Sustaining a Universal Benefits Package; The Case of Israel

1. Sustaining a Universal Benefits Package; The Case of Israel Dov Chernichovsky, Ph.D. Ben Gurion University of the Negev, Israel Health Benefits Package: Design, Implementation, and Adjustment – 1st Latin American Seminar Santiago, Chile. October 2010

2. Part A: General Comments

3. “A Universal Benefits Package” An accessible medical care package to which every citizen / resident is eligible -- in kind --based on medical indications only.

4. Underlying Normative Principle FAIRNESS Whatever Cannot be Provided to All, with Available Resources , is Provided to None

5. Fundamental Constrained Level of Funding

6. Israel – Basic Facts • Population – 7.6 millions (mid 2010) • Land area – 20,000 Sq. Km. • Life expectancy (2008) • Males -- 79 • Females -- 83 • Infant mortality – 4 per 1000 life births (2008) • Income per capita – US$ 27,000 • Spending on medical care • About US$ 2000. per capita • About 8%

7. Figure 1: Israeli System Following 1995 Legislation State

8. What have we resolved before articulating the Basic Package? • Objectives of system • Design of an integrated system • Basic common budget • Allocation system

9. Pemex Supplemental Benefits IMSS Supplemental Benefits Core benefits Core benefits Core Package IMSS PEMEX Private Private Private Other Supplemental Private Supplemental About 200 USD Annually Core benefits Others SPSS A Transposition of the Israeli Solution to Mexico Equal Benefits Equal Subsidy • Equal Benefits • Equal Subsidy; • Unrelated to Contributions

10. ISSUE Integration and Equalization of Available Public Funding for Every Citizen is a Necessary Condition for Discussing the Social/ Public Benefits הגדרה לא הייתה בעיה טרם אינטגרציה דיון במערכת אינטגרטיבית שונה לחלוטין שופט קולומביאני . שופט ישראלי יו

11. Part B: The Israeli Mechanism

12. Dimension of Universal Entitlement • Wholeness --- types of medicine (e.g., dental, long term) included • Completeness --- types of care included (e.g., only generic drugs) in each type of medicine • Form of delivery

13. Definition of Universal Entitlement • Inclusion rules • Exclusion rules • Guiding principle: “necessary care”, “common practice”, etc. הישגים ללא הגדרה

14. Figure 1: Israeli System Following 1995 Legislation State

15. Classification of Benefit Packages

16. The Challenge Adjustment / Modification / Update (once the basis was established)

17. Modification Criteria • Quantitative – preservation of the available package • Demography • Prices of care • Qualitative • “Technology”

18. The Mechanism Basket Committee – A “Jury” ?לא מוזמן - למה

19. The Process

20. Budget Variations for the “Basket”

21. Proposals for Inclusion and Adoption YEAR Proposed Adopted

22. Considerations • “Non Issue cases” • Clinical • Economic • Adoption capacity (organization and management) • Quality of life • Social issues, equity etc.

23. Basic Challenges • “Life saving” technologies • “Orphan” drugs • The “view of the “public” (paying/using)

24. Issues with the Process • Partiality of basket dealt with • Preventive care not included • Foe who • Sickness funds, MDs, hospitals • Terms of reference • Duration of work • Completeness and not wholeness • No discussion of technologies to exclude • Composition of basket committee • Who is represented • Data • Efficacy • Cost • Number of patients • Practically of decision

25. “Modifications” of Universal Entitlement • Medical indications • Cost • Administrative (follow the above two) • Competition and public pressure • “Exception” committee(s)

26. The Additions to the “Basket” A Bill of Rights

27. Emerging Structure of Core Benefits UU Universally Mandated UU Discretionary

28. Conclusion Keep it fuzzy at the margins, allowing for judgment , and competition

29. Thank you!!!!