clauses benefiting residents of Israel’s periphery.
In response, ACRI issued a letter to the committee, praising its decision to modify the capitation formula (allocations per capita) and offering suggestions to further improve health services in Israel’s periphery. The new formula will take into account important factors such as the location of residence and gender of the insured individuals in each HMO. Until now, the Ministry has employed a capitation formula based on the age of each client. The new formula would take into account and place greater weight on residence in Israel’s periphery, thereby allocating additional funding to HMOs which serve more people in Israel’s peripheral regions, where large portions of the population belong to lower-socio economic classes. The new formula is intended to provide incentives for HMOs to develop health services in these low-income areas and minimize the gaps in health quality and services existing between in the country’s central urban areas and the periphery.
In the letter, ACRI also noted that the decision marks a significant measure which has not been made in the past 15 years, since the National Health Insurance Law was instituted, despite repeated recommendations.
In October 2008, ACRI published a detailed position paper, and sent it to a special governmental committee, offering suggestions on improving the capitation formula used for determining the HMO budgets so that it could effectively deal with the serious gaps in health which exist in Israel, and so that the right to health and equality which are enshrined in the National Health Insurance Law are properly safeguarded. In the paper, ACRI noted that the capitation formula is a vital tool which allows the Health Ministry to regulate the policies of the HMOs on an individual and community level, calling for variables that take into account the socio-economic status of the clients insured by each HMO.
Despite these welcome developments, ACRI emphasized that additional actions must be taken in order to institute a formula which will appropriately address the serious gaps in health quality and services in Israel. Among these measures is the need to expand the list of serious diseases subject to additional funding to include chronic illnesses such as diabetes and vascular disease, a well as the need to establish mechanism which can monitor the results of the new formula and ensure that it is indeed minimizing gaps. ACRI also called for the inclusion of variables into the capitation formula which will take into account gaps in health that exist within cities, not only gaps between cities, as well as the inclusion of variables which will take into account the socio-economic status of each insured individual.
