Examining the degree of financial protection that the Israeli health system provides to its residents

Background

Financial protection is one of the goals of health systems, and it means that the use of health care does not result in financial hardship or unmet needs by those in need. However, there is little information on the extent to which the Israeli health system achieves this goal.

Objectives

To examine the degree of financial protection that the Israeli health system provides to its residents by (1) examining trends between 2005 and 2019; (2) comparing data from Israel with that of European countries; (3) examining the health services that undermine financial protection.

Methods

Longitudinal analysis of data from the CBS household expenditure surveys conducted between 2005-2019. Financial protection was measured using indicators developed by the WHO: catastrophic expenditure on health care; and risk of impoverishment due to these expenditures.

Catastrophic spending was defined as payments for health care exceeding 40% of the household’s ‘disposable income’ after spending on basic needs (food, housing, water, electricity and gas – ‘the basic needs line’).

A household is impoverished when total consumption after deducting out-of-pocket on health care falls below ‘the basic needs line’. This line is at the level of the average expenditure on basic needs among the 25-35 percentiles of the distribution of consumption in households standardized to the composition of the family unit.

Findings

In 2019, out-of-pocket spending for health care were catastrophic for 6% of Israeli households, and half of them were at risk of impoverishment (3%). This rate remained stable throughout the study period and is high compared to European countries with a similar rate of out-of-pocket spending as a percentage of current health spending.

Dental care is the main service that causes catastrophic spending: 57% on average of all catastrophic spending, 76% in the top spending quintile and 33% in the bottom spending quintile. Medicines are the secondary service that causes catastrophic spending, but the burden of out-of-pocket spending varies by income: medicines make up 48% of the total catastrophic spending of the lower quintile compared to 5% of the spending in the upper quintile.

Conclusions and policy recommendations

The public coverage of dental care in Israel is partial, and is the main cause of catastrophic spending, particularly among the rich. However, financial protection is underestimated by the catastrophic spending indicator for those with unmet needs. In a survey conducted in 2016 among adults aged 22 or more, a third of those belonging to the bottom quintile reported forgoing dental care. In the same survey conducted in 2021, the poor reported having difficulties paying for medicines and 13% forewent medicines due to the cost.

In order to improve financial protection, public spending on health needs to be increased to: expand dental care coverage at the National Health Insurance’s benefits basket, reduce copayments, change the coinsurance for medicines to flat-rate copayments, and add discounts on copayments based on income.

More information about Israel is available on UHC watch, a new platform tracking progress on affordable access to health care in Europe and central Asia. You can visit the country page,  explore numbers for Israel using the indicators explorer and see how it compares to other countries in Europe and explore coverage policy in Israel using the policy explorer.

Suggested citation: UHC watch. (2024). Country page for Israel (online database). WHO Regional Office for Europe. https://apps.who.int/dhis2/uhcwatch