Gaps between Low Income and Middle to High Income Individuals following the Implementation of the National Health Insurance Law, 1995-1997

One of the main goals of the National Health Insurance (NHI) Law was to make Israel’s health services system more equitable. Although low income groups are now more attractive to health plans than they were in the past, it is not clear whether NHI provides enough of an incentive for insurers to seek them out or, in general, to seek out residents of geographic areas characterized by low income.

The goals of the study were to:

  1. Examine the changes that took place in the health services between 1995 and 1997 from the perspective of those in the bottom quintile, and to compare them with the changes perceived by the rest of the population.
  2. Compare the experiences and perceptions of people belonging to the lowest quintile with those of the rest of the population in 1997.
  3. Compare the experiences and perceptions of people receiving NII income supplements with those of the rest of the population in 1997.
  4. Assess the differences that remained in 1997 after taking into account place of residence and other potential confounders.

While the material in this report refers to the years 1995-1997, it should still be of interest to readers today for the following reasons:

  • NHI was significantly modified by the Knesset in 1998; this report documents the impact of the law – in its original form – on low-income persons.
  • Recently-published and soon-to-be-published Brookdale reports examine the experience of low-income persons in the health care system post-1998. Taken together, the series provides a comprehensive picture of how low-income persons have fared in the health system since the introduction of NHI.
  • This is the only report in the series to take an in-depth look at health services for recipients of National Insurance Institute allowances, a population group of particular interest to policymakers.
  • This is the only report in the series to try to tease out the separate impacts of individual socio-economic status and locality socio-economic status on respondents’ experiences with the health care system.

Based on the study’s findings, the health system appeared to be more equitable in terms of availability, accessibility and service levels in 1997 than it had been in 1995, though there were still gaps between people from lower income levels and the rest of the population in some areas. Some of the gaps were explained in part by differences in demographic characteristics on the individual level; controlling for these variables narrowed the gaps, but did not eliminate them. The study team has continued to monitor these gaps and the findings presented here will be updated in subsequent publications.

The findings will assist policymakers in focusing their efforts toward closing gaps between low income groups and populations characterized by high income in the most critical areas.

This study was funded in part by the National Institute for Health Policy and Health Services Research.