Of the four public health funds, only Clalit Health Services had a serious deficit last year, which was almost six times the size of its shortfall in 2007. The three others - Maccabi Health Services, Kupat Holim Meuhedet and Kupat Holim Leumit - finished 2008 in the black.

A Clalit Health Services hospital room.
Photo: Ariel Jerozolimski

These are some of the statistics in a comparative report on the health funds' finances released Monday evening. The report was produced by ministry accountant Mira Waldman Asherov and external accountant Tova Hillman.

Clalit, which insures a little more than half the population, had a 2008 deficit of NIS 422 million, compared to a NIS 74m. deficit in 2007. Maccabi had a NIS 8m. profit last year, after a NIS 6m. profit in 2007; Meuhedet had a profit of NIS 3m., after a NIS 10m. profit in 2007; and Leumit had a profit of NIS 27m., after a NIS 25m. profit in 2007, even though it was often in debt.

Clalit's management attributed NIS 230m. of its deficit to retroactive costs caused by the national arbitration decision regarding doctors' wages. The health fund had warned the government that it would accumulate a deficit due to the arbitration, which was initiated by the government and not the health funds.

Clalit said the rest of its shortfall came from its 14 medical centers, which treat members of all health funds and not only its own. The heaviest costs had come from improving infrastructure and paying malpractice insurance for doctors, as well as spending large sums on pension payments for its staff, unlike government hospitals that have state pensions, Clalit said. If the Treasury had subsidized these extra costs, management said, Clalit would have ended with a profit in 2008.

The health funds spent an average of NIS 4,021 on each member last year, compared with NIS 3,978 in 2007, the report said. The figures for Clalit and Maccabi rose, while those for Meuhedet and Leumit barely changed.

The total expenditures of the health funds reached NIS 29.5 billion, compared with NIS 27.8b. in 2007. About 26 percent of this went to salaries, while 43% went toward hospitalization - the most costly expenditure. Clalit spent 3.8% more on hospital services, compared with 8.7% at Maccabi, 7.5% at Meuhedet and 5.5% at Leumit.

A third of the insurers' expenditures were for medications, but they also charged members a total of NIS 65m. in co-payments for medications and NIS 131m. for house calls by doctors.

All the health funds are spending less on medications and equipment for members, possibly due to the use of more generic drugs, more strict criteria for granting drugs, or cheaper import prices.

The report can be viewed in Hebrew on the ministry's Web site at www.health.gov.il.