Gov't changes health fund compensation formula

Health funds to be better compensated for elderly, newborns, outlying clinics.

By JUDY SIEGEL-ITZKOVICH
doctor 311 (photo credit: Avi Hayoun)
doctor 311
(photo credit: Avi Hayoun)
The age and sex of health fund members and how many community clinics the insurers have in the periphery of the country will be included in the capitation formula by which they receive compensation from the health taxes collected by the National Insurance Institute, it was decided on Wednesday.
The Knesset Labor, Social Affairs and Health Committee passed for its second and third readings this change in the National Health Insurance Law.
The Health Ministry also announced that NIS 160 million would be transferred to the health funds to improve services for residents outside the center of the country. The changes go into effect on November 1, and a team will meet every four years to recommend how to update them.
Committee chairman MK Haim Katz (Likud) said the amendment constituted a significant improvement, “even though there is still more to improve. The main target is the desire to ameliorate services for residents of the periphery,” which have for many years received less compared to those in the center of the country.
The changes will provide the health funds with more health taxes for treating the elderly as well as babies up to their critical first birthday; this will be an incentive to expand and improve services. In addition, women in their fertile years cost more to treat, as do men in their later years.
According to the latest calculations, Clalit Health Services will receive NIS 150m. more in health taxes annually; Maccabi Health Services will receive an additional NIS 15m. and Kupat Holim Leumit will get NIS 8m. more. But Kupat Holim Meuhedet, because of the demographic characteristics of its membership and relatively fewer clinics in the periphery, will get NIS 22m. less due to the new criteria. Health fund administrators said at the committee meeting while it opposed the changes, it would observe them and work to increase its share in health taxes.
A representative of the Association for Civil Rights in Israel opposed the changes, saying that treatment of residents of the disadvantaged city of Lod in the center of the country would not benefit while those in the wealthy Beersheba suburb of Omer would because it is located in the South.