The 1994 National Health Insurance Law entitles all Israeli citizens to medical insurance, and determines the scope of medical services provided by the health plans. Welfare populations in out-of-home care settings receive some of their health services through direct provision and funding by the Ministry of Welfare and Social Affairs (hereafter, Ministry of Welfare). In 2021, the Ministry of Welfare established a Health Services Scheme, designed to set standards and provide guidelines for the provision of health services to the populations under its responsibility. The scheme is meant to ensure appropriate service provision to welfare populations, enhance their physical and economic access to health services, and maintain continuity of care. The Ministry of Welfare commissioned the Myers-JDC-Brookdale Institute to review models for the regulation, provision, and funding of health services for residents of out-of-home care settings in high-income countries in the OECD, with an emphasis on primary care and consultative medicine such as psychiatry.
Review models of regulating, providing and funding health services in high-income OECD countries for welfare populations residing in of out-of-home care settings who are unable to obtain those services outside their residential settings without special assistance.
The review was conducted from September 2022 to February 2023. It was based on both academic articles and publications on websites of governments and international health organizations. The countries included in the review were Denmark, Germany, the Netherlands, Norway, Sweden, Switzerland, and England. These countries were selected to ensure a variety of models for the relations between health and welfare services. In addition, interviews were conducted with senior British, German and Swedish officials to gain a deeper understanding of how their health and welfare systems operate in this area.
- All the countries reviewed offer an administrative support system designed to ensure that residents of out-of-home care services have access to optimal health services; in some countries, national programs are dedicated to this population.
- In most countries, the model for the provision of health services in welfare institutions relies on the public health system. When the service in question cannot be provided in the residential setting, adjustments are made, including the patient’s transportation from or the service provider’s transportation to the residential setting. Some residential settings have agreements with local clinics or medical professionals who arrive at the institution or are employed thereby.
- Municipalities play an important role in organizing and supervising the services, as well as in channeling funds, even when the residential settings rely on private or philanthropic funding.
- Entrusting the responsibility with the municipality, particularly given that in some countries it is also responsible for welfare services in general, enables integration of the health and welfare services and improvement in the continuity of care.
The countries reviewed provide an administrative support system designed to make sure that welfare populations can access optimal health services, even when residing in out-of-home care settings. Nevertheless, this is still a population with complex health and social needs, including higher levels of morbidity and increased exposure to social factors that affect health, such as poverty, racism and violence. Thus, the main challenge lies in implementation. Therefore, it is essential to continue examining the degree to which the way in which services are implemented meets the needs of this population.
This preliminary review will enable the Ministry of Welfare to learn from various models in order to improve the care provided to Israeli welfare populations in out-of-home care settings and meet their health needs.