​The cost of the medical services basket to the HMOs in fiscal year 2011 exceeds NIS32 billion. However, the attrition in updating the cost sources of the basket continues.
The department of economics and insurance in the Ministry of Health publishes a summary of statistical data on the 17th anniversary of the enactment of the national health insurance law. The summary was authored by Daniella Arieli, Tuvia Horev and Nir Kedar and provides detailed information on the trends in the Israeli health system since 1995 and through to the end of 2011.

Highlights of the main details in the summary:

  • The decline in the precentage of membership in the Clalit HMO continues – 52.5% in 2011, compared with 63.2% in 1995. There is a commensurate increase in the percentage of membership in the Maccabi HMO. However, for the first time since the law was passed, the number of new members joining Clalit in 2011 has been greater than the number of those leaving that HMO.
  • The percentage of transfers between the HMOs decreased in 2011 and stood at approximately 1.3%.
  • Geographic distribution – Maccabi is largest in the Tel Aviv district (45%). Clalit is the largest in the remaining districts. Meuhedet HMO is noticeably large in the Jerusalem district (37%). In the Judea and Samaria territories, both Meuhedet and Leumit have a larger presence than their proportion in the overall population.
  • The percentage of Maccabi members whose income exceeds four times the national average income in 2011 is the highest of all HMOs, representing 2.5% of all members. Furthermore, it is twice as high as the percentage in Clalit, three times as high as the percentage in Leumit and 1.5 times as high as the incomes of the Meuheded members. 
  • The percentage of members insured under the Complementary Insurance Plans (the CIP) in the HMOs stood at about 74% in 2010, unchanged from 2008-2009, compared with an increase in the percentage of CIP members in 1999-2008.
  • The cost of the medical services basket to the HMOs in FY 2011 stands at NIS32.6 Billion.
  • About 54% of the cost of the medical services basket is covered by revenues from the health insurance fee and 39% is paid for by the state budget. The remainder of the funding is paid for via copays collected from the public (see the attached chart). Over the past two years the state’s share in the funding of the basket costs has been diminishing.
  • The attrition in the updating the cost sources of the medical services basket is continuing. Between 1995 and 2009 the basket was updated by 28% due to demographics, while the actual growth has been 50%. Regarding the issue of pricing there has also been attrition, where in the same timeframe the basket has been updated by 72% whereas the health cost index has increased by 94%. 
  • Technological Additions – between 2010 and 2011 the average technological update has been 1.36%, compared with 1.1% between 1998 and 2009. 
  • The expenditure on health insurance (CIP and commercial insurances) is the highest health expense per household (32%). In second place was the outlay on dental health care (24%). Up until 2008 the expenditure on dental health care took th efirst place.
  • The upper two deciles spend approximately 3.1 times more on health care than the two lower deciles.
  • The expenditure on nursing insurances via commercial, private insurance increased between 2003 and 2010 by 258%, whereas the expenditure on commercial medical insurances (medical expenses) increased by 141% in the same timeframe. 

The Deputy Minister of Health, MK Rabbi Jacob Litzman said, upon publication of these data that “we must continue with our policy of reducing the HMO member copays, especially in view of the fact that there are memvers of the lower socio-economic strata for whom these payments are difficult to bear.”
“The Ministry of Health will continue to stimulate competition between the HMOs and will work toward maximum transparency for the benefit of the HMO members. The success of the reform in pediatric dental care is an important challenge for leading the rest of the future steps we are planning these days, such as the nursing reform, which should considerably redue the expenditure on commercial private insurances, the mental health care reform and so on.”
Professor Roni Gamzu, Director General of the Ministry, said:  “There is no doubt that the National Health Insurance Law has revolutionized the Israeli health system. We must work to preserve the principles of the law and prevent further damage to the sources of funding of the health basket. The dental health services have so far been funded mainly by the private households, a fact that has kept regular dental care out of the reach of large segments of the population. The reform, initiated and led by Deputy Minister of Health Jacob Litzman, which brought pediatric dental health care services within the health basket, has resulted in the improved accessibility to dental health care, it has narrowed the gaps between different population groups and has promoted the health of children in Israel. Promotion of the reform in the nursing insurance will continue along the lines that the Ministry has been promoting throughout, meaning increasing accessibility, addition of more member rights and reducing copays.”